Superficial ulnar artery: A contraindication to radial forearm free tissue transfer

Objectives: Superficial ulnar artery is a vascular anomaly that may be encountered during elevation of forearm flaps for head and neck reconstruction. This anomaly should be considered in patients with a positive Allen's test. Study Design: Case report and retrospective review of forearm flaps performed at our institution. Methods: A 72-year-old man with a history of total laryngectomy presented for closure of a pharyngocutaneous fistula with radial forearm flap. A positive Allen's test and undetectable Doppler over the thenar eminence with radial artery occlusion was noted. An ulnar flap was felt to be the best alternative. A superficial ulnar artery was discovered upon elevation of the ulnar flap. Despite its anomalous course, the artery provided several fasciocutaneous branches, and the flap was successfully used to repair the patient's fistula. A retrospective review of forearm flaps and the incidence of superficial ulnar artery at our institution is presented. Results: A total of 690 forearm flaps (571 radial, 51 ulnar, and 68 osteocutaneous radial) were performed from 1998 to 2010. Superficial ulnar artery was encountered three times, yielding an incidence of 0.43%. In each case, the preoperative Allen's test suggested a dominant radial artery circulation. In all cases, a fasciocutaneous ulnar flap was successfully used. Conclusions: Superficial ulnar artery should be considered with a positive Allen's test. An ulnar fasciocutaneous flap based on the superficial ulnar artery is a safe alternative to the radial fasciocutaneous flap in this setting.