Keith A. Segalman

Radial artery use in bypass grafting does not change digital blood flow or hand function.

BACKGROUND Patient selection criteria have not been clearly established for use of the radial artery as a bypass conduit. To help establish such criteria, we measured changes in digital blood flow and hand function after radial artery removal. METHODS Ninety-eight patients of the first 122 consecutive patients considered for radial artery harvest met predetermined criteria by vascular noninvasive studies to undergo removal of the radial artery. In 42 of these 98 patients, the radial artery was actually used as a bypass conduit; 28 of these 42 patients returned for noninvasive vascular studies, a critical review of hand function, and a hand symptom questionnaire. RESULTS There were no significant differences between the operated and nonoperated hands for digital-brachial indices, cold response, grip or pinch strength, digital two-point discrimination, or nine-hole peg tests. The patients had an increased incidence of a small amount of forearm numbness and tingling, but no increase of pain or cold intolerance. CONCLUSIONS For properly selected patients, there are minimal changes in hand function after radial artery removal.

Analysis of digital pulse-volume recordings with radial and ulnar artery compression

&NA; The vascular noninvasive studies of 289 consecutive cardiac surgery patients were reviewed to better understand hand blood‐flow physiology in an older population with vascular disease. The radial artery was found to be more important to pulsatile digital blood flow than the ulnar artery. In more than 20 percent of hands, the thumb and the index and fifth fingers lost pulsatile blood flow with radial artery compression at the wrist compared with only 5 percent with ulnar artery compression. The maintenance of pulsatile digital blood flow did not follow anatomic patterns of blood vessels previously presumed to be of paramount importance. The hand acts more like a single vascular bed than it does like two separate systems with a connecting arch. (Plast. Reconsir. Surg. 102: 1993, 1998.)

Restoration of Longitudinal Forearm Stability Using a Suture Button Construct

PURPOSE This study proposed a method of restoring the longitudinal stability of the forearm provided by the central band of the interosseous membrane (IOM) by using a percutaneously placed suture button construct. We hypothesized that supporting the forearm IOM with a suture button construct would restore longitudinal stability in a cadaveric model of the Essex-Lopresti lesion. METHODS We assessed 7 adult cadaver upper extremities radiographically for evidence of previous elbow, forearm, or wrist fracture. Each limb was mounted onto a materials testing system with the elbow held at 90° and the forearm in neutral. The intact specimen was loaded cyclically at 134 N to determine the native mobility of the forearm segment. Each specimen was tested after each of the following steps: radial head removal, transection of the IOM, and suture button construct reconstruction of the IOM. After the final reconstruction, each specimen was examined for forearm range of motion and evidence of neurovascular injury. RESULTS Removal of the radial head and sectioning of the IOM sequentially increased average proximal migration of the radius by 3.6 and 7.1 mm, respectively. After reconstruction with the suture button construct, the IOM was restored to the intact state with only the radial head removed. Forearm rotation was not compromised by the reconstruction, and there was no evidence of neurovascular injury in any specimen. CONCLUSIONS A percutaneously placed suture button construct can restore the longitudinal stability provided by an IOM. The method described did not limit forearm rotation. We encountered no neurovascular injury in the specimens tested in this series. This construct may be an effective adjunct when combined with bony reconstruction to treat longitudinal forearm axis injuries.

Diagnosis and treatment of post-traumatic medial and lateral elbow ligament incompetence

Elbow instability may occur secondary to soft tissue or bony injuries. Predictable patterns of instability do occur. Identification of disrupted osseous or ligamentous constraints allows for an algorithmic and predictable treatment plan. Maintaining a high index of suspicion allows early recognition and treatment of elbow instability. Treatment based on recognized principles is the key to preventing recurrent instability and late arthrosis while maintaining functional elbow motion.

Unusual Case of Cutaneous and Synovial Paecilomyces lilacinus Infection of Hand Successfully Treated with Voriconazole and Review of Published Literature

Paecilomyceslilacinus infection is rare and is found worldwide. The majority of infections occur in immunocompromised people. Among immunocompetent patients, cutaneous infections are the second most common site of infection but are difficult to treat because of antifungal resistance. We report a case of hand cutaneous involvement with synovitis in an immunocompetent patient that improved after treatment with oral voriconazole. To the best of our knowledge, there are only five published cases of cutaneous P.lilacinus infection, all in immunocompromised patient, treated with oral voriconazole. We review all previously reported cases.

Microvascular solution for vascular complication in surgery for Dupuytren's contracture: A case report

Vascular complications in surgery for Dupuytrens contracture are rare.J Prior to the introduction of microvascular techniques, vascular compromise after correction of Dupuytrens contracture was marked by tissue necrosis and finger amputations. 2 We report a patient with vascular insufficiency alter surgery for DupuytTens contracture. The linger was salvaged by arterial reconstruction using microvascular techniques.

Successful treatment of primary cutaneous Aspergillus flavus infection of the hand with oral itraconazole.

Primary cutaneous Aspergillus flavus infections of the hand are exceedingly rare. Usually, these infections are present in severely immunocompromised patients suffering from lymphoreticular malignancies. The majority of cases result in invasive systemic infections and often culminate in death. We report a case of primary cutaneous A. flavus infection in the hand of a patient immunocompromised only by non-insulin-dependent diabetes, who ultimately was cured of this infection with oral itraconazole.