Investigation of the anatomic pattern of perforator arteries for reconstructive DAP flap surgery - a Cadaveric study.

Abstract

Objective: This study aimed to provide a detailed anatomical mapping of proper palmar digital artery perforators, focusing on their number, anatomical 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 and anatomically guided flap planning in digit and fingertip reconstruction.

Materials and Methods: A cadaveric anatomical study was conducted on 20 digits from five fresh-frozen upper limb specimens (three left, two right), excluding the thumbs. A gelatine and methylene blue dye solution was injected to visualise the perforator arteries. Dissections were performed at the University of Edinburgh in 2025. Images were processed using Adobe Photoshop to enhance anatomical clarity. Data were analysed using SPSS, employing descriptive statistics and non-parametric tests (Mann-Whitney U, Kruskal-Wallis), with significance set at p < 0.05. All procedures were carried out in accordance with the Human Tissue (Scotland) Act 2006 and adhered to the departmental Standard Operating Procedures (SOP v1.0, July 2024; ANATED_0047).

Results: 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. The fourth (ring) and fifth (little) digits exhibited greater vascular richness on the ulnar (U) side, while the proximal phalanx showed higher variability in perforator location.

Conclusion: This study highlights the anatomical consistency and clinical relevance of proper palmar digital artery perforators, offering a consistent and clinically applicable reference for flap planning. The findings support joint-based spatial referencing and emphasise the fourth and fifth digits as favourable donor sites. The results reinforce the value of cadaveric research in improving reconstructive strategies and minimising surgical complications.