Investigation of the Anatomical Pattern of Perforator Arteries for Reconstructive Digital Artery Perforator ( DAP ) Flap Surgery: A Cadaveric Study

This study aimed to provide a detailed anatomical mapping of proper palmar digital artery perforators, focusing on their number, distribution, and spatial relationship to the proximal (PIP) and distal interphalangeal (DIP) joints. The goal was to establish a reliable anatomical reference to support accurate, anatomically guided flap planning in fingers and fingertip reconstruction. A cadaveric study was conducted on 20 digits from five fresh-frozen upper limbs (three left, two right), excluding thumbs. Methylene blue dye was injected to visualize perforator arteries, and dissections were performed in an accredited anatomy facility. Images were processed using Adobe Photoshop, and data were analyzed in SPSS with descriptive and nonparametric tests (Mann-Whitney U, Kruskal-Wallis), with significance set at p < 0.05. A total of 441 phalangeal sites were assessed, of which 406 (92.1%) contained perforators. The proximal phalanx (P1) showed the highest concentration (69.2%), followed by the middle (P2; 22.9%) and distal (P3; 7.9%) phalanges. No significant side dominance (radial vs. ulnar) was observed. Perforator clustering was consistently found approximately 8 mm from the DIP joint and 22 mm from the PIP joint. This study highlights the anatomical consistency and clinical relevance of proper palmar digital artery perforators, providing a practical reference for flap planning and supporting safer reconstructive strategies.