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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2021; 06(01): e45-e50
DOI: 10.1055/s-0041-1726303
Case Report

Observation of the Absence of Ulnar Artery in a Patient Planned to Free Dorsoulnar Artery Perforator Flap for Finger Defect: Is Preoperative Doppler evaluation of Perforator Alone Sufficient?

Burak Ergün Tatar 
1   Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Can Uslu 
1   Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Mehmet Erdem 
1   Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Fahri Sabancıogullarından 
1   Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Caner Gelbal 
1   Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
,
Mehmet Bozkurt 
1   Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
› Author Affiliations Funding None.
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Abstract

Background Volar finger defects where critical structures exposed are always challenging for plastic surgeons. In these types of defects, local flaps, cross finger flaps, abdominal flaps, and free flaps are used. Free dorsoulnar artery perforator (DUAP) flaps and superficial palmar branch of radial artery (SPBRA) flaps are also used. In this case, we present a patient who was scheduled to receive a DUAP flap to address defect on the second finger of right hand; however, we repaired the defect with a SPBRA flap because intraoperative absence of the ulnar artery was observed.

Materials and Methods A 34-year-old male patient was admitted with a wound that exposed the tendon and neurovascular bundle on the volar side of the second finger of the right hand. A free DUAP flap was planned for the patient. A perforator was detected during the preoperative Doppler ultrasound examination. While dissecting the perforator, we noted the absence of an ulnar artery proximal to the perforator vessel. The elevated SPBRA flap from same extremity and the defect were closed.

Results Postoperative computer tomography showed an absence of the ulnar artery distal to the right antecubital region. No complications were seen in the donor and recipient areas. Long-term motor movements were natural, and the patient's quality of life was good.

Conclusion Determining the perforator site using Doppler alone may not be sufficient in preoperative evaluation of patients scheduled to receive DUAP flaps. Performing an Allen test and using advanced imaging methods can prevent surgeons from encountering a bad surprise.

Keywords

dorsoulnar artery perforator flap - superficial palmar branch of radial artery flap - finger defects


Publication History

Received: 24 October 2020

Accepted: 11 January 2021

Article published online:
24 June 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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