scholarly journals Anatomical variations of the innervated radial artery superficial palmar branch flap: A series of 28 clinical cases

2020 ◽  
Vol 47 (5) ◽  
pp. 435-443
Author(s):  
Jae-Won Yang
Keyword(s):  
Radial Artery ◽  
Skin Flap ◽  
Large Diameter ◽  
Anatomical Variations ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Secondary Procedures ◽  
Potential Damage ◽  
Neural Anatomy ◽  
Clinical Cases

Background The innervated radial artery superficial palmar branch (iRASP) flap was designed to provide consistent innervation by the palmar cutaneous branch of the median nerve (PCMN) to a glabrous skin flap. The iRASP flap is used to achieve coverage of diverse volar defects of digits. However, unexpected anatomical variations can affect flap survival and outcomes.Methods Cases in which patients received iRASP flaps since April 1, 2014 were retrospectively investigated by reviewing the operation notes and intraoperative photographs. The injury type, flap dimensions, arterial and neural anatomy, secondary procedures, and complications were evaluated.Results Twenty-eight cases were reviewed, and no flap failures were observed. The observed anatomical variations were the absence of a direct skin perforator, large-diameter radial artery superficial palmar branch (RASP), and the PCMN not being a single branch. Debulking procedures were performed in 16 cases (57.1%) due to flap bulkiness.Conclusions In some cases, an excessively large RASP artery was observed, even when there was no direct skin perforator from the RASP or variation in the PCMN. These findings should facilitate application of the iRASP flap, as well as any surgical procedures that involve potential damage to the PCMN in the inter-thenar crease region. Additional clinical cases will provide further clarification regarding potential anatomical variations.

scholarly journals The cadaveric anatomy of the distal radius: implications for the use of volar plates

2012 ◽  
Vol 94 (2) ◽  
pp. 116-120 ◽  
Author(s):  
PA McCann ◽  
D Clarke ◽  
R Amirfeyz ◽  
R Bhatia
Keyword(s):  
At Risk ◽  
Median Nerve ◽  
Radial Artery ◽  
Distal Radius ◽  
Surgical Anatomy ◽  
Operative Intervention ◽  
Distal Radial Fractures ◽  
Palmar Cutaneous Branch ◽  
Superficial Branch ◽  
Cutaneous Branch

INTRODUCTION Fractures of the distal radius are common upper limb injuries, representing a substantial proportion of the trauma workload in orthopaedic units. With ever increasing advancements in implant technology, operative intervention is becoming more frequent. As growing numbers of surgeons are performing operative fixation of distal radial fractures, an accurate understanding of the relevant surgical anatomy is paramount. The flexor carpi radialis (FCR) tendon forms the cornerstone of the Henry approach to the volar cortex of the distal radius. A number of key neurovascular structures around the wrist are potentially at risk during this approach, especially when the FCR is mobilised and placed under retractors. METHODS In order to clarify the safe margins of the FCR approach, ten fresh frozen human cadaver limbs were dissected. The location of the radial artery, the median nerve, the palmar cutaneous branch of the median nerve and the superficial branch nerve were measured with respect to the FCR tendon. Measurements were taken on a centre-to-centre basis in the coronal plane at the watershed level. In addition, the distances between the tendons of brachioradialis, abductor pollicis longus and flexor pollicis longus, and the radial artery and median nerve were measured to create a complete picture of the anatomy of the FCR approach to the distal radius. RESULTS The structure most at risk was the palmar cutaneous branch of the median nerve. It was located on average 3.4mm from the FCR tendon. The radial artery and the main trunk of the median nerve were located 7.8mm and 8.9mm from the tendon. The superficial branch of the radial nerve was 24.4mm from the FCR tendon and 11.1mm from the brachioradialis tendon. CONCLUSIONS Operative intervention is not without complication. We believe a more accurate understanding of the surgical anatomy is key to the prevention of neurovascular damage arising from the surgical management of distal radial fractures.

scholarly journals Anomalous Medial Branch of Radial Artery: A Rare Variant

2016 ◽  
Vol 59 (3) ◽  
pp. 100-103 ◽  
Author(s):  
Surbhi Wadhwa ◽  
Vandana Tomar
Keyword(s):  
Radial Artery ◽  
Anatomical Variations ◽  
Medial Branch ◽  
Normal Pattern ◽  
Access Site ◽  
Capillary Vessel ◽  
Radial Forearm ◽  
Coronary Procedures ◽  
Technical Failures ◽  
Flexor Carpi Radialis Muscle

Radial artery is an important consistent vessel of the upper limb. It is a useful vascular access site for coronary procedures and its reliable anatomy has resulted in an elevation of radial forearm flaps for reconstructive surgeries of head and neck. Technical failures, in both the procedures, are mainly due to anatomical variations, such as radial loops, ectopic radial arteries or tortuosity in the vessel. We present a rare and a unique anomalous medial branch of the radial artery spiraling around the flexor carpi radialis muscle in the forearm with a high rising superficial palmar branch of radial artery. Developmentally it probably is a remanent of the normal pattern of capillary vessel maintenance and regression. Such a case is of importance for reconstructive surgeons and coronary interventionists, especially in view of its unique medial and deep course.

scholarly journals The Palmar Cutaneous Branch Mimicking the Recurrent Motor Branch of the Median Nerve

2018 ◽  
Vol 10 (01) ◽  
pp. 052-053
Author(s):  
Feiran Wu ◽  
Chye Ng
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Transverse Carpal Ligament ◽  
Proximal Margin ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Iatrogenic Nerve Injury ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch ◽  
Tunnel Syndrome

AbstractWe report an unusual anatomical variant of the palmar cutaneous branch (PCB) of the median nerve in a 46-year-old man presenting with recurrent carpal tunnel syndrome. At surgery, after neurolysis, the PCB was visualized arising at the level of the proximal margin of the transverse carpal ligament, mimicking the appearance of the recurrent motor branch. To date, there has been no description of this branch arising at this level. We aim to remind surgeons of this variation and highlight the importance of maintaining vigilance to avoid iatrogenic nerve injury.

scholarly journals Study on variations in the palmar cutaneous branch of median nerve

2014 ◽  
Vol 5 (8) ◽  
pp. 507
Author(s):  
Raviprasanna K H ◽  
Poornima G.C ◽  
Dakshayani K.R
Keyword(s):  
Median Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch

scholarly journals Diagnosis and Treatment of Three-Rooted Maxillary Premolars

2009 ◽  
Vol 03 (01) ◽  
pp. 62-66 ◽  
Author(s):  
Hacer Deniz Arisu ◽  
Tayfun Alacam
Keyword(s):  
Clinical Management ◽  
Anatomical Variations ◽  
Endodontic Treatment ◽  
Diagnosis And Treatment ◽  
Free Entry ◽  
Treatment Access ◽  
Cavity Preparation ◽  
Complex Anatomy ◽  
Maxillary Premolars ◽  
Clinical Cases

ABSTRACTAnatomical variations must be considered in clinical and radiographical evaluations during endodontic treatment. Access cavity modifications may be required for stress free entry to complex anatomy. Higher magnification and illumination can be useful for access cavity preparation and to recognize and locate additional canals. This article describes the diagnosis and clinical management of two clinical cases of three rooted maxillary premolars. (Eur J Dent 2009;3:62-66)

Navigating a proximal loop in the radial artery and avoiding the recurrent radial artery

2020 ◽  
Vol 12 (7) ◽  
pp. 724-724 ◽  
Author(s):  
Rimal Dossani ◽  
Muhammad Waqas ◽  
Michael K Tso ◽  
Gary B Rajah ◽  
David E Smolar ◽  
...  
Keyword(s):  
Radial Artery ◽  
Chronic Subdural Hematoma ◽  
Anatomical Variations ◽  
Middle Meningeal Artery ◽  
Conventional Technique ◽  
Artery Embolization ◽  
Transradial Approach ◽  
Road Map ◽  
Radial Artery Catheterization ◽  
Meningeal Artery

Several anatomical variations of the radial artery have been described in the literature. Common variations include radial artery loop, recurrent branch, and anastomotic channels connecting the radial and brachial arteries. These variations can pose significant technical challenges to safe radial artery catheterization. Because radial access for neurointervention is becoming popular, appreciation of these variations and mastery of techniques for safe radial artery catheterization are of paramount importance. In this operative video,(video 1) we present a case of a 75-year-old man who underwent middle meningeal artery embolization for treatment of chronic subdural hematoma using a transradial approach. The patient was found to have a radial artery loop and a recurrent branch off the radial artery. The loop could not be negotiated with the conventional technique. We therefore used a microcatheter system with a stiff microwire to navigate and straighten the radial loop under road map guidance. The remaining procedure was performed successfully.

Transradial access for neurointerventions: management of access challenges and complications

2019 ◽  
Vol 12 (1) ◽  
pp. 82-86 ◽  
Author(s):  
Marie-Christine Brunet ◽  
Stephanie H Chen ◽  
Eric C Peterson
Keyword(s):  
Radial Artery ◽  
Randomized Trials ◽  
Endovascular Procedures ◽  
Anatomical Variations ◽  
Artery Occlusion ◽  
Morbidity And Mortality ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
The Common ◽  
Catheter Knots

BackgroundNumerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.MethodA careful review of the literature and of all our transradial cases was carried out to identify the common challenges and complications that are encountered when using TRA for diagnostic cerebral angiography and neurointerventions.ResultsA stepwise approach is provided to prevent and manage common challenges including radial artery access failure, radial artery spasm, radial artery anomalies and tortuosity, radial artery occlusion, radial artery perforation and hematoma, subclavian tortuosity and anomalies, and catheter knots and kinks.ConclusionThe ability to recognize and navigate anatomical variations and complications unique to TRA will accelerate learning, decrease unnecessary morbidity and mortality, and further advance the neurovascular field.

Palmar cutaneous branch of the ulnar nerve

1980 ◽  
Vol 5 (1) ◽  
pp. 26-29 ◽  
Author(s):  
William D. Engber ◽  
James G. Gmeiner
Keyword(s):  
Ulnar Nerve ◽  
Palmar Cutaneous Branch ◽  
Cutaneous Branch
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