Propeller Flap Based on the Ulnar Artery Perforator for the Closure of Defects Following the Harvesting of a Radial Forearm Free Flap.

The reconstruction of skin defects in the forearm following radial forearm free flap harvesting is challenging due to the limited availability of local soft tissue. Traditional skin grafts often lead to complications such as partial or total graft loss and suboptimal aesthetic outcomes. The perforator-based propeller flap, utilizing the ulnar artery perforator, has emerged as an effective solution for such reconstructions. This fasciocutaneous rotational flap, designed in a helix shape, provides stable coverage without compromising the vascular pedicle. Its advantages include aesthetic outcomes, functional recovery, and primary closure of the donor site, eliminating the need for additional grafts. The surgical technique involves careful preoperative planning, identification of robust perforators, and precise flap elevation while preserving vascular structures. Although the technique requires meticulous dissection and presents anatomical variability, its reliability in covering tendinous and neural structures of the forearm has been well established. The authors present 2 clinical cases of patients with squamous cell carcinoma, who underwent tumor resection and defect reconstruction using a radial forearm free flap. The propeller flap provided excellent defect coverage, with satisfactory functional and aesthetic results. Close monitoring of flap perfusion in the postoperative period is essential. These outcomes suggest that the propeller flap is a preferred option for forearm defect reconstruction following radial forearm flap harvesting. In conclusion, the ulnar artery perforator-based propeller flap is an innovative and effective technique that offers significant benefits in reconstructive surgery.