• Archives of Plastic Surgery
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• v.38 no.4
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• pp.498-500
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• 2011

Purpose: Neurilemoma is benign tumor of the nerve sheath which arises from Schwann cells. It is usually formed along the path of a peripheral nerve but is rarely separate from normal nerve fascicles. We experienced a patient with an isolated neurilemoma localized in the palmaris longus tendon with no connection to the major nerve trunk, which was in an unusual location and has never been reported. We report our case with the review of the literature. Methods: A 23-year-old female visited our clinic with mild pain on the mass at the flexor area of the right wrist which had been present for about one year. The physical examination revealed a $1{\times}1cm$ sized subcutaneous mass at the flexor area of the right wrist. Sonography and computed tomography showed an ovoid, superficial solid mass on the palmaris longus tendon. Upon surgical excision, a $1{\times}0.5cm$ sized mass attached to the palmaris longus tendon was found. The tumor had no connection with the median nerve and was detached easily from the palmaris longus tendon. Results: Histological examination demonstrated the mass to be a neurilemoma, which consists of spindle shaped cells with oval elongated nuclei arranged fascicles. No sensory dysfunction or evidence of recurrence was found during the 12 months of postoperative follow-up. Conclusion: We experienced a rare case of neurilemoma attached to the palmaris longus tendon with no connection to the major nerve trunk. We wish to emphasize its unusual location through our case and hope to expand our spectrum in exploring the upper extremity mass.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.48-52
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• 2011

Purpose: Many advances have been made in lower eyelid reconstruction surgical procedures after tumor ablative therapy. These include skin grafts, local flaps, free flaps, and skin expansion. When a full-thickness defect of the lower eyelid is reconstructed with many free flaps, ectropion and deformity of the medial and lateral canthal areas are common late complications caused by gravitational descent. The radial forearm free flap is widely used because of its lack of bulk, ease of dissection, malleability, and hairlessness. This report introduces a novel method for preventing ectropion using a composite radial forearm free flap reconstruction and palmaris longus suspension technique. Methods: A 70-year-old man had a malignant melanoma on his left lower eyelid. The patient was referred to our department after a biopsy confirmed the initial diagnosis. A full-thickness wide resection with a 25 mm free margin was performed, and a $5{\times}8cm$ radial forearm flap was elevated with a vascularised palmaris longus tendon. The palmaris longus tendon was fixed to the medial and lateral orbital rim perisoteum and the deep temporal fascia. The buccal mucosa was grafted to reconstruct the inner conjunctival layer. The pedicle vessels were anastomosed to the left superficial temporal artery and vein. Results: The postoperative clinical course was uneventful. The flap showed good texture and color match. No ectropion was noted 14 months after surgery and the tumor did not recur. The patient was quite satisfied with the final outcomes. Conclusion: Use of a radial forearm free flap and the palmaris longus tendon is an effective method for a full-thickness lower eyelid reconstruction.

• Korean Journal of Bronchoesophagology
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• v.6 no.2
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• pp.185-188
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• 2000

The goals of lip reconstruction are to provide oral competence, adequate support for the lower lip, contour restoration, adequate lip sulcus, and adequate oral aperture. The composite radial forearm palmaris longus free flap is thin enough that it can be folded onto itself without a significant increase in bulk. The flap is easy to dissect, the pedicle contains long vessels of large diameter, and the skin is a good color and texture match for the perioral region. Moreover, the vascularized tendon can be used for lower lip reconstruction. This makes the flap ideally suited for total lower lip reconstruction. We experienced the case of total lower lip excision and reconstruction with the radial forearm free flap including palmaris longus tendon, so we reported that case with literature. The patient has a lower lip squamous carcinoma(T3NIM0), and performed a total lower lip excision with right modified radical neck dissection and left extended supraomohyoid neck dissection, and a reconstruction with radial forearm free flap includng palmaris longus tendon. The oral competence and masticatory function were nearly normalized and cosmetical result was very acceptable.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.60-63
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• 2001

The reconstruction of the suborbital area followed by resection of skin cancer has been used many methods including skin graft, local flaps, free flaps, and skin expansion. The radial forearm free flap has become a workhorse flap in this area because of its lack of bulk, ease of dissection, malleability, and hairlessness. When the suborbital defect especially including full-thickness defect of lower lid was reconstructed with many free flaps, the ectropion and the deformity of medial and lateral canthal area were common problems encountered as late complication due to gravitational descent. To improve the final aesthetic result in patients with suborbital defect, the radial forearm free flap was elevated as a composite radial forearm - palmaris longus free flap, in which the vascularized palmaris longus london was included and anchored to the periorbital bone with $mitek^{(R)}$ as sling, to suspend the flap against gravity and inferior descent, and thereby creating a more natural cheek contour. Two clinical cases were presented as an example of this procedure. Postoperative results emphasize the importance of suspension sling with palmaris longus tendon using $mitek^{(R)}$ in reconstruction of the suborbital defect with radial forearm free flap.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.198-204
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• 2001

Background and Objectives: As the laryngopharyngeal cancer is usually found at a advanced stage, it is difficult to get a wide surgical margin that preserves functional aspect and that is oncologically safe simultaneously. There were many operative technique to fulfill this principle, but none were satisfactory. Recently there were some reports about glottic and pharyngeal reconstruction using radial forearm free flap(RFFF) with palmaris longus tendon, which provided satisfactory oncologic and functional results. We attempted to perform this technique and to test usefulness at patients of laterally localized laryngopharyngeal tumor. Materials and Methods: Three patients were reconstructed glottis and pharynx using radial forearm free flap with palmaris longus tendon. Two hypopharyngeal cancer (T2N0M0) patients were performed wide vertical hemilaryngopharyngectomy and one supraglottic cancer(T2N0M0) patient was performed horizontovertical laryngopharyngectomy. Deglutitional function was evaluated with modified barium swallow and speech function was evaluated by speech pathologist. Results: Mean follow-up time was 29.3 months. There were no cancer recurrence. Their speech was satisfy-actory at social communication and oral feeding. They all have a complete oral nutrition from 26 days to 53 days. Decanulation time was from 71 days to 30 months. Conclusion: Glottic and pharyngeal reconstruction with radial forearm free flap could be accepted as a promising technique which offers a wide resection margin but satisfactory functional result in lateralized laryngohypopharyngeal cancer patients.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.25-30
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• 2012

Background : The soft palate functions as a valve and helps generate the oral pressure required for normal speech resonance. Speech problems and nasal regurgitation can result from a soft palatal defect. Reduction of the size of the velopharyngeal orifice is required to compensate for the lack of mobility in a reconstructed soft palate. We suggest a large volume folded free flap for reduction of the caliber and a palmaris longus tendon sling for suspension of the reconstructed palate. Methods : Six patients had total soft palate resection for tonsillar cancer and reconstruction with a large volume folded radial forearm free flap combined with a palmaris longus sling. A single surgeon and speech therapist examined the patients with three standardized speech assessment tools: nasometer test, consonant articulation test, and speech acuity test performed for speech evaluation. Results : Mean nasalance score was 76.20% for sentences with nasal sounds and 43.60% for sentences with oral sounds. Hypernasality was seen for oral sound sentences. The mean score of the picture consonant articulation test was 84% (range, 63% to 100%). The mean score of the speech acuity test was 5.84 (range, 5 to 6). These mean ratings represent a satisfactory level of speech function. Conclusions : The large volume folded free flap with a palmaris longus tendon sling for total soft palate reconstruction resulted in satisfactory prognosis for speech despite moderate hypernasality.

• Archives of Plastic Surgery
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• v.33 no.1
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• pp.120-123
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• 2006

Spontaneous extensor pollicis longus tendon rupture is commonly caused by attrition of the tendon from trauma or inflammatory processes. We experienced a patient with extensor pollicis longus tendon rupture after steroid injection, in which the rupture may have been caused by the effects of steroid itself as well as direct damage from the needle. A 51-year-old woman complained of inability to extend her right thumb at the first metacarpophalangal & interphalangeal joint level. The patient had a history of local steroid injection into the dorsal & radial side of wrist on two occations, and had no history of trauma or rheumatologic disease. After a physical examination of the patient, we decided to explore the wrist. The patient agreed with operation. Intraoperatively, an incision was made into the wrist and the proximal and distal ends of the ruptured extensor pollicis longus tendon were identified. The defect between the proximal and the distal end was measured to approach 8cm, and a palmaris longus tendon graft was performed. After three months of rehabilitation, the first metacarpophalangal & interphalangeal joint recovered the normal range of motion. Steroid injection has been widely used in various musculoskeletal disorders such as rheumatoid arthritis and osteoarthritis. However, inadvertent steroid injection into the extra or intra articular spaces may lead to tendon rupture. Steroids reduce tensile strength by decreasing tenocyte activity and collagen synthesis. Also, the physical effect of direct needle-stick injury into the mesotenon and blood vessels around the tendon may cause damage. In addition, hematoma and edema may increase pressure around the tendon and compromise blood supply, leading to tendon degeneration and subsequent rupture. When injecting steroid into an articular area, all physicians should have a complete understanding of the surrounding anatomy and always keep in mind the hazards of such procedures.

• Clinics in Shoulder and Elbow
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• v.2 no.2
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• pp.138-142
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• 1999

Coracoclavicular ligament is main restraint to superior instability of the distal clavicle. Coracoacromial ligament, extensor tendon of toe, palmaris longus tendon, and Dacron tape have been used to reconstruct coracoclavicular ligament. We used semitedinosus tendon to reconstruct coracoclavicular ligament. The semitendinosus tendon was harvested as a usual fashion. After the distal clavicle and coracoid process were exposed, a hole of six millimeter diameter was made on the center of whole thickness of the distal clavicle. A malleolar screw was fixed from distal clavicle to coracoid process to maintain the reduced position of the acromioclavicular joint. The leading suture of tendon graft was passed through the hole of the distal clavicle and looped under the coracoid process. After leading portion of ten­don graft was looped over the clavicle, sutures were made between each end of the tendon graft with nonabsorbable suture materials.

• Korean Journal of Acupuncture
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• v.22 no.1
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• pp.67-74
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• 2005

Objectives : This study was carried to identify the component of the Pericardium Meridian Muscle in human. Methods : The regional muscle group was divided into outer, middle, and inner layer. The inner part of body surface were opened widely to demonstrate muscles, nerve, blood vessels and to expose the inner structure of the Pericardium Meridian Muscle in the order of layers. Results We obtained the results as follows; He Perfcardium Meridian Muscle composed of the muscles, nerves and blood vessels. In human anatomy, it is present the difference between terms (that is, nerves or blood vessels which control the muscle of the Pericardium Meridian Muscle and those which pass near by the Pericardium Meridian Muscle). The inner composition of the Pericardium Meridian Muscle in human is as follows ; 1) Muscle P-1 : pectoralis major and minor muscles, intercostalis muscle(m.) P-2 : space between biceps brachialis m. heads. P-3 : tendon of biceps brachialis and brachialis m. P-4 : space between flexor carpi radialis m. and palmaris longus m. tendon(tend.), flexor digitorum superficialis m., flexor digitorum profundus m. P-5 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum superficialis m., flexor digitorum profundus m. tend. P-6 : space between flexor carpi radialis m. tend. and palmaris longus m. tend., flexor digitorum profundus m. tend., pronator quadratus m. H-7 : palmar carpal ligament, flexor retinaculum, radiad of flexor digitorum superficialis m. tend., ulnad of flexor pollicis longus tend. radiad of flexor digitorum profundus m. tend. H-8 : palmar carpal ligament, space between flexor digitorum superficialis m. tends., adductor follicis n., palmar interosseous m. H-9 : radiad of extensor tend. insertion. 2) Blood vessel P-1 : lateral cutaneous branch of 4th. intercostal artery, pectoral br. of Ihoracoacrornial art., 4th. intercostal artery(art) P-3 : intermediate basilic vein(v.), brachial art. P4 : intermediate antebrachial v., anterior interosseous art. P-5 : intermediate antebrarhial v., anterior interosseous art. P-6 : intermediate antebrachial v., anterior interosseous art. P-7 : intermediate antebrachial v., palmar carpal br. of radial art., anterior interosseous art. P-8 : superficial palmar arterial arch, palmar metacarpal art. P-9 : dorsal br. of palmar digital art. 3) Nerve P-1 : lateral cutaneous branch of 4th. intercostal nerve, medial pectoral nerve, 4th. intercostal nerve(n.) P-2 : lateral antebrachial cutaneous n. P-3 : medial antebrachial cutaneous n., median n. musrulocutaneous n. P-4 : medial antebrachial cutaneous n., anterior interosseous n. median n. P-5 : median n., anterior interosseous n. P-6 : median n., anterior interosseous n. P-7 : palmar br. of median n., median n., anterior interosseous n. P-8 : palmar br. of median n., palmar digital br. of median n., br. of median n., deep br. of ulnar n. P-9 : dorsal br. of palmar digital branch of median n. Conclusions : This study shows some differences from already established study on meridian Muscle.

• Clinics in Shoulder and Elbow
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• v.4 no.2
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• pp.191-195
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• 2001

Posterolateral rotatory instability is the most common pattern of elbow instability especially which is recurrent, and is usually post-traumatic because of inadequate soft tissue healing. The lateral ulnar collateral ligament was reconstructed by using ipsilateral palmaris longus tendon. Functionally good result was obtained. This is a case report illustrating the posterolateral rotatory instability of the elbow and its reconstruction with palmaris longus.