Flap

Tissue

Skin or fascia

Course of the vessels

Underneath the flap in Scarpa’s fascia; passes laterally under the flexor carpi ulnaris

Dimensions

4 × 15 cm at the ulnar aspect of the forearm

Extensions and combinations

—

Surgical technique

Preoperative examination and markings

Doppler identification of perforator vessel; flap centered over the lateral ulnar aspect of the forearm

Patient position

Supine with arm on arm table to avoid tourniquet ischemia

Dissection

Incise the skin along the markings; perform a subfascial dissection with sparing of ulnar artery and nerve; preserve the extensor paratenon; identify the distal perforator; create a distal skin incision when taking as an island flap, otherwise leave the distal skin bridge intact; open tourniquet; check the flap for perfusion; rotate the flap into the defect

Disadvantages

Flap

Flap leaves dog-ear at pivot point that frequently requires secondary correction; donor site has to be skin grafted in most cases

Bulkiness

Flap may be bulky

Donor site morbidity

Skin grafted area may be conspicuous; impairment of tendon gliding rarely encountered; major risk is injury or division of the ulnar nerve