Study of the Anatomical Bases of a Perforator Flap from the Hypothenar Eminence
The perforators of the deep branch of the ulnar artery, which nourish the skin overlying the proximal portion of the abductor and flexor digiti minimi muscles, were studied in 60 hand of cadavers by three dimensional angiography following injection of barium sulfate. The deep branch of the ulnar artery gave off 0 to 5 skin perforating arteries. These perforating arteries could be divided into two types. The first type was characterized by branching of the perforator from the proximal portion of the deep branch of the ulnar artery, and its spreading directly to the subcutaneous tissues and skin. The average distance between the distal margin of the pisiform and the site of these proximal perforators was 5.7 (±3.4) mm. The second type was characterized by branching of the perforator from a more distal portion of the deep branch of the ulnar artery, and it divided with the abductor digiti minimi muscle perforator and ran distally. The portion of the distal perforators which emerged from the deep fascia was 25.8 (±4.7) mm from the distal margin of the pisiform. This finding provides the basis for a new perforator flap from the proximal portion of the hypothenar eminence. In hand surgery, post-traumatic losses of the palmar aspect of the hand i.e., the palm, wrist and finger are frequent. These losses can present difficulties in reconstruction leading to functional and cosmetical limitations. Ideal repair of these regions is coverage with skin possessing characteristics similar to the original skin. Based on this assumption, various skin flaps from the palm have been reported. In introducing the concept of the perforator flap, it is neccesary to determine specific information concerning the vascular anatomy of the donor site. In this study, the author investigated the anatomical basis for the perforator flap from the hypothenar eminence, which is nourished by perforators from the deep branch of the ulnar artery.