ABSTRACT
Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly
important for optimal handling and sensation. Ideal substitute must provide matching
texture, tenacity, and slim subcutaneous fat. This article presents six cases in which
fingertip and finger pulp reconstruction were performed via free dorsoulnar artery
perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without
any complications by the end of at least 3 months follow-up. Free DUAP flap has proved
to be a suitable substitute for pulp reconstruction with its thin structure, minimally
morbid donor site which is also close to the trauma zone, and possibility for neurotization.
It can be especially favorable when splitting the surgical team for a glabrous flap
harvest from the foot is not possible.
KEYWORDS
Dorsoulnar artery - perforator flap - finger pulp - free flap - finger reconstruction
REFERENCES
- 1
Ozaksar K, Toros T, Sügün T S, Bal E, Ademoğlu Y, Kaplan I.
Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular
advancement flap.
J Hand Surg Eur Vol.
2010;
35
(2)
125-129
- 2
Teoh L C, Tay S C, Yong F C, Tan S H, Khoo D B.
Heterodigital arterialized flaps for large finger wounds: results and indications.
Plast Reconstr Surg.
2003;
111
(6)
1905-1913
- 3
Adani R, Marcoccio I, Tarallo L, Fregni U.
The reverse heterodigital neurovascular island flap for digital pulp reconstruction.
Tech Hand Up Extrem Surg.
2005;
9
(2)
91-95
- 4
Woon C Y, Lee J Y, Teoh L C.
Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications,
technical refinements, outcomes, and long-term neurosensory recovery.
Ann Plast Surg.
2008;
61
(4)
385-391
- 5
Puhaindran M E, Paavilainen P, Tan D M, Peng Y P, Lim A Y.
Dermal pocketing following distal finger replantation.
J Plast Reconstr Aesthet Surg.
2010;
63
(8)
1318-1322
- 6
Sassu P, Lin C H, Lin Y T, Lin C H.
Fourteen cases of free thenar flap: a rare indication in digital reconstruction.
Ann Plast Surg.
2008;
60
(3)
260-266
- 7
Huang S H, Wu S H, Lai C H et al.
Free medial plantar artery perforator flap for finger pulp reconstruction: report
of a series of 10 cases.
Microsurgery.
2010;
30
(2)
118-124
- 8
Pan Z H, Jiang P P, Wang J L.
Posterior interosseous free flap for finger re-surfacing.
J Plast Reconstr Aesthet Surg.
2010;
63
(5)
832-837
- 9
Pelzer M, Sauerbier M, Germann G, Tränkle M.
Free “kite” flap: a new flap for reconstruction of small hand defects.
J Reconstr Microsurg.
2004;
20
(5)
367-372
- 10
Lee D C, Kim J S, Ki S H, Roh S Y, Yang J W, Chung K C.
Partial second toe pulp free flap for fingertip reconstruction.
Plast Reconstr Surg.
2008;
121
(3)
899-907
- 11
Wong C H, Teoh L C, Lee J Y, Yam A K, Khoo D B, Yong F C.
Free digital artery flap: an ideal flap for large finger defects in situations where
local flaps are precluded.
Ann Plast Surg.
2008;
60
(3)
254-259
- 12
Ozkan O, Akyürek M, Coşkunfirat O K, Safak T, Ozgentaş H E.
The free radial artery septal perforator vessel-based flap.
Plast Reconstr Surg.
2005;
115
(7)
2062-2069
- 13
Kushima H, Iwasawa M, Maruyama Y.
Recovery of sensitivity in the hand after reconstruction with arterialised venous
flaps.
Scand J Plast Reconstr Surg Hand Surg.
2002;
36
(6)
362-367
- 14
Iwasawa M, Ohtsuka Y, Kushima H, Kiyono M.
Arterialized venous flaps from the thenar and hypothenar regions for repairing finger
pulp tissue losses.
Plast Reconstr Surg.
1997;
99
(6)
1765-1770
- 15
Yang J W, Kim J S, Lee D C et al.
The radial artery superficial palmar branch flap: a modified free thenar flap with
constant innervation.
J Reconstr Microsurg.
2010;
26
(8)
529-538
- 16
Inada Y, Tamai S, Kawanishi K et al.
Free dorsoulnar perforator flap transfers for the reconstruction of severely injured
digits.
Plast Reconstr Surg.
2004;
114
(2)
411-420
- 17
Ulkur E, Uygur F, Karagöz H, Celiköz B.
Use of free dorsoulnar perforator flap in the treatment of postburn contractures of
the fingers.
Burns.
2006;
32
(6)
770-775
- 18
Ülkür E, Karagöz H, Uygur F, Çeliköz B.
Serbest dorsoulnar perforatör flep ile parmak ucu onarımı: Olgu sunumu.
Turk J Plast Surg.
2006;
14
(1)
47-49
- 19
Yabe T, Takahashi M, Kamano M.
The free true perforator flap.
J Reconstr Microsurg.
2007;
23
(6)
329-333
- 20
Chen S H, Xu D C, Tang M L, Ding H M, Sheng W C, Peng T H.
Measurement and analysis of the perforator arteries in upper extremity for the flap
design.
Surg Radiol Anat.
2009;
31
(9)
687-693
- 21
Kanellakos G W, Yang D, Morris S F.
Cutaneous vasculature of the forearm.
Ann Plast Surg.
2003;
50
(4)
387-392
- 22
Yii N W, Niranjan N S.
Fascial flaps based on perforators for reconstruction of defects in the distal forearm.
Br J Plast Surg.
1999;
52
(7)
534-540
- 23
Karacalar A, Ozcan M.
Preliminary report: the distally pedicled dorsoulnar forearm flap for hand reconstruction.
Br J Plast Surg.
1999;
52
(6)
453-457
- 24
Ignatiadis I A, Xeinis S F, Tsiamba V A, Yiannakopoulos C K, Nomikos G N, Gerostathopoulos N E.
Distal radial and ulnar arteries perforator-based adipofascial flaps for covering
hand traumatic defects.
Microsurgery.
2007;
27
(5)
372-378
- 25
Rodriguez E D, Mithani S K, Bluebond-Langner R, Manson P N.
Hand evaluation following ulnar forearm perforator flap harvest: a prospective study.
Plast Reconstr Surg.
2007;
120
(6)
1598-1601
- 26
Wong C, Ho P C, Tse W L, Cheng S, Chan D K, Hung L K.
Do we need to repair the nerves when replanting distal finger amputations?.
J Reconstr Microsurg.
2010;
26
(5)
347-354
Tekin SimsekM.D.
Assistant Professor, Department of Plastic, Reconstructive and Aesthetic Surgery
Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
Email: drtekinsimsek@hotmail.com
