• Journal of Korean Neurosurgical Society
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• v.49 no.2
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• pp.139-141
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• 2011

Compression of the ulnar nerve in Guyon's canal can result from repeated blunt trauma, fracture of the hamate's hook, and arterial thrombosis or aneurysm. In addition, conditions such as ganglia, rheumatoid arthritis and ulnar artery disease can rapidly compress the ulnar nerve in Guyon's canal. A ganglion cyst can acutely protrude or grow, which also might compress the ulnar nerve. So, clinicians should consider a ganglion cyst in Guyon's canal as a possible underlying cause of ulnar nerve compression in patients with a sudden decrease in hand strength. We believe that early decompression with removal of the ganglion is very important to promote complete recovery.

• The Journal of Korean Orthopaedic Ultrasound Society
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• v.4 no.2
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• pp.84-87
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• 2011

We had applied Doppler ultrasound guided modified Allen's test for a Volkmann's ischemic contracture patient who had ulnar artery constriction which was not detected with acoustic Doppler and CT-angiogram preoperatively. We report this case of Volkmann's ischemic contracture with brief review of literatures for awareness of the Doppler-ultrasound guided modified Allen's test.

• Archives of Plastic Surgery
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• v.38 no.1
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• pp.105-108
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• 2011

Purpose: An extensive knowledge of the arterial anatomy of the upper extremity and its variations is indispensable to the hand surgeon. We report a patient with anomalous radial artery, superficial course of two radial arteries, encountered during the excision of volar wrist ganglion. Methods: The patient was a 53-year-old man who had a painful mass on the left volar wrist for 1 year. Under general anesthesia, a curved incision was made around the mass. With the skin flaps retracted, the dome of the cyst was identified. Particular care was taken to identify and protect the radial artery, which was intimately attached to the wall of the ganglion. Two radial arteries completely encircled the ganglion. The pedicle was traced to the volar joint capsule, radiocarpal ligament. The joint was open and the capsular attachments were excised. Results: The patient made an uneventful recovery. There were two arterial pulsations at the volar side of the wrist joint. Compressing this site revealed that the major arterial contributor to blood supply in the hand was the ulnar artery. At angioCT, an anomaly of the radial artery was found with a duplication. The pathway of this aberrant artery was superficial to the original radial artery. It changed its course subcutaneously at the level of the tendon of the brachioradialis muscle, and crossing the wrist lateral to the original radial artery and ending in the deep palmar arch. Conclusion: Authors experienced a case of bifurcating radial artery encountered during the excision of ganglion on the volar of the wrist. Because these duplicated radial arteries make strong contributions to the thumb and index finger as well as to the deep palmar arch, when they are present there may be probably less blood supply to the hand from the ulnar artery. If the radial artery is palpated superficially on the brachioradialis muscle, it is important to remember the kind of anomaly.

• Archives of Plastic Surgery
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• v.44 no.1
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• pp.12-18
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• 2017

Background Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. Methods Eight vessels-the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery-were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media. The dissection time from skin incision to application of vessel clamps was also measured. Results The EDs of the vessels varied. The ischiatic vein had the largest ED of $2.69{\pm}0.33mm$, followed by the basilic vein ($1.88{\pm}0.36mm$), ischiatic artery ($1.68{\pm}0.24mm$), common dorsal metatarsal artery ($1.23{\pm}0.23mm$), cranial tibial artery ($1.18{\pm}0.19mm$), brachial artery ($1.08{\pm}0.15mm$), ulnar artery ($0.82{\pm}0.13mm$), and radial artery ($0.56{\pm}0.12mm$), and the order of size was consistent across all subjects. Thicknesses of the tunica adventitia and media were also diverse, ranging from $74.09{\pm}19.91{\mu}m$ to $158.66{\pm}40.25{\mu}m$ (adventitia) and from $31.2{\pm}7.13{\mu}m$ to $154.15{\pm}46.48{\mu}m$ (media), respectively. Mean dissection time was <3 minutes for all vessels. Conclusions Our results suggest that nonliving chickens can provide various vessels with different anatomic characteristics, which can allow trainees the choice of an appropriate microvascular anastomosis training model depending on their purpose and skillfulness.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.68-72
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• 1998

With the advent of microvascular free-tissue transfer, this single stage resurfacing method for large scar and soft tissue defects around the wrist in the patients of electrical burn has distinctive advantage over the conventional multistage pedicle-flap transfer. Between 1992 and 1996, we treated 9 cases of 8 patients who had large scar around the wrist due to old electrical burn with free flaps as a preparation of staged tendon graft. Mean age was 30.3 years and average scar area was $6{\times}11cm$. The length of time the injury and free flaps was 9 months on an average. Prior to the free flap, we performed the angiography to all patients in order to evaluate the circulation of the forearm and hand and to choose the recipient vessel. In all cases, proximal ulnar arteries in the forearm remained intact and all radial arteries remained intact in 8 of 9 cases on angiogram. The interosseous arteries were well visualized in all cases. We used the ulnar arteries as a recipient artery. The types of flaps used were f scapular cutaneous flaps, 2 dorsalis pedis flaps and a radial forearm flap. Flap survial was 100 percents with satisfactory functional and cosmetic results. Free flaps using ulnar artery as a recipient artery is one of the useful reconstruction methods for the resurfacing of large scar around the wrist in the patients of old electrical burn.

• The Academic Congress of Korean Shoulder and Elbow Society
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• 2008.03a
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• pp.175-175
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• 2008

We report a rare case of late-onset brachial artery occlusion caused by subclavian artery stenosis with excessive scar tissue after open reduction and plate fixation for clavicular fracture. When he referred to us, the right hand were pale and the radial and ulnar pulses at the wrist were absent. CT-angiogram showed compression of subclavian artery by excessive scar tissue beneath the fracture site and angiography revealed stenosis of subclavian artery with thrombus and complete obstruction of blood flow in the brachial artery with emboli. Therefore, we performed embolectomy. 2 years after operation, patient was essentially asymptomatic except mild pain after long standing elevation of arm. We recommend that minimal soft tissue dissection should be needed in the operative treatment of clavicular fracture, especially soft tissue beneath the clavicle should be protected maximally.

• Archives of Plastic Surgery
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• v.36 no.6
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• pp.691-701
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• 2009

Purpose: Deviations of arterial palmar arches in the hand can be explained on the embryological basis. The purpose of this study was to provide new information about palmar arches through cadaver's dissection. The values of the location and diameter in these vessels were analyzed in order to support anatomical research and clinical correlation in the hand. Methods: The present report is based on an analysis of dissections of fifty - three hands carried out in the laboratory of gross anatomy. A reference line was established on the distal wrist crease to serve as the X coordinate and a perpendicular line drawn through the midpoint between middle and ring fingers, which served as the Y coordinate. The coordinates of the x and y values were measured by a digimatic caliper, and statistically analyzed with Student's t - test. Results: Complete superficial palmar archs were seen in 96.2 % of specimens. In the most common type of males, the superficial arch was formed only by the ulnar artery. In the most common type of females, the superficial arch was formed anastomosis between the radial artery and the ulnar artery. The average length of the superficial and deep palmar arch is $110.3{\pm}33.0mm$ and $67.9{\pm}14.0mm$ respectively. Regarding the superficial palmar arch, ulnar artery starts $-16.1{\pm}5.1mm$ on X - line, and $2.5{\pm}24.5mm$ on Y - line. Radial artery appears on palmar side $7.7{\pm}3.2mm$ on X - line, and $20.9{\pm}10.9mm$ on Y - line. But radial artery starts on $6.3{\pm}3.6mm$ on X - line, and $3.4{\pm}5.1mm$ on Y - line. Digital arteries of superficial palmar arch starts on $6.1{\pm}3.7mm$, $33.9{\pm}8.8mm$ on index finger, $1.8{\pm}3.4mm$, $40.1{\pm}7.3mm$ on middle finger, $-3.2{\pm}4.9mm$, $42.6{\pm}7.0mm$ on ring finger, and $-8.9{\pm}5.1mm$, $42.5{\pm}80mm$ on little finger in respective X and Y coordinates. Radial artery of deep palmar arches measured at the palmar side perforating from the dorsum of hand. It's coordinates were $9.7{\pm}4.8mm$ on X - line, $21.7{\pm}10.2mm$ on Y - line. Ulnar artery was measured at hypothenar area, and it's coordinates were $-20.4{\pm}6.3mm$ on X - line, and $30.6{\pm}7.4mm$ on Y - line. Conclusions: Anatomically superficial palmar arch can be divided into a complete and an incomplete type. Each of them can be subdivided into 4 types. The deep palmar arch is less variable than the superficial palmar arch. We believe these values of the study will be used for the vascular surgery of the hand using the endoscope and robot in the future.

• Archives of Reconstructive Microsurgery
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• v.21 no.1
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• pp.41-49
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• 2012

Purpose: To report clinical appearances and the outcomes of patients treated for wrist laceration with suicidal intent. Materials and Methods: Between March 2005 and February 2008, patients with wrist laceration were treated at our center. Among them, 14 patients with suicidal intent were reviewed retrospectively. They were 8 females and 6 males with a mean age of 33 years at the time of treatment. The side of injured wrist, injured structures, suicidal instrument, the time of injury, a suicidal motive, drug or alcohol abuse or not, indication of combined psychiatric disease, the duration of postoperative treatment, and the results of treatment were analyzed. Results: The injured wrist was the left one in 13 cases (93%), and knife wounds in 11 cases (79%) was the most frequent mechanism of injury. An average of 4.6 structures were injured including 3.5 tendons, 0.57 nerves and 0.5 arteries. The most frequently injured structures were the palmaris longus (71%), FCU (50%), FCR (43%), FDS 3 (36%), FDS 2, median nerve, and ulnar artery (each 29%). Simultaneous injury of both median and ulnar nerves occurred in 3 cases (21%), and simultaneous injury of both radial and ulnar artery occurred in 1 case (7%). The injury time was the night in 12 cases (86%), and the most frequent suicidal motive was human relations such as lover or spouse in 12 cases (86%). In 9 cases (64%), the injured were in a drunken state, 3 cases (21%) had been treated for a psychiatric disease at the time of the injury. The durations of postoperative treatment were an average of 5 days of admission and 1 day follow up. Only 1 case results could be evaluated. Conclusions: Patient's poor compliance in wrist laceration with suicidal intent should be expected and these characteristics may affect the management plan.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.409-414
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• 2023

The anterior interosseous artery (AIA) perforator flap is not commonly used in hand dorsum reconstruction compared with alternatives. However, it is a versatile flap with several advantages. Literature on the AIA perforator flap is based on the dorsal septocutaneous branch (DSB), which branches from the AIA and passes through fascia between the extensor pollicis longus (EPL) and extensor pollicis brevis muscles. In the described case, the authors reconstructed a hand dorsum defect in a 78-year-old man using an AIA perforator flap with double perforators supplied by the DSB and a new perforator branching from the distal than DSB. No complication was encountered, and the flap survived completely. A retrospective computed tomography review revealed the presence of the new perforator in 14 of 21 patients. Two types of new perforator were observed. One passed through the ulnar side of the extensor indicis proprius (EIP) muscle and penetrated fascia between the extensor digitorum minimi and extensor digitorum communis tendons, whereas the other passed between the EPL and EIP muscles. This report describes the anatomical location and clinical application of the new AIA perforators. The double perforators-based AIA flap provides a straightforward, reliable means of reconstructing hand dorsum defects.

• Journal of Trauma and Injury
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• v.36 no.1
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• pp.60-64
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• 2023

Upper extremity vascular injuries occurring with acute compartment syndrome are very challenging to manage in an emergency context in resource-poor settings. The need to always recognize the likelihood of coexisting compartment syndrome guides surgeons to perform concomitant fasciotomy to ensure a better outcome. We managed three vascular injuries in the upper extremities in two patients with concomitant imminent compartment syndrome observed intraoperatively. The first injury was complete brachial artery disruption following blunt trauma, while the second and third injuries were radial and ulnar artery transection caused by sharp glass cuts. Both patients were treated with vascular repair and fasciotomy. Secondary wound coverage was applied with split-thickness skin grafting, and the outcomes were satisfactory. Concomitant fasciotomy potentially improves the outcomes of vascular repair in emergency vascular surgery and should be considered for all injuries with the potential for acute compartment syndrome.