ABSTRACT
This paper reviews 7 years of experience with the ulnar artery free flap at the Wellington Regional Plastic Surgery Unit. It has become the free flap we use most commonly to repair defects after resection of intraoral cancers, other head and neck defects, and soft-tissue defects of the lower limbs. Of 56 attempted cases, 52 have been successful. Two procedures were abandoned intraoperatively because of abnormalities in vascular pattern, and 2 failed in the lower limb because of anastomotic failure. These 4 cases occurred early in the development of the technique; all cases in the last 4 years have been successful. The ulnar artery free flap has some important advantages over the radial artery free flap, including ease of donor site repair, cosmetic acceptability, and hairlessness.
Subject(s)
Surgical Flaps/methods , Ulnar Artery/transplantation , Adult , Aged , Bone Transplantation/methods , Carcinoma, Squamous Cell/secondary , Carcinoma, Squamous Cell/surgery , Foot Diseases/surgery , Forearm/blood supply , Forearm/innervation , Head and Neck Neoplasms/surgery , Humans , Intraoperative Complications , Leg Injuries/surgery , Male , Maxillary Neoplasms/secondary , Maxillary Neoplasms/surgery , Mouth Neoplasms/secondary , Mouth Neoplasms/surgery , Muscles/blood supply , Muscles/innervation , Muscles/transplantation , Radial Artery/transplantation , Retrospective Studies , Skin Transplantation/methods , Surgical Flaps/adverse effectsABSTRACT
Salvage of limbs with combined vascular, skeletal and extensive soft tissue injury requires the skills of several surgical specialities. Four illustrative cases are presented, three successes and one failure, and from these some conclusions are drawn. Contrary to accepted teaching, it is believed that in the emergency management of most patients with complex limb trauma, vascular reconstruction should take priority, followed by skeletal stabilization, soft tissue repair and early flap cover.
Subject(s)
Arm Injuries/surgery , Emergency Medical Services , Leg Injuries/surgery , Adult , Arm/blood supply , Arm/innervation , Axillary Artery/surgery , Axillary Vein/surgery , Debridement , Humans , Humeral Fractures/surgery , Ischemia/prevention & control , Leg/blood supply , Leg/innervation , Male , Muscles/surgery , Patient Care Team , Popliteal Artery/surgery , Saphenous Vein/transplantation , Surgical FlapsABSTRACT
The forearm is a convenient donor site for local flap cover in upper limb defects. Island flaps based on either of the major forearm arteries share properties suiting them for reconstruction from elbow to fingertips. The ulnar artery flap has some advantages over the radial flap, especially the easy management, low morbidity and better aesthetics of the donor site. Illustrative cases of proximally and distally based island ulnar flaps are presented.
Subject(s)
Forearm/surgery , Hand/surgery , Surgical Flaps , Adolescent , Adult , Female , Forearm/blood supply , Humans , Male , Middle AgedABSTRACT
The case is presented of a young man who suffered a traumatic hind-quarter amputation and penile infarction. One stage penile reconstruction was performed using a free ulnar forearm flap.
Subject(s)
Penis/surgery , Surgical Flaps , Accidents , Adult , Forearm , Hemipelvectomy , Humans , Infarction/etiology , Male , Methods , Penis/blood supply , Prostheses and ImplantsABSTRACT
A case of aplasia cutis congenita involving the scalp, cranium, and dura is presented to illustrate the complication of major hemorrhage from the sagittal sinus that may occur if closure is delayed. Subsequent problems with scalp-flap cover eventually required split-skin grafting of the defect. The case for surgery as soon after birth as possible is reinforced.
Subject(s)
Hemorrhage/etiology , Scalp/abnormalities , Skull/abnormalities , Surgery, Plastic , Adolescent , Dura Mater/transplantation , Female , Humans , Infant, Newborn , Postoperative Complications , Scalp/surgery , Skull/surgery , Surgical FlapsABSTRACT
The ulnar artery forearm flap is a reliable, versatile and convenient fasciocutaneous flap. Based on the ulnar artery distal to the common interosseous branch it may include muscle (FCU) tendon (PL) and bone (ulna). The arterial and venous anatomy allow a flow-through capability and a reversal of flow which permits its use as a distally pedicled island flap. Many of its properties are shared with the radial flap, but the ulnar flap has further advantages. The donor site is virtually hairless, easily closed even when bone is taken, and is less obvious as it lies on the proximal ulnar aspect of the forearm. The ulnar artery is not reconstituted and in 11 cases there has been no clinical evidence of any circulatory, sensory or motor impairment of the hand. The flap is especially useful in intra-oral reconstruction and has been valuable in the lower leg where it may restore deficient distal circulation.
