Purpose
Although the palm is spared mostly in severe burn injuries, it often is affected in
children and requires radical excision of contracting scar tissue to allow normal
hand development. Since alternatives are limited for palmar coverage, we primarily
use a reverse-perfused, neurocutaneous dorsal ulnar artery flap. We report here our
long-term follow-up results.
Methods
We reviewed the long-term results of 10 postburn palmar contracture release and flap
coverage procedures in 10 children. The applied flap was based distally on the dorsal
branch of the ulnar artery and harvested along the ulnar aspect of the hand and wrist.
The pivot point of the flap was located dorsally, close to the 4th and 5th metacarpal
base. Patients were followed for a median period of 6 years (range, 4–20 years).
Results
Flap size ranged from 60–130 mm in length and 20–35 mm in width. This variation in
flap dimensions resulted from different hand sizes, because of the various patient
ages at surgery. All flaps survived, donor site healing was uneventful, and marginal
flap necrosis occurred only once. Satisfactory restoration of range of motion without
secondary contractures was observed. Moreover, we detected adequate progressive growth,
adaptability and sensory recovery in all flaps. Over time, the flaps mostly become
hairless and progressively flattened without debulking.
Conclusions
The importance of this flap lies in the potential for considerable tissue mobilization
to cover palmar defects without sacrificing any major vascular axis. The adequate
progressive growth of the flap facilitates functional hand development in children.
The predictable vascular anatomy, wide range, and durable, thin, and pliable skin
make the reverse neurocutaneous dorsal ulnar artery flap an appealing option for soft
tissue reconstruction of the palm in children.
Type of study/level of evidence
Therapeutic V.
Key words
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Article info
Publication history
Published online: October 19, 2022
Accepted:
September 1,
2022
Received:
April 12,
2022
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
