This document discusses different types of perforator flaps that can be used in hand surgery. It outlines the evolution of perforator flaps from musculocutaneous flaps to septocutaneous perforator flaps. The document then describes several specific perforator flap options for the hand, including ulnar artery perforator flaps, posterior interosseous artery perforator flaps, posterolateral mid-forearm perforator flaps, dorsal metacarpal artery perforator flaps, and digital artery perforator flaps.

1. Soft tissue
anatomy
Flaps in the hand
Vaikunthan Rajaratnam
@handsurgeryinternational

2. Evolution of flap

3. Perforator Flaps
Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle. Br J Plast Surg.
1989;42:645–8.
Septocutaneous perforators:
Musculocutaneous perforators

5. Types of perforator flaps

6. Elevation of perforator flap

7. Flap advancement
• Preoperative Doppler
• Outline flap
• Cover the defect
• Donor site closed
directly

9. Reversed flow
radial artery flap

21. Ulnar Artery Perforator Flap

22. Posterior
Interosseous
Artery
Perforator Flap

26. Posterolateral Mid-Forearm Perforator
Flap

27. Dorsal
Metacarpal Artery
Perforator Flaps

28. Digital Artery
Perforator Flap