Perforator patterns of the ulnar artery perforator flap

BACKGROUND: Flaps based on the ulnar artery have never gained the same popularity as the radial forearm flap, despite several potential advantages. In this article, the authors describe a true ulnar artery perforator flap with perforator mapping. METHODS: Thirty-eight consecutive patients who underwent ulnar artery perforator flap surgery were included in the study. The size, number, and location of perforators were recorded intraoperatively. Preoperative and postoperative grip strength was tested and compared. RESULTS: One to three cutaneous perforators from the ulnar artery were identified and designated as A, B, and C from distal to proximal. Perforator A was present in 79 percent of cases and located 7.3 ± 1.1 cm from the pisiform. Perforator B was present in 95 percent of cases and located 11.4 ± 1.0 cm from the pisiform. Perforator C was present in 87 percent of cases and located 15.9 ± 1.8 cm from the pisiform. All patients had at least two perforators, and 61 percent had three perforators. All flaps were used for head and neck reconstruction and all were successful. Donor-site morbidity was minor. Grip testing demonstrated a transient decrease in grip strength during the postoperative period, and most recovered to the contralateral level by 3 months. CONCLUSIONS: At least two perforators are present in the ulnar artery perforator flap territory. This flap is reliable and easy to harvest and has minimal donor-site morbidity. It should be considered as an alternative to the radial forearm flap in select patients.