One Stage Thumb Reconstruction Using a Previously Injured Little Finger from the Contralateral Hand (original) (raw)

Subtotal reconstruction of the thumb by transposition of index finger

The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 1985

A case of subtotal reconstruction of the thumb is described. The reconstruction was carried out as a staged procedure with an intact index finger transposition, followed by opposition transfer using the abductor digiti quinti muscle after three weeks. Twenty-eight months postoperatively, power grip and precision grip were restored despite destruction of the thenar muscles.

Anatomic study of the dorsal arterial system of the hand

2004

Historically, the dorsal arterial system of the hand received less attention than the palmar system. The studies concerning dorsal arterial anatomy present some controversies regarding the origin and presence of the dorsal metacarpal artery branches. Knowledge of the anatomy of dorsal metacarpal arteries is especially applied in the surgical planning for flaps taken from the dorsum of the hand. The purpose of this study is to analyze the arterial anatomy of the dorsum of the hand, compare our observations with those of previous studies from the literature, and therefore to define parameters for surgical planning for flaps supplied by the dorsal metacarpal arteries. METHOD: Twenty-six dissections were performed at the dorsum of the right hand of 26 cadavers by making a distal-based U-shaped incision. After catheterization of the radial artery at the wrist level, a plastic dye solution with low viscosity and quick solidification was injected to allow adequate exposure of even small vessels. The radial artery and its branches, the dorsal arterial arch, the dorsal metacarpal arteries, the distal and proximal communicating branches of the palmar system, and the distal cutaneous branches were carefully dissected and identified. RESULTS: The distal cutaneous branches originating from the dorsal metacarpal arteries were observed in all cases; these were located an average of 1.2 cm proximal from the metacarpophalangeal joint. The first dorsal metacarpal artery presented in 3 different patterns regarding its course: fascial, subfascial, and mixed. The branching pattern of the radial artery at the first intermetacarpal space was its division into 3 branches. We observed the presence of the dorsal arterial arch arising from the radial artery in 100% of the cases. The distance between the dorsal arterial arch and the branching point of the radial artery was an average of 2 cm. The first and second dorsal metacarpal arteries were visualized in all cases. The third and fourth dorsal metacarpal arteries were visualized in 96.2% and 92.3% of cases, respectively. There was proximal and distal communication between the dorsal arterial arch and the palmar system through the communicating branches contributing to the dorsal metacarpal artery formation. CONCLUSION: At the dorsum of the hand there is a rich arterial net that anastomoses with the palmar arterial system. This anatomical characteristic allows the utilization of the dorsal aspect of the hand as potential donor site for cutaneous flaps.

Original Research Anatomic Study of the Dorsal Arterial System of the Hand

2003

Historically, the dorsal arterial system of the hand received less attention than the palmar system. The studies concerning dorsal arterial anatomy present some controversies regarding the origin and presence of the dorsal metacarpal artery branches. Knowledge of the anatomy of dorsal metacarpal arteries is especially applied in the surgical planning for flaps taken from the dorsum of the hand. The purpose of this study is to analyze the arterial anatomy of the dorsum of the hand, compare our observations with those of previous studies from the literature, and therefore to define parameters for surgical planning for flaps supplied by the dorsal metacarpal arteries. METHOD: Twenty-six dissections were performed at the dorsum of the right hand of 26 cadavers by making a distal-based U-shaped incision. After catheterization of the radial artery at the wrist level, a plastic dye solution with low viscosity and quick solidification was injected to allow adequate exposure of even small ve...

Arterial supply of the thumb: Systemic review

Clinical Anatomy, 2017

We offer a complete systematic review of the anatomy of arteries of the thumb, including their sources in the first web space. Materials and Methods Eleven studies were selected from the PubMed, Medline, Embase, Scopus and Ovid databases. Data about each artery of the thumb were obtained; in particular, the incidence and dominance of each of these arteries were calculated. Results The ulnopalmar digital artery of the thumb (UPDAT) was found in 99.63%, the radiopalmar digital artery of the thumb (RPDAT) in 99.26%, the ulnodorsal digital artery of the thumb (UDDAT) in 83.39%, and the radiodorsal digital artery of the thumb (RDDAT) in 70.38%. The sources for the thumb arteries are the first palmar metacarpal artery (for UPDAT in 63.15%, for RPDAT in 78.88%, for UDDAT in 56.95% and for RDDAT in 41.48%), the first dorsal metacarpal artery (for UPDAT in 20.54%, for RPDAT 2.53%, for UDDAT in 20.62%, and for RDDAT in 4.81%) and the superficial palmar arch, either complete or incomplete (for UPDAT in 25.57%, for RPDAT in 23.04%, for UDDAT in 0%, and for RDDAT in 5.19%).

On behalf of: British Society for Surgery of the Hand

Additional services and information for Journal of Hand Surgery (European Volume) can be found at: Methods: The anatomical study was performed on 15 elbows of fresh unprepared cadavers. Results: Medial compartment: The anterior medial compartment of the elbow joint is innervated by two direct capsulo-periosteal branches of the median nerve. The medial epicondyle is innervated by branches of the medial cutaneous nerve of the forearm coming from its middle third. The region between trochlea humeri and the olecranon is innervated by direct capsular branches of the ulnar nerve. The posterior medial compartment of the elbow is innervated by a proximal branch of the radial nerve, which partially follows the trajectory of the ulnar nerve. Lateral compartment: The anterior lateral compartment of the elbow is innervated by an inconstant capsular branch of the musculocutaneous nerve, which begins 4 to 7 cm proximally to the joint in close contact with the humerus. In some cases, a branch of t...

Key aspects of anatomy, surgical approaches and clinical examination of the hand

Orthopaedics and Trauma, 2019

Knowledge of the functional anatomy of the hand is essential to be able to successfully clinically examine and operate on it. The topic of hand anatomy, clinical examination and surgical approaches is therefore closely linked and discussed in this article. The focus will be on detailed functional anatomy of the joints, tendons, and other soft tissue structures of the hand, related to the clinical examination and surgical approaches. Particular attention will be paid to the superficial and deep flexor tendons and how to examine them; the extensor mechanism and examination of the central slip; and surgical approaches to the finger. The pathoanatomy of Dupuytren's disease and fingertip infections are also discussed.

Reconstruction of the Superficial Palmar Arch Using the Subscapular Arterial System

Plastic and Reconstructive Surgery - Global Open, 2019

BACKGROUND Hypothenar hammer syndrome (HHS) involves repetitive blunt trauma or vibrational forces to the ulnar aspect of the hand, causing injury to the ulnar artery and potentially leading to thrombosis and distal ischemia. 1 Signs and symptoms of hypoperfusion or ischemia to the ulnar digits may include pain, coolness, and pallor. 2 Neuropathy of the adjacent ulnar nerve may occur. 3 Conservative measures are appropriate for most cases and may include activity modification, smoking cessation, cold avoidance, and/or calcium channel blockers. 2,4 Operative management is indicated when nonoperative management fails, or if critical ischemia is present. Reconstruction of the ulnar artery with venous and arterial interposition grafts has been described. 4-9 Venous donor sites include the greater saphenous vein, dorsal venous arch of the foot, or flexor aspect of the arm but have high thrombosis rates. 6,7,9 Previously described arterial donor sites include the descending branch of the lateral femoral circumflex artery, the deep inferior epigastric artery, or the serratus branch of the thoracodorsal artery. 4,8,9 We present a case of acute HHS that resulted in a large, complex arterial defect in the hand after resection of thrombosed arterial segments. Successful treatment utilized an interposition graft from the subscapular arterial system, which included multiple branches to reconstruct the arterial defect with 1 contiguous graft. CASE REPORT A 53-year-old right-hand-dominant carpenter presented with a 2-week history of right-sided intermittent median and ulnar nerve paresthesias and ulnar-sided hand pain. His symptoms worsened acutely with the development of bluish discoloration and exquisite pain to the tip of the fourth digit. History revealed frequent repetitive trauma to the hypothenar eminence when he used the ulnar aspect of his hand "like a hammer" to forcefully turn a large wrench. Medical history included well-controlled type 2 diabetes with no history of smoking, cardioembolic disease, or coagulopathy. The pulp of the fourth digit was cool to touch with a bluish hue, decreased capillary refill, and pain to