Finger Pulp Reconstruction with Free Dorsoulnar Artery Perforator (DUAP) Flap Tekin Simsek, M.D., 1 M. Sinan Engin, M.D., 1 Ozan Aslan, M.D., 1 Tale Neimetzade, M.D., 2 and Lutfi Eroglu, M.D. 1 ABSTRACT Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complica- tions by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible. KEYWORDS: Dorsoulnar artery, perforator flap, finger pulp, free flap, finger reconstruction Finger pulp defects with exposed deep structures almost always require flap coverage. 1 Several options including local flaps from immediate vicinity, homodi- gital axial flaps, staged flaps from close proximity such as adjacent digit or palm, distant flaps such as abdominal flaps and free tissue transfers; all with individual advan- tages and limitations. 2–5 Refinement of the techniques in microsurgery and international sharing of knowledge and experience have increased the availability of free tissue transfers world- wide, and fingers likewise have gotten their share. Among available free flap options, free glabrous skin transfers from the foot seems to be the golden standard in microsurgical resurfacing of the finger pulp. 6–15 The use of free dorsoulnar artery perforator (DUAP) flap for finger reconstruction has first been introduced by Inada et al. 16 Its amenability to be thinned as desired, pedicle diameter matching those of the recipient vessels, close proximity to the field of reconstruction, and consistent vascular anatomy have suggested that it is also suitable for finger pulp reconstruction as well. 17,18 In this article we are presenting our experience with the DUAP flap for finger pulp reconstruction in six patients, along with a discussion of its advantages and disadvantages. MATERIALS AND METHODS Free DUAP flaps were used for six patients who were admitted for traumatic fingertip and pulp defects. Four of the patients were males and two were females. Mean age was 29 years (range, 14 to 43). The traumatized fingers were left-sided in two patients and right-sided in others. In all, right hand was dominant. Involved fingers were thumbs in three patients, indexes in two, and third and fourth digits 1 Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun; 2 Clinic of Plastic Surgery, Tokat State Hospital, Tokat, Turkey. Address for correspondence and reprint requests: Tekin Simsek, M.D., Assistant Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey (e-mail: drtekinsimsek@hotmail.com). J Reconstr Microsurg. Copyright # by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. Received: May 14, 2011. Accepted after revision: May 30, 2011. DOI: http://dx.doi.org/10.1055/s-0031-1285986. ISSN 0743-684X. Downloaded by: Ondokuz Mayis University. Copyrighted material.