A systematic review of outcomes following hand reconstruction using flaps from the superficial palmar branch of the radial artery (SUPBRA) system

Abstract Background : Flaps based on the superficial branch of the radial artery (SUPBRA) are indicated when homodigital or heterodigital flaps are inappropriate, but glabrous or like-for-like reconstruction is required. Aim : To systematically review the outcomes of hand reconstruction using SUPBRA flaps. Methods : PubMed was searched for English-language articles studying SUPBRA flaps in November 2019. Data collected included flap vascular supply, dimensions, complications, donor site closure, and two-point discrimination. Results : Twenty-six papers were eligible (410 flaps). Flaps were classified as glabrous, nonglabrous or combined. Nonglabrous flaps were either free- (52%) or reverse-flow pedicled (1.7%) wrist flaps. Glabrous flaps were either free palmar (36.3%), reverse-flow pedicled palmar (2%), antegrade-flow pedicled palmar (0.2%), or perforator-based island palmar flaps (3.7%). Combined glabrous/nonglabrous flaps formed 4.1% of flaps. Maximal flap dimensions allowing direct closure were: 3.1 × 6 cm for wrist flaps and Conclusions : Flaps based on the SUPBRA are robust, provide like-for-like reconstruction of glabrous skin defects in one-stage, offer versatility due to diverse skin paddle orientation patterns and are in the same operative field as the defect.