1/11. Fascial flaps based on perforators for reconstruction of defects in the distal forearm.Twenty fascial flaps were used in the reconstruction of defects in the distal forearm, wrist and hand in 18 patients over a 2-year period. In 16 patients the fascial flaps were based on a single fascial feeding vessel or 'perforator' arising from the anterior interosseous artery and/or ulnar artery when the radial artery had been used as the donor vessel in free flap reconstruction elsewhere in the body. There was no loss of any fascial flap in the study. The use of fascial flaps based on fascial feeders of the anterior interosseous and ulnar arteries extends the range of fascial flaps that can be raised in the forearm for reconstruction of defects in the distal forearm, wrist and hand.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/11. Anchor limited arthrodesis of the wrist.We present a case of lunate dislocation with total disruption of all ligaments and, consequently, nutrient vessels. The injury was handled by fusion of the lunate with the scaphoid, capitate and triquetrum. This 'anchor fusion' has led to a very good long-term result.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
3/11. Primary and secondary microvascular reconstruction of the upper extremity.Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
4/11. Early vascular grafting to prevent upper extremity necrosis after electric burns: additional commentary on indications for surgery.Early vascular grafting has been used to reestablish circulation to the hand in the treatment of electric injuries of the wrist with arterial damage. Since 1972 this therapy has yielded good results by preventing necrosis of the injured hand and by helping to maintain function. However, the indications and timing for performing this operation still are poorly defined. The surgeon is faced with the difficult task of determining whether the injury is severe enough to affect distal circulation and thereby lead to necrosis. The lack of reliable clinical signs is chiefly responsible for this difficulty; however, the potential for delayed thrombosis of vessels complicates the problem. In this article, indications for early vascular grafting in an electrically injured wrist are discussed based on recent clinical experience, with emphasis on the use of arteriography. A case history involving electric burns of both upper extremities is presented as an illustration.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
5/11. Free vascularized bone grafts in surgery of the upper extremity.Free vascularized fibular grafts were employed in five patients with segmental bone defects following trauma or resection of tumors of the upper extremity with excellent results in three patients and satisfactory results in two. No donor site morbidity was experienced. A comparison with rib and iliac crest grafts indicates that the fibula is more suitable for reconstruction of long bone defects. The advantages of this technique are stability without sacrificing viability and a shorter immobilization period with more rapid incorporation and hypertrophy of the graft. The disadvantages are prolonged operating time, difficulty in assessing patency of anastamoses in the immediate postoperative period, and sacrifice of a major vessel in the lower extremity.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
6/11. Immediate reconstruction of the wrist and dorsum of the hand with a free osteocutaneous groin flap.A free osteocutaneous groin flap, based on the deep circumflex iliac artery, was used to primarily fuse the wrist and stabilize the first and second metacarpal bones, as well as provide soft tissue coverage for a severely injured hand. The indications for primary reconstruction with free tissue transfers include a tidy wound with minimal bacterial contamination, ready access to uninjured recipient vessels, and a predictable advantage in the use of free tissue transfer over conventional techniques.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
7/11. Traumatic pseudoaneurysm in an ulnar artery vein graft.ulnar artery thrombosis is well reported but treatment recommendations still vary. We report the 10-year follow-up of a vein graft used to treat a patient with ulnar artery thrombosis. The graft remained patent until the tenth year, when the patient sustained a blunt hyperextension injury to the involved wrist and developed a pseudoaneurysm of the vein graft. The pseudoaneurysm was found to be in the graft itself and not at the anastomosis. The vein graft thrombosed and was successfully treated with resection of the thrombosed vessel, embolectomy of the superficial palmer arch, and replacement with a new vein graft.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
8/11. Fracture-dislocation of the radiocarpal joint.In five patients with fracture-dislocation of a radiocarpal joint, the wrist injury was severe and associated with injuries to other systems. Typically there was neurovascular impairment and closed reduction was performed as soon as possible to relieve pressure to tension on vessels and nerves. Fracture of the radial and ulnar styloid processes, fracture of the dorsal rim of the radial articular surface, and a multitude of carpal and intercarpal injuries were present in all cases. Early open reduction, internal fixation of the fractures, and repair of all torn ligaments appeared to be the treatment of choice.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/11. Free vascularized temporal parietal flap in hand surgery.Free vascularized temporo-parietal fascia (TPF) flap is a flap of thin, pliable and vascularized tissue which can cover an area measuring up to 12 cm x 14 cm. The flap is harvested based on temporal vessels, which provide a smooth, gliding surface for tendon function and eliminates the need for secondary procedures usually required by the pedicled or bulky free vascularized myocutaneous flaps. The donor pedicle is long and consistent with an average diameter of 3 mm in adults. This flap is versatile. In 12 resurfacings for traumatic wounds of hand and wrist, no flaps were lost. Donor site morbidity, except for a transient sideburn hair loss in one case, was not encountered. We recommend this flap as a viable one-stage procedure for coverage of complex hand wounds.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
10/11. Reversed free osteoarthrocutaneous dorsalis pedis flap for simultaneous reconstruction of the trapeziometacarpal joint and the first metacarpal bone.Simultaneous reconstruction of a traumatic defect of the trapeziometacarpal joint and the first metacarpal with a composite dorsalis pedis flap is described. The transplant, consisting of the second metatarsal and the second metatarsophalangeal joint, was reversed at the defect site for the metatarsophalangeal joint to become a new trapeziometacarpal joint. A long vascular pedicle was necessary for direct micro-vascular anastomoses to the radial vessels at the wrist. This transfer can be expected to be effective in reconstructing composite hand defects involving the trapeziometacarpal joint and the entire first metacarpal bone.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
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