Compensatory response of the radial and ulnar arteries after radial artery cannulation in hypertensive patients.

BACKGROUND: Limited literature exists on the vascular reactivity of the radial and ulnar arteries in hypertensive patients following radial artery cannulation. This study assessed the vascular reactivity of the radial and ulnar arteries by comparing Doppler images and laser speckle contrast imaging (LSCI) obtained from both normotensive and hypertensive patients after radial artery cannulation under general anesthesia. METHODS: This study recruited 99 normotensive and 99 hypertensive patients who required arterial cannulation under general anesthesia. In the course of research, to evaluate the impact of hypertension on arterial reactivity, we employed duplex Doppler ultrasonography to measure the inner diameter (ID), resistance index (RI) and mean volume flow (MVF) of both arteries at five different time points. We equally performed perfusion of thumb and little finger by laser speckle contrast imaging. RESULTS: After radial artery cannulation, the hypertensive group showed less increase in radial ID and less decrease in RI compared to the normotensive group. The MVF increase was also less pronounced in hypertensive patients, while both groups demonstrated equivalent ulnar ID changes, and the normotensive group exhibited a more significant decrease in RI and a greater MVF increase. Thumb perfusion decreased post-cannulation in both groups, with the hypertensive group showing a less robust recovery. Little finger perfusion increased after artery cannulation in both groups, but the hypertensive group's increase was lower. The incidence of vasospasm in the hypertensive group is higher than that in the normotensive group. CONCLUSIONS: The radial and ulnar arteries in hypertensive patients may lack a compensatory response to radial artery cannulation during general anesthesia.

Does the resistive index of the radial artery change after arterial cannulation in patients undergoing abdominal surgery? A prospective observational study.

Background and Aims: To evaluate the flow at the cannulation site in the radial artery, the resistive indices (RIs) before cannula insertion and 6 h after decannulation were measured (primary outcome). The secondary outcomes were measurement of the artery size by anteroposterior (AP) diameter at the insertion site, RI and AP diameter at a point 4 cm proximal and in the ipsilateral ulnar artery before insertion and 6 h after cannula removal. Methods: In 96 patients requiring an arterial line during surgery, peak systolic velocity (PSV) and end-diastolic velocity (EDV) were measured to derive RI using a linear ultrasound transducer. The RI was measured at R1 (insertion point), R2, 4 cm proximal to R1, and U1 on the ipsilateral ulnar artery. The AP diameter of the arteries at baseline R10, R20 and U10 was measured and repeated 6 h after removal of the cannula, R16, R26 and U16. Results: RI or AP diameter in R1 or R2 did not differ pre- and post-cannulation. Mean R10 1.143 [standard deviation (SD: 0.239)] versus R16 1.181 (SD: 0.260) m/sec [mean difference (MD): -0.0372 (95% confidence interval (CI): -0.098, 0.023), P = 0.230]. Mean AP diameter at baseline versus 6 h decannulation 0.177 (SD: 0.042) versus 0.172 (SD: 0.045) cm [MD: 0.005 (95% CI: 0.003, 0.013), P = 0.222] was also similar. The mean PSV in U10 versus U16 was higher: 0.480 (SD: 0.178) versus 0.528 (SD: 0.316) m/sec [MD: 0.120 (95% CI: -0.185, -0.054), P = 0.002] and AP diameter was also higher than baseline (P = 0.001). Conclusion: The flow in the radial artery did not change following cannulation. The PSV and AP diameter in the ulnar artery increased after decannulation, suggesting a compensatory increase in flow.

Diagnostic and management strategies for pseudoaneurysm of the ulnar artery: A scoping review.

Introduction: Pseudoaneurysm of the ulnar artery (PUA) can arise secondary to several inciting etiologies and may lead to pain, arterial insufficiency, and ulnar nerve palsy. Given the relative infrequency of PUA diagnosis, there is no consensus regarding its proper diagnosis and management strategies. The purpose of this review is to summarize the existing data regarding PUA and develop an algorithm for management. Methods: A review was performed following PRISMA Extension for Scoping Reviews guidelines. Manuscripts were included if they 1) studied patients over the age of 18, 2) discussed specifics of the PUA and 3) detailed its management. Results: Thirty-one manuscripts were included, presenting data on 32 patients with a mean â€‹± â€‹standard deviation age of 46.9 â€‹± â€‹19.6 years. Ulnar artery injury mechanism included trauma (13/32, 40.6 â€‹%), iatrogenic (9/32, 28.1 â€‹%), and inherent connective tissue disease (4/32, 12.5 â€‹%), among others. Ultrasonography was the most common imaging modality (14/32, 43.7 â€‹%), and a majority (22/32, 68.8 â€‹%) of patients were managed surgically, typically via pseudoaneurysm resection â€‹± â€‹venous grafting for reconstruction. Non-operative interventions included ultrasound-guided compression therapy and thrombin injection. Conclusion: While PUA are infrequently diagnosed, inciting events such as accidental or iatrogenic trauma continue to be documented, and management guidelines are lacking. Duplex ultrasonography is recommended as the first line imaging study, with subsequent Allen Test to assess for ulnar artery vs. mixed dominance for hand perfusion. A pseudoaneurysm of 3 â€‹cm is proposed as a general threshold for considering intervention, with caveats for smaller lesions causing pain or neurologic symptoms. This review serves as a reference for physicians who encounter PUA.

Endovascular clot removal in small and tortuous arteries: a case series.

Acute limb ischemia (ALI) due to arterial thromboembolic occlusion is a critical emergency in vascular medicine, requiring attention for rapid diagnosis and intervention, to prevent limb loss and major amputation, which is associated with patient disability in the long term. Traditionally, surgical embolectomy has been used for the treatment of ALI. Endovascular treatment of ALI traditionally involved catheter-directed thrombolysis. This option, however, poses some limitations, including an increased risk for access site and systemic bleeding complications, especially in patients with high bleeding risk. Therefore, in the last decades, several devices have been developed and tested for the mechanical endovascular treatment of ALI. Such devices involve either rotational thrombectomy or continuous thrombus aspiration. While rotational thrombectomy is limited in rather large arteries due to the risk of dissection and perforation in arteries <3 mm, continuous thrombus aspiration can be applied in smaller vessels and tortuous anatomies. In our case series we present a minimal-invasive endovascular approach for the treatment of two patients with ALI due to thrombotic occlusion of tortious and small diameter arteries. Minimal-invasive mechanical thrombectomy using the Penumbra Aspiration System emerged as a successful alternative to surgical embolectomy, enabling prompt treatment and with a short hospital stay for both patients. Our article therefore highlights the use of continuous thrombus aspiration in small diameter vessels and tortuous anatomies, which may represent a contraindication for the use of rotational thrombectomy. In addition, this technique may be applied even in patients with higher bleeding risk since additional lysis is not necessary in patients, where complete thrombus removal can be achieved by this device.

[Accurate repair of oral and maxillofacial soft tissue defects with ulnar artery flap].

Objective: To investigate the characteristics of the clinical application of ulnar artery flap in the repair of oral and maxillofacial soft tissue defects. Methods: The clinical data of 12 patients with oral and maxillofacial defects repaired with ulnar artery flap between June 2021 and July 2023 was retrospectively analyzed. Among them, 11 cases were male and 1 case was female; their ages ranged from 28 to 76 years, with a mean age of 54.8 years. The lesions were located in the lateral margin of the tongue in 3 cases, the root of the tongue in 2 cases, the base of the tongue in 4 cases, and the buccal region, upper gingiva, and lower lip in 1 case each. The pathological types were squamous cell carcinoma in 11 cases and adenoid cystic carcinoma in 1 case; according to the TNM staging of the International Union Against Cancer (UICC), there were 5 cases of T 3N 0M 0, 2 cases of T 3N 1M 0, 1 case of T 4aN 0M 0, 1 case of T 4aN 1M 0, 1 case of T 4aN 2bM 0, and 2 cases of T 4aN 2cM 0. After complete resection of the lesion, the defect ranged from 6 cm×3 cm to 8 cm×5 cm. Preoperatively, colour Doppler ultrasound was used to detect the non-dominant forearm, measure the thickness of the subcutaneous fat in the donor area, confirm and mark the ulnar artery and reflux vein, and measure the diameter of the vessels, flow velocity, and the perforator position; intraoperatively, the flap was designed, prepared, anastomosed, and positioned according to the corresponding data. The vessels were all anastommosed with one artery and two veins to form a super-reflux. After complete hemostasis, the defects were repaired with sliding flap (2 cases), direct suture (4 cases), biomembrane (2 cases), or razor thin skin graft (4 cases). Results: No vascular crisis occurred after operation, and all the flaps survived in 12 cases. Wounds in the donor site healed by first intention in 10 cases and by second intention in 2 cases. Wounds in the recipient site healed by first intention in all cases. All 12 patients were followed up 5-18 months, with an average of 11.4 months. The colour and texture of the flap were normal. The function of hand and upper limb was evaluated according to the trial standard of upper limb function assessment of the Chinese Society of Hand Surgery of the Chinese Medical Association, and the score was 65-81 (mean, 71.3), and achieved excellent in 1 case and good in 11 cases. The score of Oral Health Impact Scale (OHIP) was 9-18, with an average of 14.2, and the oral function was satisfactory. During the follow-up, 1 case had local recurrence and underwent extended resection again, while the other patients had no recurrence or metastasis. Conclusion: For moderate soft tissue defects with complex oral and maxillofacial function, ulnar artery flap repair is effective.

An unreported variant of palmaris longus muscle.

Palmaris longus is a highly variable muscle of the forearm. Knowledge of its variability is of importance to plastic surgeons, hand surgeons and radiologists. During our routine dissection classes for undergraduate medical students, a peculiar palmaris longus muscle was noted in the left upper limb of an adult male cadaver. The muscle had a fleshy belly in the middle and two tendons: a proximal and distal. The distal tendon of palmaris longus gave origin to a variant fleshy slip of muscle which was inserted partly to the pisiform bone and partly merged with the hypothenar muscles. The ulnar nerve and artery passed deep to this variant fleshy slip. The ulnar artery was tortuous both proximal and distal to this slip. The distal loop of the ulnar artery was very superficial and was in the median position. Both the palmaris longus and the variant fleshy slip were innervated by median nerve.

Serial dilation to enable ulnar artery access for endovascular neurointervention: Technical report and systematic review of the literature.

BACKGROUND: For rare neuro-endovascular cases in which transfemoral access is not feasible and the palmar circulation is insufficient for radial artery access, ulnar artery access may be considered. MATERIALS AND METHODS: Mechanical thrombectomy via ulnar artery access was performed to preserve the dominant radial artery. The ulnar artery was serial dilated to 7-French with microdilator. Angiography was performed using a diagnostic catheter. The sheath was exchanged for a guide catheter, and a triaxial system was inserted. A mechanical thrombectomy was performed. The systematic literature review included all studies pertaining to techniques for ulnar artery access for neurointervention in the last 20 years (2003-2023) published in the PubMed, Web of Science, and Embase databases. RESULTS: 67-year-old male developed left MCA syndrome in the setting of an infected abdominal aortic endograft. A transfemoral approach was ruled out due to concern for crossing the infected endograft. Allen test and ultrasound demonstrated that the right radial artery was of adequate size for access, but the ulnar artery was insufficient to support the palmar arch. Mechanical thrombectomy resulted in TICI 3 reperfusion. Systematic review of the literature yielded 2 case series and 1 case report of transulnar neurovascular procedures. Access site complications were rare and included 3 access site hematomas and 1 ulnar artery occlusion. CONCLUSION: We report our technique of serial dilation of the ulnar artery for neuroendovascular procedures and provide a systematic review of the literature for complication avoidance in ulnar artery access.

Morphological study of superficial palmar arch and the significance in clinical operation.

BACKGROUND: The superficial palmar arch is a crucial blood supply to the palm. However, it exhibits significant variations, posing challenges in surgical procedures. Gaining a comprehensive understanding of the relationship between different types, physiological indices, and the clinical significance of the superficial palmar arch will enhance the accuracy of diagnosing and treating patients. MATERIALS AND METHODS: In this study, we dissected a total of 72 specimens, comprising 39 males and 33 females. We observed the type, length, and diameter of the superficial palmar arch and analyzed its correlation with the disease. Additionally, we conducted Doppler ultrasound measurements on 20 healthy volunteers (10 males and 10 females) and 18 patients with superficial palmar arch injury (10 males and 8 females) to assess the classification, diameter, intimal thickness, and blood flow velocity of the superficial palmar arch. We collected information on 9 male patients with finger fracture and observed the classification of the superficial palmar arch, fracture healing time, and basic function recovery time. Lastly, we analyzed rare variant specimens encountered during the anatomy process. RESULTS: In the exploration of human anatomy, there were four types of superficial palmar arch: ulnar artery arch type in 17 cases (23.61%), radial ulnar artery type in 46 cases (63.89%), ulnar artery without arch type in 6 cases (8.33%), and 3 cases (4.17%) of double arch type of radial and ulnar artery. One case non-arched type was found in imaging examination (5%). In one elderly male specimen, the hand's superficial palmar arch artery was tortuous and dilated. In addition, there was a positive correlation between the diameter and length of the superficial palmar arch (except the second common palmar digital artery in women), among which the ulnar artery and the third common palmar digital artery had the strongest correlation. Compared to healthy volunteers, patients with ulnar injury in the Radial-ulnar artery type exhibited a decrease in the diameter and blood flow velocity of the ulnar artery, as well as the second and third common palmar digital arteries. No such change was observed in patients with radial injury. Additionally, patients with ulnar injury in other types of Radial-ulnar artery also experienced a decrease in the diameter and blood flow velocity of the ulnar artery. Finger fracture patients with Ulnar artery with arch and Ulnar artery without arch had shorter fracture healing time and basic function recovery time compared to those with Radial-ulnar artery type. CONCLUSIONS: This study investigated the relationship between the classification, physiological index, and clinical significance of the superficial palmar arch at all levels. The results demonstrated that when the superficial palmar arch is damaged, it is important to consider both the classification and the site of damage, as this can potentially result in improved therapeutic outcomes. These findings provide a basis for future clinical research.

Surgical Treatment of a Giant Proximal Ulnar Artery Aneurysm Potentially Associated With Subacute Endocarditis.

Ulnar artery aneurysms (UAAs), although infrequent, pose limited challenges in terms of timely diagnosis and surgical intervention. Their intricacy lies in discerning and addressing the underlying pathology, often necessitating prolonged hospitalization. Herein, we present a case detailing a giant aneurysm located in the proximal ulnar artery, measuring 5.2 cm in diameter. The patient exhibited negative microbial cultures and non-pathological transthoracic echocardiography (TTE). Successful treatment involved aneurysmal exclusion and saphenous vein graft interposition. While the initial microbiological cultures and TTE yielded negative results, the diagnosis of endocarditis was ultimately confirmed through a subsequent transesophageal echocardiography (TEE) examination. This case report underscores the imperative for heightened clinical suspicion when confronted with upper-limb aneurysms. The diagnostic process necessitates sustained diligence for identifying the underlying pathology, a task that, in certain instances, requires prolonged hospitalization. Both microbiological cultures and TTE have exhibited diminished sensitivity in the diagnosis of infective endocarditis and should consistently be complemented by TEE.

Superficial ulnar artery diagnosed by vascular ultrasound: case report.

The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

Delayed ulnar artery pseudoaneurysm presentation after percutaneous cardiac intervention: A case report and review of the literature.

PURPOSE: Here we present a case of a 62-year-old female with a delayed ulnar artery pseudoaneurysm presentation after cardiac catheterization. CASE REPORT: A 62-year-old woman with multiple medical comorbidities including end-stage renal disease (ESRD) on hemodialysis (HD) and atrial fibrillation on tablet apixaban who presented 8 weeks after cardiac catheterization through right ulnar artery access with a pulsatile mass, pain, and tingling of her right-hand fingers. Ultrasound exam confirmed presence of ulnar artery pseudoaneurysm with >2 cm active chamber. This pseudoaneurysm was repaired via forearm exploration, evacuation of hematoma, and primary repair with non-absorbable sutures. CONCLUSION: We report a case of delayed ulnar artery pseudoaneurysm presentation following cardiac catheterization through the right ulnar artery. Open surgical repair offers a definitive addressal of ulnar artery pseudoaneurysm and removes ulnar nerve compressive neuropathy with less risk of distal embolization in patients with delayed pseudoaneurysm presentation whenever ultrasound-guided thrombin injection (UGTI) is contraindicated.

Reconstruction of the ulnar artery in Guyon's canal with an arterial graft: Anatomical study.

Ulnar artery thrombosis in Guyon's canal can lead to vascular insufficiency in the fingers. The recommended treatment is resection and reconstruction of the pathological area. A bypass may be necessary, which may be venous or arterial. Arterial bypasses have better long-term patency; however, they are a source of donor-site complications. We carried out an anatomical study on 11 upper limbs and 7 lower limbs from cadavers to identify a technically accessible arterial graft, of a diameter suitable for bypassing the ulnar artery in Guyon's canal and with acceptable scar sequelae (few predicted postoperative complications, discreet size and/or location of scar). Three grafts were considered: anterior interosseous artery, radial recurrent artery and descending genicular artery. The various grafts were dissected and harvested from cadaver specimens, then their lengths and diameters were measured. The diameter of the candidate grafts was compared to the diameter of the distal ulnar artery. The diameter of the descending genicular artery matched the ulnar artery better than the radial recurrent artery or the anterior interosseous artery (103% vs 44% and 67%, respectively). Mean graft length was 6.6 cm. The anatomical configuration of the descending genicular artery allowed Y-shaped bypasses to be performed. Harvesting this artery appears to cause little damage and allows bypasses up to 6 cm to be performed. Despite its smaller diameter making it necessary to perform a microvascular size adjustment, the anterior interosseous artery is a candidate graft because it is long enough (119 mm) and located near the surgical site. LEVEL OF EVIDENCE: V.

The Use of a Novel Chimeric Flexor Carpi Ulnaris and Ulnar Artery Flap for Elbow Coverage.

Elbow defects have a number of etiologies and present a difficult task for the reconstructive surgeon. A number of reconstructive options have been previously reported. We describe a case of a 54-year-old woman with a recurrent elbow defect secondary to prior trauma, surgical fixation, and infection. This was successfully managed with a novel chimeric flexor capri ulnaris and ulnar artery flap for coverage of the defect, which has not been previously described. This may serve as a useful guide for surgeons moving forward.

Artéria ulnar superficial diagnosticada por ultrassom vascular: relato de caso / Superficial ulnar artery diagnosed by vascular ultrasound: case report

Resumo O maior ramo da divisão terminal da artéria braquial é a artéria ulnar, que se origina após a fossa cubital. Essa artéria usualmente tem trajeto profundo aos músculos do antebraço anterior e é responsável pela vascularização da musculatura superficial e profunda da região ulnar do antebraço e hipotênar da mão, sendo a principal responsável pela formação do arco palmar superficial após o retináculo dos flexores. Reportamos uma variação anatômica após diagnóstico com ultrassom vascular na qual a artéria ulnar situava-se em posição superficial no antebraço. A ocorrência da artéria ulnar superficial é rara, porém de grande importância para clínicos, cirurgiões e profissionais de enfermagem.

Abstract The largest branch of the terminal division of the brachial artery is the ulnar artery, which arises after the cubital fossa. This artery usually has a deep path in the muscles of the anterior forearm and is responsible for vascularization of the superficial and deep musculature on the ulnar side of the forearm and hypothenar area of the hand. We report an anatomical variant diagnosed by Doppler ultrasound in which the ulnar artery had a superficial position in the forearm. Occurrence of a superficial ulnar artery is rare, but it is an important fact for clinicians, surgeons, and nursing professionals.

Superficial ulnar artery pseudoaneurysm.

The ulnar artery is the larger terminal branch of the brachial artery. It originates in the cubital fossa and is covered by the flexor muscles of the forearm. We report an anatomic variant in which the ulnar artery was in a superficial position in the forearm. Since this variant was unknown, an attempted venous puncture injured the artery, causing formation of a pseudoaneurysm.

Fistulized Pseudoaneurysm Associated with Hypothenar Hammer Syndrome to the Skin in a 12-Year-Old Patient: A Case Report.

In this case, we present a condition where the extension of the hamate hook in the Guyon canal can damage the ulnar artery or its branches, leading to the development of an aneurysm or pseudoaneurysm. The patient, a 12-year-old female, presented to our clinic with a complaint of an uncontrolled palm lump that has been growing for several months and began to bleed in a pulsatile manner after trauma. She was an amateur volleyball player who trained twice weekly for two hours. Color Doppler ultrasound examination revealed a 1.1×0.8 cm pseudoaneurysm in a branch of the ulnar artery. Aneurysmectomy and primary repair were performed. Timely diagnosis and treatment planning are crucial for ulnar artery pseudoaneurysms or aneurysms to prevent ischemic events in a later period.

Superficial brachioulnar artery in man.

The individual arterial pattern of the upper limb is considerably variable (11-24%) and relevant for intraarterial interventions performed by cardiologists, plastic and vascular surgeons, radiologists, anaesthesiologists, transplant specialists, orthopaedists and neurosurgeons. Arterial variants in the upper limb result from modifications in the maintenance and regression of the initial capillary plexus, which forms dominant arterial channels and gradually expands into the growing upper limb bud between stages 12 and 21. In this case report we present the superficial brachioulnar artery with its external diameter of 3 mm and length of 525 mm, and of relevant course in the left upper limb of a 78-year-old male Caucasian formalin-fixed cadaver. The superficial brachioulnar artery unusually started with the superior part of axillary artery, presented the following five parts: axillary, brachial, cubital, antebrachial and palmar, and was finally continuous with the superficial palmar arch. The typical ulnar artery was somewhat hypoplastic and limited to the forearm. To the best of our knowledge, this is the first report in the professional literature to describe the start of the superficial brachioulnar artery with the superior part of axillary artery. We conclude the individual arterial pattern of the upper limb to be indispensably recognised preoperatively, so as to circumvent any unwanted injuries to the superficial brachioulnar artery that is considerably large, overlies the antebrachial fascia and supplies the superficial palmar arch.

Peripheral stent-graft for the management of an ulnar artery pseudoaneurysm.

Penetrating injury can cause pseudoaneurysm which can then affect nerve compression. Although rare, penetrating injuries leading to ulnar artery pseudoaneurysm (UAP) are implicated slightly more frequently than other upper extremity arterial segments. Manual compression, thrombin injections, and surgical reconstruction are typically chosen to effect repair. Conversely, peripheral stent-graft implantation has rarely been reported as an option to exclude upper extremity pseudoaneurysm. We describe a case of a 25-year-old male who was stabbed, presented with signs of ulnar nerve compression, and in whom UAP was instead discovered and treated by stent-graft deployment.

Management of Traumatic Radial and Ulnar Artery Injuries and Risk Factors for Amputation.

INTRODUCTION: Traumatic injuries to the radial and/or ulnar arteries represent a subset of arterial injuries. In the absence of injury to both forearm arteries, treatment was historically ligation if perfusion was maintained to the hand via the uninjured vessels or adequate collateral vessels. We sought to determine management of traumatic forearm arterial injuries in 2019 and to identify risk factors for major upper extremity amputation. METHODS: The American College of Surgeons Trauma Quality Improvement Program database was queried by International Classification of Diseases 10 code for patients with traumatic radial and/or ulnar artery injuries within the year 2019. Patient demographics, Injury Severity Score, time to operating room, type of repair, outcomes, and mortality were collected. Multivariable logistic regression was used to identify risk factors for major upper extremity amputation. RESULTS: A total of 4048 patients with traumatic radial and/or ulnar artery injuries were identified. A total of 1907 radial artery operations were performed including repair (59%), ligation (29%), and interposition bypass (12%). A total of 1637 ulnar artery operations were completed including repair (67%), ligation (21%), and interposition bypass (12%). Major upper extremity amputation occurred in 0.6%. Older age (adjusted odds ratio [AOR]: 1.014, 95% confidence interval [CI]: 1.004-1.024, P = 0.0048), blunt mechanism (AOR: 2.457, 95% CI: 1.730-3.497, P < 0.0.0001), and ipsilateral radial and ulnar artery injury (AOR: 2.148, 95% CI: 1.298-3.553, P = 0.0029) were associated with major amputation. Surgical revascularization, time to operating room, fasciotomy, and compartment syndrome were not associated with major amputation, but this may be secondary to Type II error. CONCLUSIONS: In the operating room, radial and ulnar artery injuries were managed more often with restoration of flow versus ligation. Older age, blunt mechanism, and ipsilateral radial and ulnar artery injury were associated with major amputation. Amputation rate was low at 3% overall and 0.6% for amputation of the hand or a more proximal level. Upper extremity fracture, upper extremity nerve injury, and ipsilateral radial and ulnar artery injury were associated with need for revision operation.

Subcutaneous Dorsomedial Triangle of Forearm: Surgical Anatomy and Clinical Implication.

Background The purpose of the study was to provide a practical landmark for localizing the dorsal branch of the ulnar artery and nerve, to approach for microsurgical flaps, for harvesting nerve grafts and also to avoid these nerves during insertion of wrist arthroscopy portals. Material and methods Forty adult cadaveric upper limbs (20 right and 20 left) were dissected for localizing the dorsal branches of the ulnar artery and nerve. The ramification patterns of the nerve were mapped. The wrist arthroscopy portals are located radial and ulnar to the tendon of extensor carpi ulnaris at the level of the wrist joint, and their designated names are '6R & 6U', respectively. The distance of branches of the nerve from the 6U and 6R portals for wrist arthroscopy was recorded. Results The present study has delineated a subcutaneous dorsomedial triangular area in the distal forearm. The construction of this triangle uses palpable landmarks, i.e. pisiform bone, styloid process and subcutaneous border of the ulna. The measure of the sides of the triangle uses proportion rather than absolute measurements and hence is person specific. The dorsal branches of the ulnar nerve and artery are consistently given off in the triangle's upper third and middle third, respectively. Four branching patterns have been mapped, with one dominant pattern in 67.5% of limbs. In three-fourths of cases, one branch of the dorsal branch of the ulnar nerve consistently overlies the 6U portal and hence runs a higher risk of injury. Conclusion The study suggests more practical, accurate, reliable and consistent surface landmarks for the localization of the dorsal branch of the ulnar artery and nerve for reconstructive microsurgery for distal hand defects.