Adam M. Feintisch

An Anatomic Variant of Persistent Median Artery in Association with Carpal Tunnel Syndrome: Case Report and Review of the Literature

The persistent median artery can be a rare cause of carpal tunnel syndrome. We present an anatomic variant of this artery. A 47-year-old female patient with bilateral carpal tunnel syndrome was found to have bilateral patent, functional persistent median arteries (PMA) upon operative exploration. Unlike previous reports, the PMAs were not located dorsal to the flexor retinaculum (FR). Rather, the PMAs were interposed between the palmar aponeurosis and the FR. Accompanied by two venae comitantes, the aberrant arteries were positioned directly in line with our carpal tunnel incisions on both hands. Although rare, it is important for the surgeon to be aware of this anatomic variant to prevent inadvertent injury to what may be an important vascular supply to the distal median nerve.

Dorsal Wrist Ganglion Associated with Extensor Digitorum Brevis Manus: Case Report and Review of the Literature

Aberrant accessory muscles are rare entities in the hand. The extensor digitorum brevis manus (EDBM) muscle is amongst them and may be seen in association with dorsal ganglion cysts. Distinguishing an EDBM muscle is relevant in the diagnostic consideration of a dorsal ganglion in order to facilitate and guide its proper treatment. To date, there have been only few reports of an EDBM in association with a dorsal ganglion cyst. We report our experience with an incidental intraoperative finding of an intramuscular EDBM dorsal ganglion cyst and follow with a literature review and guide to management.

Intravascular Papillary Endothelial Hyperplasia (Masson’s Tumor) of the Hand

A nonspecific soft tissue mass of the hand can be difficult to diagnose due to the multitude of possible etiologies. In this case, we discuss our experience in diagnosing and treating intravascular papillary endothelial hyperplasia, or Massons tumor, of the hand. The wide range of differential diagnoses and the morphological resemblance to angiosarcoma make Massons tumor an important clinical entity to understand. The purpose of this study is to familiarize the reader with the appropriate diagnostic and treatment modalities that allow the clinician to recognize Massons tumor, differentiate it from similar clinical entities, and institute the appropriate management regimen.

Bilobed Flap for Nasal Reconstruction

Commonly used in the reconstruction of facial skin defects, the double transposition bilobed flap is particularly suited for nasal defect reconstruction. Initially described by Zitelli in 1989, the bilobed flap has become the repair of choice for defects in the lower third of the nose (lateral tip, supratip, ala near the tip) measuring between 0.5 and 1.5 cm. By enabling the transposition of skin over a larger distance than would be possible via a single flap, the bilobed flap allows for the use of local tissue well matched in color and texture to the recipient site. Its design is favorable as the secondary defect may be closed primarily with minimization of dog-ear formation. The flap can be designed with its base medially or laterally, best suited for alar or nasal tip defects, respectively. The defect, flap, and surrounding donor site should all be undermined widely in the submuscular, perichondrial, and periosteal planes, in order to facilitate unrestricted flap transposition. This reduces the potential for nasal distortion, pin cushioning, or trap-door deformity.