Ulnar artery distal cutaneous descending branch as free flap in hand reconstruction

Summary These authors aimed to evaluate the method and therapeutic effects of surgical hand-wound repair using free vascularised flaps based on the descending ramus of the above-wrist cutaneous branch of the ulnar artery. We retrospectively reviewed records of 75 patients with 79 finger defects who had received hand surgery between January 2001 and December 2007. Soft-tissue defects of the hand were repaired using free flaps with the descending ramus of the above-wrist cutaneous branch of the ulnar artery as the vascular pedicle. Intra-operative and postoperative variations in vascular anatomy were observed and surgical outcomes were compared. All flaps were vascularised and survived, including one in which the distal end showed partial necrosis that healed after skin grafting. Three anatomical variations of the ulnar artery branch were observed intra-operatively, requiring appropriate adaptation of the surgical method. All patients were followed postoperatively for 6–24 months. The texture and appearance of all the flaps were satisfactory (two-point discrimination: 6–11 mm) with satisfactory recovery of finger function. The outcomes of surgical hand-wound repair using free vascularised flaps based on the descending branch of the ulnar artery were successful. The operative method was simple, and the method appears to be worthy of clinical application.