Heitor J.R. Ulson

Absence of the anastomosis between the anterior and posterior interosseous arteries in a posterior interosseous flap: A case report

The posterior interosseous flap is an island fasciocutaneous forearm flap supplied by branches of the posterior interosseous artery. After its description r-3 the flap has proved to be successful in cover, ing defects of the hand, wrist, and elbow region.3,4 The most important anatomical detail of the posterior interosseous flap is the presence of an anastomotic branch between the anterior and posterior interosseous arteries, located at the distal end of the posterior compartment of the forearm (Fig. 1). The presence of this anastomosis is essential in the design of a commonly configured, distally based flap, perfused by retrograde arterial flow through this anastomotic branch. We report a case of absence of the anastomosis between the two interosseous arteries.

The superficial branch of the radial nerve: a morphologic study

Study the morphology of the superficial branch of the radial nerve (SBRN) of the forearms and wrists of fresh adult human cadavers. Methods: Twenty three dissections were performed under 3.5x loupe magnification, histological sections of the nerve were obtained in 20 dissections for fascicle identification. Results: The SBRN emerged, in average, at 8.65cm proximal to the radial styloid apophysis (RSA) between the Brachioradialis (BR) and Extensor Carpi Radialis Longus (ECRL) tendons. In 6/23 cases the SBRN emerged between an accessory BR tendon and the main BR tendon. The first branch of the SBRN arose at an average of 4.58 cm proximal to the RSA. A branch running across the RSA was found in 7/23 cases. At that level, the average number of branches crossing the wrist was 3.4. A fascicle count of the nerve and its first branch showed an average of 6.6 and 4.0 fascicles, respectively. Conclusion: Our anatomical findings are similar to those in the revised literature and contribute towards a better knowledge of the SBRN. Great caution is required in surgical procedures such as percutaneous bone fixation of the distal 1/3 of the forearm and wrist and particularly, in those susceptible to SBRN injury, as in seven of the 23 cases the SRBN ran directly accross the RSA. The authors recommend performing small longitudinal incisions down to the subcutaneous tissue, separating the nerve branches by blunt soft tissue dissection, with a delicate haemostat, before introducing the Kirschner wires (minimally invasive procedures).

The Use of Synthetic Plaster Casting Tape for Hand and Wrist Splints

In a prospective study, 40 patients were fitted with synthetic plaster splints to assess the use of such material for hand and/or wrist splints. Factors assessed in both splint fabrication and use included molding properties, elastic traction fixation, weight, ventilation, durability, patient comfort, effectiveness, practicability, time, and cost. The patients were divided into three groups according to basic pathology: tendon/nerve injuries; bone and joint disorders; and rheumatoid disease deformities. Recovery of 50-100% of active range of motion was considered a good result. Good results were obtained in 37 patients (92.5%), whereas in the remaining three patients (7.5%) the results were poor. It is suggested that synthetic plaster is a suitable material for the fabrication of splints in hand rehabilitation.

Estudo morfológico do ramo superficial do nervo radial

O autor apresenta um estudo anatomico-histologico do Ramo Superficial do Nervo Radial (RSNR) no terco distal do antebraco e punho atraves de disseccoes anatomicas em vinte e tres cadaveres humanos. O ponto de emergencia do RSNR entre os tendoes do braquiorradial e extensor radial longo do carpo foi encontrado, em media, a 8,65cm da apofise estiloide do radio (AER). Em seis casos (26%) foi identificado um tendao acessorio do braquiorradial, com RSNR emergindo entre este e o tendao principal. A primeira ramificacao teve origem, em media, a 4,58cm da AER. Em 30% dos casos notou-se a presenca de um ramo cruzando o punho diretamente sobre a AER. A media de ramos cruzando o punho a altura da AER foi de 3,4. Cortes histologicos do nervo e suas ramificacoes cruzando o punho a altura da AER foram realizados em vinte disseccoes para a contagem do numero de fasciculos. O numero medio de fasciculos do RSNR no seu ponto de emergencia foi de 6,6. Na sua primeira ramificacao, observou-se a media de 4 fasciculos. A literatura disponivel parece nao indicar relato semelhante, o qual pode nos auxiliar nos casos de uso do RSNR para enxerto de nervo. Os achados anatomicos apresentam resultados semelhantes aos da literatura especifica sobre o tema. Estes achados vem a somar para um melhor conhecimento do RSNR e reforcam a necessidade de extremo cuidado em procedimentos cirurgicos no terco distal do antebraco e punho, principalmente nos procedimentos percutâneos Abstract