Use of Pedicled Perforator Flaps in Volar Defects of Hand

BACKGROUND: Local flaps for volar hand defects allow rapid reconstruction and provide coverage of major structures such as vessels and tendons. However, these flaps are limited by the potential need for major vessel sacrifice and their restricted arcs of rotation. With the perforator anatomy of the volar hand being clarified, perforator flaps have become a valuable option for the reconstruction of defects in this region, offering rapid repair without the need for major arterial sacrifice. To date, no comprehensive study has described the use of perforator-based flaps for defects in different subregions of the volar hand, such as the thenar and hypothenar regions. This study aimed to demonstrate the feasibility and reliability of pedicled perforator flaps for the reconstruction of various defects in different regions of the volar hand. METHODS: This report included patients who underwent soft-tissue reconstruction of the volar hand using perforator flaps between January 2022 and February 2025. A total of 12 patients were included in the report. In 7 patients, perforator flaps were used for early soft-tissue reconstruction following trauma and tumor excision, while in 5 patients they were preferred for defects that developed after late contracture release. Three defects were located in the hypothenar region, three in the first web space, one in the mid-palmar region, one in the flexor zone 2 of the thumb, one in flexor zone 2 of the 2nd finger, one in flexor zone 2 of the 5th finger, one in the thenar region, and one in the 4th web space. The mean defect size was 1.6 × 3.8 cm. Color Doppler ultrasonography was used to identify and mark the perforator vessels. The perforator flaps were elevated based on the identified perforators and were rotated and inset into the defects. RESULTS: of superficial necrosis at the distal portion of the flap. The necrotic tissue was debrided and healed by secondary intention. No other postoperative complications were observed. The mean follow-up period was 9 months. None of the patients who underwent perforator flap reconstruction following trauma or tumor excision experienced any limitation in range of motion. Among the five patients who underwent flap reconstruction following contracture release, two patients achieved a 40° gain in abduction, while one patient achieved a 50° gain. Of the remaining two patients, one achieved a 60° gain in extension, while the other achieved a 40° gain in extension. CONCLUSIONS: Although various perforator flaps have been described for the dorsal aspect of the hand, local flaps based on perforator vessels for volar hand defects remain limited. With the advancement of knowledge regarding perforator vessel anatomy, successful reconstruction of volar hand defects with minimal donor-site morbidity has become achievable through the use of perforator flaps.