Shape-modified radial artery perforator flap method: analysis of 112 cases.

BACKGROUND: To overcome the donor-site morbidity associated with radial forearm flaps, many modifications of this technique have been reported, including the development of the perforator flap method. In this article, the authors analyze the efficacy of their shape-modified radial artery perforator flap method. METHODS: The authors analyzed all of their 112 cases of reconstruction with the shape-modified method with regard to the cause of injury, recipient site, whether the flap was free or pedicled, flap size, number of components that were divided by perforators, flap survival, and quality of the outcome. Donor-site morbidity, including the development of scars and dorsal hand numbness, was also evaluated. RESULTS: The reconstructed areas were the head and neck (27 cases, 24.1 percent), upper extremity (58 cases, 51.8 percent), and lower extremity (27 cases, 24.1 percent). Free flaps were used in 75 cases (67.0 percent). In total, 109 flaps (97.3 percent) survived completely, but three free flaps exhibited venous thrombosis. In terms of aesthetics, 48 cases had excellent outcomes (42.9 percent), 61 cases had good outcomes (54.5 percent), and three cases had poor outcomes (2.7 percent). Impaired blood circulation and numbness of the donor hand were never observed, but one patient complained about a donor-site cosmetic problem. CONCLUSIONS: The authors' flap can be considered as a kind of propeller flap. It also resembles the flap-in-flap method. It is suitable for a wide range of surgical indications and is useful and safe in not only adults but also young and elderly patients.

Analysis of 22 posterior ulnar recurrent artery perforator flaps: a type of proximal ulnar perforator flap.

BACKGROUND: The proximal ulnar artery has several branches, including perforators that are directly derived from the ulnar artery and anterior/posterior recurrent arteries. There are only a few reports of flaps that use the anterior/posterior recurrent arteries, and flaps employing their perforators as a main pedicle are yet to be reported. In this study, posterior ulnar recurrent artery perforator (PURAP) flaps were employed for elbow and forearm reconstruction. METHODS: The 22 cases of reconstruction by PURAP flaps were analyzed in terms of the cause of injury, the recipient site, the vascular pedicle of the flap, flap size and survival, and the quality of the outcome. Donor-site morbidity, including the development of scars and numbness, was also evaluated. RESULTS: All flaps were vascular pedicled island flaps. The perforator used was the medial and posterior perforator in 14 (63.6%) and 8 (36.4%) cases, respectively. The average flap size was 10 x 5 cm. Six months after the operation, the outcomes were judged to be excellent in 15 cases (68.2%), good in 6 cases (27.3%), and poor in 1 case (4.5%) because of partial necrosis of the distal part of the flap. CONCLUSIONS: PURAP flaps can be harvested with 2 types of perforator pedicles (the medial or posterior perforator) and offer greater safety and flexibility, and less donor-site morbidity, than existing flaps used for elbow and forearm reconstruction. The ability to close the donor site primarily is a significant benefit of this flap.