scholarly journals The composite extensor retinaculum cutaneous flap: an anatomical cadaveric study

2019 ◽  
Vol 2 (2) ◽  
pp. 33-39
Author(s):  
Sadhishaan Sreedharan ◽  
Richard J Ross ◽  
Jens J Froelich ◽  
William A Cuellar ◽  
Siddharth Karanth
Keyword(s):  
Subcutaneous Tissue ◽  
Adhesion Formation ◽  
Extensor Tendon ◽  
Anatomical Study ◽  
Vascular Supply ◽  
Extensor Retinaculum ◽  
Cutaneous Flap ◽  
Interosseous Artery ◽  
Skin Reconstruction ◽  
Composite Flap

Background: Complex digital extensor tendon injuries are difficult to manage when adhesion formation and stiffness prevail. Vascularised tissue to reconstruct the skin and extensor defect would be the ideal reconstruction in both the acute and delayed settings. This anatomical study evaluates vascular supply to a suitable composite flap comprising skin, subcutaneous tissue and extensor retinaculum.Methods: An anatomical study of 18 cadaveric upper limbs was conducted to investigate the technical feasibility of a composite flap prior to its clinical application. The anterior (n = 9) or posterior (n = 9) interosseous artery was exposed and selectively injected with a coloured dye. Specimens were then dissected to raise the proposed composite flap of extensor retinaculum and the overlying integument. Specimens were subsequently assessed by digital subtraction angiography to evaluate the corresponding microvascular supply to the composite flap. Results: The anterior and posterior interosseous arteries supplied the extensor retinaculum through a dense network of vessels with choke anastomoses. The skin overlying the extensor retinaculum was predictably supplied by either artery through the perforator vessels between the fourth and fifth extensor tendon compartments.Conclusion: A composite unit of skin and extensor retinaculum can be harvested on either the anterior or posterior interosseous arteries. It can be employed for simultaneous vascularised tendon and skin reconstruction.

Late laryngo-tracheal cartilage necrosis with external fistula 44 years after radiotherapy

2003 ◽  
Vol 117 (8) ◽  
pp. 658-659 ◽  
Author(s):  
Yoshitaka Takiguchi ◽  
Hiro-Oki Okamura ◽  
Ken Kitamura ◽  
Seiji Kishimoto
Keyword(s):  
Clinical Course ◽  
Subcutaneous Tissue ◽  
Bacterial Colonization ◽  
Histological Study ◽  
Inflammatory Cells ◽  
Late Complications ◽  
Laryngeal Oedema ◽  
Anterior Neck ◽  
Tracheal Cartilage ◽  
Cutaneous Flap

Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.

Anatomical Basis of Dorsal Forearm Flap

1988 ◽  
Vol 13 (4) ◽  
pp. 435-439
Author(s):  
P. BAYON ◽  
R. W. H. PHO
Keyword(s):  
Upper Limbs ◽  
Forearm Flap ◽  
Posterior Interosseous Artery ◽  
Anatomical Basis ◽  
Skin Loss ◽  
Cutaneous Flap ◽  
Interosseous Artery ◽  
Vascular Contribution

Injection studies on 35 upper limbs with neoprene latex were carried out and the limbs carefully dissected to observe the vascular contribution of the posterior interosseous branches of the dorsal forearm, the transverse anastomosis between anterior and posterior interosseous vessels and the calibre of the vessel. The findings indicated that a fascia-cutaneous flap based on septocutaneous branches of the posterior interosseous artery can be raised as a reversed forearm for resurfacing after skin loss in the hand.

scholarly journals Complications of extensor tendon repairs at the extensor retinaculum

2016 ◽  
Vol 02 (01) ◽  
pp. 3-12 ◽  
Author(s):  
Shrikant Chinchalkar ◽  
Joey Pipicelli
Keyword(s):  
Extensor Tendon ◽  
Extensor Retinaculum

Digital Oedema, Adhesion Formation and Resistance to Digital Motion after Primary Flexor Tendon Repair

2008 ◽  
Vol 33 (6) ◽  
pp. 745-752 ◽  
Author(s):  
Y. CAO ◽  
C. H. CHEN ◽  
Y. F. WU ◽  
X. F. XU ◽  
R. G. XIE ◽  
...  
Keyword(s):  
Flexor Tendon ◽  
Subcutaneous Tissue ◽  
Adhesion Formation ◽  
Tendon Repair ◽  
Flexor Tendon Repair ◽  
Postoperative Changes ◽  
Three Stages

The development of digital oedema, adhesion formation, and resistance to digital motion at days 0, 3, 5, 7, 9 and 14 after primary flexor tendon repairs using 102 long toes of 51 Leghorn chickens was studied. Oedema presented as tissue swelling from days 3 to 7, which peaked at day 3. After day 7, oedema was manifest as hardening of subcutaneous tissue. The degree of digital swelling correlated with the resistance to tendon motion between days 3 and 7. At day 9, granulation tissues were observed around the tendon and loose adhesions were observed at day 14. Resistance to digital motion increased significantly from day 0 to day 3, but did not increase between days 3 and 9. The early postoperative changes appear to have three stages: initial (days 0–3, increasing resistance with development of oedema), delayed (days 4–7, higher resistance with continuing oedema) and late (after day 7–9, hardening of subcutaneous tissue with development of adhesions).

scholarly journals Management of Extensor Tendon Injuries

2012 ◽  
Vol 6 (1) ◽  
pp. 36-42 ◽  
Author(s):  
M Griffin ◽  
S Hindocha ◽  
D Jordan ◽  
M Saleh ◽  
W Khan
Keyword(s):  
Subcutaneous Tissue ◽  
Primary Repair ◽  
Tendon Repair ◽  
Extensor Tendon ◽  
Tendon Injuries ◽  
Lateral Instability ◽  
Avulsion Fractures ◽  
Post Surgery ◽  
Human Bites ◽  
Extensor Tendon Injuries

Extensor tendon injuries are very common injuries, which inappropriately treated can cause severe lasting impairment for the patient. Assessment and management of flexor tendon injuries has been widely reviewed, unlike extensor injuries. It is clear from the literature that extensor tendon repair should be undertaken immediately but the exact approach depends on the extensor zone. Zone I injuries otherwise known as mallet injuries are often closed and treated with immobilisaton and conservative management where possible. Zone II injuries are again conservatively managed with splinting. Closed Zone III or ‘boutonniere’ injuries are managed conservatively unless there is evidence of displaced avulsion fractures at the base of the middle phalanx, axial and lateral instability of the PIPJ associated with loss of active or passive extension of the joint or failed non-operative treatment. Open zone III injuries are often treated surgically unless splinting enable the tendons to come together. Zone V injuries, are human bites until proven otherwise requires primary tendon repair after irrigation. Zone VI injuries are close to the thin paratendon and thin subcutaneous tissue which strong core type sutures and then splinting should be placed in extension for 4-6 weeks. Complete lacerations to zone IV and VII involve surgical primary repair followed by 6 weeks of splinting in extension. Zone VIII require multiple figure of eight sutures to repair the muscle bellies and static immobilisation of the wrist in 45 degrees of extension. To date there is little literature documenting the quality of repairing extensor tendon injuries however loss of flexion due to extensor tendon shortening, loss of flexion and extension resulting from adhesions and weakened grip can occur after surgery. This review aims to provide a systematic examination method for assessing extensor injuries, presentation and management of all type of extensor tendon injuries as well as guidance on mobilisation pre and post surgery.

scholarly journals Anatomical study of nutrient foramen in lower limb dry long bones

2021 ◽  
Vol 9 (8) ◽  
pp. 2246
Author(s):  
Samyog Mahat ◽  
Shamsher Shrestha ◽  
Prabhakar Yadav
Keyword(s):  
Lower Limb ◽  
Anatomical Study ◽  
Vascular Supply ◽  
Long Bones ◽  
Posterior Surface ◽  
Nutrient Foramen ◽  
Nutrient Artery ◽  
Linea Aspera ◽  
Upper Third ◽  
Gain Access

Background: Nutrient artery gain access through nutrient foramen and provide vascular supply to bone. Number, size and location of nutrient foramen has significant medical as well as surgical importance. Any insult to nutrient artery during surgical procedure or during trauma may lead to devascualarization or poor prognosis.Methods: The present study consist of 50 femurs, 50 tibia and 50 fibula, collected from department of anatomy, BPKIHS. Mean length of bone, number, position and size and foraminal index of nutrient foramen was observed and recorded accordingly.Results: In femur 62% bone shows single nutrient foramen. Nutrient foramen was commonly located in medial lip of linea aspera and in upper third of bone which was noted in 80% of bone. In tibia 82% of total bone shows single foramen with absent of foramen in 6% bone. Foramen was commonly located above the soleal line and middle third of bone which was noted in 56% of bone. In fibula 6% of total bone shows absent of nutrient foramen and majority of bone shows single nutrient foramen (82%). Foramen was commonly located in lower part of posterior surface (60%) and in middle third of bone.Conclusions: This study provides details topographic knowledge about nutrient foramen which is important clinically for proper planning of surgery and its outcome.

scholarly journals The Vascular Basis of the Pronator Quadratus Muscle Flap and Its Use in Clinical Cases

2020 ◽  
Author(s):  
Binu P. Thomas ◽  
Sasi P. Kiran ◽  
Maolin Tang ◽  
Christopher R. Geddes ◽  
Steven F. Morris
Keyword(s):  
Muscle Flap ◽  
Anatomical Study ◽  
Vascular Supply ◽  
Soft Tissue Reconstruction ◽  
Pronator Quadratus ◽  
India Ink ◽  
Pedicle Length ◽  
Human Cadavers ◽  
The Mean ◽  
Pronator Quadratus Muscle

AbstractBackground Pronator quadratus (PQ) is a deeply situated muscle in the forearm which may occasionally be utilized for soft-tissue reconstruction. The purpose of this anatomical and clinical study was to confirm vascular supply of PQ muscle (PQM) in order to optimize its transfer and confirm its utility in clinical situations. Methods In Part A of the anatomical study, fresh human cadavers (n = 7) were prepared with an intra-arterial injection of lead oxide and gelatin solution, and PQM and neurovascular pedicle were dissected (n = 14). In the anatomical study Part B, isolated limbs of embalmed human cadavers (n = 12) were injected with India ink-gelatin mixture and PQ were dissected.Results PQ is a type II muscle flap, with one major pedicle, the anterior interosseous (AI) vessels and two minor pedicles from the radial and ulnar vessels. The mean dimensions of the muscle were 5.5 × 5.0 × 1.0 cm3, mean pedicle length was 9.6 cm, and the mean diameter of the artery and the vein was 2.3 mm and 2.8 mm, respectively. The dorsal cutaneous perforating branch (DPB) of the artery supplied the skin over the dorsal forearm and wrist. This branch also anastomosed with the 1, 2 intercompartmental supraretinacular artery (ICSRA). Conclusion This study confirms the potential utility and vascular basis of the PQM flap and its associated cutaneous paddle.In the clinical part, two patients with nonhealing wounds exposing the median nerve and flexor tendons in the distal forearm were treated using the PQM flap with good results.

scholarly journals An Anatomical Study of Primary Pattern of Arteries of Upper Limb With Relevance to Their Variations

2012 ◽  
Vol 02 (01) ◽  
pp. 08-14
Author(s):  
Suresh Bidarkotimath ◽  
Ramakrishna Avadhani ◽  
Arunachalam Kumar
Keyword(s):  
Undergraduate Students ◽  
Anatomical Study ◽  
Branching Pattern ◽  
Vascular Pattern ◽  
Upper Limbs ◽  
Therapeutic Approaches ◽  
Branching Patterns ◽  
Interosseous Artery ◽  
T Values ◽  
Primary Pattern

AbstractA detailed description of the vascular pattern of upper limbs especially their variations in their origin, course and branching pattern is of utmost importance anatomically in general and clinically in particular. These variations have drawn attention of surgeons, physicians, radiologist and interventionists due to the advanced surgical procedures practicd in vascular surgeries, plastic (reconstructive) surgeries and also for diagnostic and therapeutic approaches. 50 cadavers (100 upper limbs) were used for the study, which were dissected as the part of routine dissection for teaching undergraduate students at our institution. Length of the normal and variant arteries with mean, standard deviation, 'p' and 't' values are noted in each of the limbs. The following variations are observed - i) high division of brachial artery ii) higher origin of profunda brachii artery, iii) high origin of radial artery, iv) absence of common interosseous artery. The variations are of particular importance to the surgeons operating in the area, especially for those involved in vascular reconstructive surgeries. So it is prudent to do pre-operative studies of the brachial and antebrachial arteries and their branching patterns, to prevent possible complications post operatively.

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