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J Reconstr Microsurg 2020; 36(09): 667-672
DOI: 10.1055/s-0040-1713601
Original Article

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Megumi Ishiko
1   Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
,
Koichi Yano
2   Department of Orthopaedic Surgery, Seikeikai Hospital, Osaka, Japan
,
Ema Onode
3   Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
,
Kiyohito Takamatsu
1   Department of Orthopaedic Surgery, Yodogawa Christian Hospital, Osaka, Japan
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Abstract

Background The ulnar artery perforator (UAP) flap, which is hairless, thin, and pliable, has been used for the reconstruction of soft tissues from the finger to the elbow. Preoperative planning is essential for a perforator flap surgery, and there are some tests to identify perforators. Color Doppler ultrasonography (US) with a high-frequency transducer helps in detecting decreased flow in smaller vessels, such as perforators. The purpose of this study was to determine the anatomical locations and origins of perforators arising from the ulnar artery using color Doppler US in healthy volunteers.

Methods Forty forearms of 20 healthy volunteers were included in the study. Perforators arising from the ulnar artery, within 100 mm proximal to the pisiform, were investigated using color Doppler US with a high-frequency transducer.

Results A total of 205 perforators were identified. On comparing the locations in each 20 mm section from the pisiform, the largest number of perforators was 58 (28%), within 20 mm proximal to the pisiform. The axial view demonstrated 44 (21%), 64 (31%), 32 (16%), and 65 (32%) perforators in the radial, ulnar, superficial, and deep aspects of the ulnar artery, respectively. Fifty-two and 28 essential perforators were supplied by the UAPs arising from the superficial and ulnar aspect within 20 mm proximal to the pisiform and between 21 and 40 mm proximal to the pisiform, respectively, while elevating the UAP flap.

Conclusion This is the first study to assess the UAP using color Doppler US. Identification of UAP using color Doppler US can be used as a preoperative assessment for reliable elevation of a UAP flap.

Keywords

perforator flap - ulnar artery perforator - color Doppler ultrasonography


Publication History

Received: 11 February 2020

Accepted: 17 May 2020

Article published online:
24 June 2020

© 2020. Thieme. All rights reserved.

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333 Seventh Avenue, New York, NY 10001, USA.

 

  • References

  • 1 Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg 1989; 42 (06) 645-648
    CrossrefPubMedGoogle Scholar
  • 2 Saint-Cyr M, Schaverien MV, Rohrich RJ. Perforator flaps: history, controversies, physiology, anatomy, and use in reconstruction. Plast Reconstr Surg 2009; 123 (04) 132e-145e
    CrossrefPubMedGoogle Scholar
  • 3 Debelmas A, Camuzard O, Aguilar P, Qassemyar Q. Reliability of color Doppler ultrasound imaging for the assessment of anterolateral thigh flap perforators: a prospective study of 30 perforators. Plast Reconstr Surg 2018; 141 (03) 762-766
    CrossrefPubMedGoogle Scholar
  • 4 Klasson S, Svensson K, Wollmer P, Velander P, Svensson H. Blood flow dynamics and sensitivity in breasts after reconstruction with DIEP-flap. J Plast Surg Hand Surg 2014; 48 (06) 407-411
    CrossrefPubMedGoogle Scholar
  • 5 Ono S, Chung KC, Hayashi H, Ogawa R, Takami Y, Hyakusoku H. Application of multidetector-row computed tomography in propeller flap planning. Plast Reconstr Surg 2011; 127 (02) 703-711
    CrossrefPubMedGoogle Scholar
  • 6 Versluis B, Tuinder S, Boetes C. , et al. Equilibrium-phase high spatial resolution contrast-enhanced MR angiography at 1.5T in preoperative imaging for perforator flap breast reconstruction. PLoS One 2013; 8 (08) e71286
    CrossrefPubMedGoogle Scholar
  • 7 Hallock GG, Brown CL, DeSantis MJ. Preoperative identification of perforating vessels to the skin by color duplex imaging. J Ultrasound Med 1995; 14 (04) 263-266
    CrossrefPubMedGoogle Scholar
  • 8 Onode E, Takamatsu K, Shintani K. , et al. Anatomical origins of radial artery perforators evaluated using color Doppler ultrasonography. J Reconstr Microsurg 2016; 32 (08) 594-598
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Shintani K, Takamatsu K, Uemura T. , et al. Planning digital artery perforators using color Doppler ultrasonography: a preliminary report. J Plast Reconstr Aesthet Surg 2016; 69 (05) 634-639
    CrossrefPubMedGoogle Scholar
  • 10 Becker C, Gilbert A. [The ulnar flap]. Handchir Mikrochir Plast Chir 1988; 20 (04) 180-183
    PubMedGoogle Scholar
  • 11 Bertelli JA, Pagliei A. The neurocutaneous flap based on the dorsal branches of the ulnar artery and nerve: a new flap for extensive reconstruction of the hand. Plast Reconstr Surg 1998; 101 (06) 1537-1543
    CrossrefPubMedGoogle Scholar
  • 12 Liu J, Zheng H. Free distal ulnar artery perforator flaps for the reconstruction of a volar defect in fingers. J Plast Reconstr Aesthet Surg 2014; 67 (11) 1557-1563
    CrossrefPubMedGoogle Scholar
  • 13 Yii NW, Niranjan NS. Fascial flaps based on perforators for reconstruction of defects in the distal forearm. Br J Plast Surg 1999; 52 (07) 534-540
    CrossrefPubMedGoogle Scholar
  • 14 Lovie MJ, Duncan GM, Glasson DW. The ulnar artery forearm free flap. Br J Plast Surg 1984; 37 (04) 486-492
    CrossrefPubMedGoogle Scholar
  • 15 Maruyama Y, Onishi K, Iwahira Y. The ulnar recurrent fasciocutaneous island flap: reverse medial arm flap. Plast Reconstr Surg 1987; 79 (03) 381-388
    CrossrefPubMedGoogle Scholar
  • 16 Blondeel PN, Hallock GG, Morris SF, Neligan PC. , eds. Perforator flaps: Anatomy, technique, & clinical applications. CRC Press; 2013: 367-385
    Google Scholar
  • 17 Rand RP, Cramer MM, Strandness Jr DE. Color-flow duplex scanning in the preoperative assessment of TRAM flap perforators: a report of 32 consecutive patients. Plast Reconstr Surg 1994; 93 (03) 453-459
    CrossrefPubMedGoogle Scholar
  • 18 Kehrer A, Sachanadani NS, da Silva NPB. , et al. Step-by-step guide to ultrasound-based design of alt flaps by the microsurgeon - basic and advanced applications and device settings. J Plast Reconstr Aesthet Surg 2019 S1748-6815(19)30536-4
    PubMedGoogle Scholar
  • 19 Kehrer A, Heidekrueger PI, Lonic D. , et al. High-resolution ultrasound-guided perforator mapping and characterization by the microsurgeon in lower limb reconstruction. J Reconstr Microsurg 2020
    PubMedGoogle Scholar
  • 20 Hwang K, Hwang JH, Jung CY, Won HS, Chung IH. Cutaneous perforators of the forearm: anatomic study for clinical application. Ann Plast Surg 2006; 56 (03) 284-288
    CrossrefPubMedGoogle Scholar
  • 21 Kimura T, Ebisudani S, Osugi I, Inagawa K. Anatomical analysis of cutaneous perforator distribution in the forearm. Plast Reconstr Surg Glob Open 2017; 5 (10) e1550
    CrossrefPubMedGoogle Scholar
  • 22 Mathy JA, Moaveni Z, Tan ST. Perforator anatomy of the ulnar forearm fasciocutaneous flap. J Plast Reconstr Aesthet Surg 2012; 65 (08) 1076-1082
    CrossrefPubMedGoogle Scholar
  • 23 Sun C, Hou ZD, Wang B, Ding ZH. An anatomical study on the characteristics of cutaneous branches-chain perforator flap with ulnar artery pedicle. Plast Reconstr Surg 2013; 131 (02) 329-336
    CrossrefPubMedGoogle Scholar
  • 24 Wei Y, Shi X, Yu Y, Zhong G, Tang M, Mei J. Vascular anatomy and clinical application of the free proximal ulnar artery perforator flaps. Plast Reconstr Surg Glob Open 2014; 2 (07) e179
    CrossrefPubMedGoogle Scholar
  • 25 Yu P, Chang EI, Selber JC, Hanasono MM. Perforator patterns of the ulnar artery perforator flap. Plast Reconstr Surg 2012; 129 (01) 213-220
    CrossrefPubMedGoogle Scholar
  • 26 Vergara-Amador E. Anatomical study of the ulnar dorsal artery and design of a new retrograde ulnar dorsal flap. Plast Reconstr Surg 2008; 121 (05) 1716-1724
    CrossrefPubMedGoogle Scholar