First Experience of Plastination at 4150 Meters Above Sea Level, at the Altitude of La Paz, Bolivia / Primera Experiencia de Plastinación a 4150 Metros sobre el Nivel del Mar, en la Altura de La Paz, Bolivia

SUMMARY: Despite attempts to develop the plastination technique in Bolivia, standardized results have not yet been achieved that could be communicated via scientific publications. There is a great deal of misunderstanding around the technique, confusing it with classic techniques of inclusion in different types of resin, such as polyester and epoxy, but these protocols are not plastination. The aim of this work was to communicate the first standardized room-temperature plastination protocol with silicone in Bolivia, with the unique feature of doing so at the altitude of the city of La Paz, thus constituting the first communication of a plastination technique at 4,150 m.a.s.l. sub sede La Paz, La Paz, Bolivia.

En Bolivia, a pesar de los intentos en el desarrollo de la técnica de Plastinación, aún no se han alcanzado resultados estandarizados que pudieran ser comunicados por medio de publicaciones científicas. Existe una gran confusión al momento de desarrollar la técnica, confundiéndola con técnicas clásicas de inclusión en distintos tipos de reina, como poliéster y epoxy, pero no correspondiendo estos protocolos desarrollados a la técnica de plastinación. En este sentido, el objetivo de esta trabajo consistió en comunicar el primer protocolo estandarizado de plastinación a temperatura ambiente con silicona de Bolivia, con la particularidad de desarrollarlo en la altura de la ciudad de La Paz, constituyéndose, de esta manera, en la primera comunicación de una técnica de plastinación a 4.150 metros sobre el nivel del mar.

Nationwide Stature Estimation from Forearm Length Measurements in Montenegrin Adolescents / Estimación de la Estatura a Partir de Mediciones de la Longitud del Antebrazo en Adolescentes Montenegrinos

SUMMARY: The purpose of this research is to determine a regression equation for estimation of stature from forearm length measurements. This research was carried out on 1200 subjects (604 male and 596 female) among the population of Montenegrin adolescents. The stature and forearm length measurements were taken according to the ISAK protocol, and the data were analyzed statistically. Linear regression analysis determined the prediction of forearm length on the criterion variable a body height at the significance level of p <0.05. These relations are presented in the form of scatter diagram. Thereby, we obtained the coefficient of determination, the multiple correlation coefficients, the partial correlation coefficient, the regression, t-test and standardized beta coefficient. The results of this research study confirmed that forearm length reliably predicts stature in both sexes of Montenegrin adolescents and revealed a very useful finding for physical anthropologists and experts from related fields. It was confirmed that there is a correlation between forearm length and body height (males: 31.9 %, females: 33.3 %).

El propósito de esta investigación fue determinar una ecuación de regresión para la estimación de la estatura a partir de medidas de la longitud del antebrazo. Esta investigación se llevó a cabo en 1200 sujetos (604 hombres y 596 mujeres) entre la población de adolescentes montenegrinos. Las medidas de estatura y longitud del antebrazo se tomaron de acuerdo con el protocolo ISAK y los datos se analizaron estadísticamente. El análisis de regresión lineal determinó la predicción de la longitud del antebrazo en la variable de criterio una altura del cuerpo en el nivel de significación de p <0,05. Estas relaciones se presentan en forma de diagrama de dispersión. De tal manera obtuvimos el coeficiente de determinación, los coeficientes de correlación múltiple, el coeficiente de correlación parcial, la regresión, la prueba t y el coeficiente beta estandarizado. Los resultados de este estudio confirmaron que la longitud del antebrazo predice de manera confiable la estatura en adolescentes montenegrinos de ambos sexos y reveló un hallazgo muy útil para los antropólogos físicos y expertos en áreas relacionadas. Se confirmó que existe una correlación entre la longitud del antebrazo y la altura del cuerpo (hombres: 31,9 %, mujeres: 33,3 %).

Prevalence of Palmaris Longus Muscle Agenesis Among Students Assessed Using Various Clinical Assessment Tests

Introduction: Since the lack of Palmaris Longus Muscle (PLM) has no effect on hand and wrist function, it is considered a non-essential muscle. However, its clinical relevance stems from its widespread application in reconstructive and hand surgery. In addition to gender differences, some sources assert that its absence is more prevalent in those genders who lack it in some way, that it is more prevalent when both eyes are missing, and that it is more prevalent when just one eye is present. Aim: The primary objective of this research was to find out how common PLM agenesis is among students of both genders. The secondary objective was to demonstrate that a classical test (Schaffer’s test) can be reliably compared to other tests such as Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test. Materials and Methods: The study was a cross-sectional study carried out at the MAHSA University; A total of 224 cases, comprised of 126 (56.3%) females and 98 (43.8%) males. Each participant was requested to perform five clinical tests namely, Schaeffer’s test, Thompson’s test, Mishra’s test, AIIM’s test, and the Hiz-Ediz test. Results: The frequent agenesis of the palmaris longus in the right forearm of our study with the Schaeffer’s test was (20.5%) and Thompson’s and Hiz-Ediz tests had equal percentages of agenesis (22.3%) while Mishra’s test (22.8%), and AIIMs test (29.5%) of the participants. Moreover, Thompson’s test had the highest percentage of (70.5%) compared to other tests for detecting the presence of PLM in the left forearm. The second nearest test for PLM detection was Schaeffer’s test with a percentage of (67.4%). AIIMs test was able to detect PLM in (64.3%) of the participants and Mishra’s test and Hiz-Ediz tests had close percentages of (59.4%) and (57.6%) respectively for PLM detection. Conclusion: It can be concluded that Thompson’s test had a higher percentage among the tests to detect the presence of the PLM tendon in females while Schaeffer’s test was more significant in males. Thompson’s test had the best accuracy level and the highest percentage level of agreement with Schaeffer’s test compared to the other tests.

Diagnosis and treatment of finger flexion contracture caused by forearm flexor disease / 中国修复重建外科杂志

OBJECTIVE@#To summarize the clinical characteristics, differential diagnosis, and treatment methods of finger flexion contracture caused by three kinds of forearm flexor diseases.@*METHODS@#Between December 2008 and August 2021, 17 patients with finger flexion contracture were treated, including 8 males and 9 females, aged 5-42 years, with a median of 16 years. The disease duration ranged from 1.5 months to 30 years, with a median of 13 years. The etiology included 6 cases of Volkmann's contracture, all of which were flexion deformity of the 2nd to 5th fingers, accompanied by limitation of thumb dorsiflexion in 3 cases and limitation of wrist dorsiflexion in 3 cases; 3 cases of pseudo-Volkmann's contracture, including 2 cases of flexion deformity of middle, ring, and little fingers, and 1 case of flexion deformity of ring and little fingers; 8 cases of ulnar finger flexion contracture caused by forearm flexor disease or anatomical variations, all of which were flexion deformity of middle, ring, and little fingers. Operations such as slide of flexor and pronator teres origin, excision of abnormal fibrous cord and bony prominence, and release of entrapped muscle (tendon) were performed. Hand function was evaluated according to WANG Haihua's hand function rating standard or modified Buck-Gramcko classification standard, and muscle strength was evaluated according to British Medical Research Council (MRC) muscle strength rating standard.@*RESULTS@#All patients were followed up 1-10 years (median, 1.5 years). At last follow-up, 8 patients with contracture caused by forearm flexor disease or anatomical variations and 3 patients with pseudo-Volkmann's contracture achieved excellent hand function, with muscle strength of grade M5 in 6 cases and grade M4 in 5 cases. One patient with mild Volkmann's contracture and 3 patients with moderate Volkmann's contracture without severe nerve damage had excellent hand function in 2 cases and good in 2 cases, with muscle strength of grade M5 in 1 case and grade M4 in 3 cases. Two patients with moderate or severe Volkmann's contracture had poor hand function, with 1 case of muscle strength of grade M3 and 1 case of grade M2, which improved when compared with those before operation. The overall excellent and good rate of hand function and the proportion of patients with muscle strength of grade M4 and above were 88.2% (15/17), respectively.@*CONCLUSION@#The finger flexion contracture caused by different etiology can be differentiated by analyzing the history, physical examination, radiographs, and intraoperative findings. After different surgical treatments, such as resection of contracture band, release of compressed muscle (tendon), and downward movement of flexor origin, most patients have a good outcome.

Can temporary artery catheterization extend limits of ischemia time for macroreplantation? / Cateterização temporária arterial amplia o limite de tempo de isquemia no macrorreimplante?

ABSTRACT We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries. Objective: To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results. Methods: A case-series study including all patients with a proximal wrist upper limb amputation and a cold ischemic time equal to or above six hours from 2017 to 2021. Results: In total, two surgeons operated eight patients who had experienced forearm amputation injuries. Median ischemia time totaled eight hours. All patients required additional surgeries, most commonly split-thickness skin graft or fixation revision (three patients). This study obtained five successful macroreimplantations. The mean cold ischemia time was longer in the group with successful macroreimplantations (7.4 hours) than of the unsuccessful group (9 hours). Conclusion: Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes. Level of Evidence IV, Retrospective Case Series.

RESUMO Observa-se um atraso no referenciamento dos casos para o tratamento definitivo das amputações traumáticas de membros no Brasil. Casos com amputações proximais ao punho apresentam um prazo limite para reimplante, sendo lesões que promovem risco de vida ao paciente. Objetivo: Analisar os macrorreimplantes com tempo de isquemia prolongado submetidos à cateterização temporária da artéria, para determinar a viabilidade do coto de amputação, e seus resultados. Métodos: Série de casos de todos os pacientes com amputações traumáticas proximais ao punho, cujo tempo de isquemia fria foi igual ou superior a seis horas, entre 2017 e 2021. Resultados: A amostra foi composta por oito pacientes com amputações traumáticas de antebraço operados por dois cirurgiões. O tempo médio de isquemia foi de oito horas. Todos os pacientes necessitaram de cirurgias adicionais, sendo as mais comuns o enxerto de pele ou a revisão da fixação óssea. Sucesso do macrorreimplante foi observado em cinco pacientes. O tempo médio de isquemia fria foi maior no grupo com sucesso no macrorreimplante (7,4 horas) quando comparado com o grupo sem sucesso (9 horas). Conclusão: Os macrorreimplantes necessitam de transferência imediata para serviços especializados, e, apesar de a cateterização temporária arterial auxiliar no manejo cirúrgico, a técnica parece não interferir nos resultados. Nível de Evidência IV, Série de Casos.

Development of orthopedic simulator to practice closed reduction of pediatric fractures of the middle third of forearm / Desenvolvimento de um simulador ortopédico para prática de redução incruenta de fraturas pediátricas do terço médio do antebraço

ABSTRACT In the current scenario of medical education, a trend of using models and simulators to train operational skills, especially in the practice of basic orthopedic techniques, is growing. This form of teaching allows academics to maximize learning opportunities and contributes to improving the quality of care for their future patients. However, the realistic simulation has high costs as a major limitation. Objective: To develop a low-cost orthopedic simulator for practicing pediatric forearm reduction skills in the preclinical setting. Methods: A model of an arm and forearm with a fracture in the middle third was developed. Orthopedists, residents, and medical students evaluated the simulator's ability to reproduce fracture reduction. Results: The simulator had a significantly lower cost than the others in the literature. The participants agreed that the model had a good performance, and that the manipulation was consistent with the reality of reducing closed pediatric forearm fracture. Conclusion: The results suggest that this model can be used to teach orthopedic residents and medical students the skill of closed reduction of fractures in the middle third of the forearm. Level of Evidence III, Case Control Study.

RESUMO No cenário atual de ensino médico existe uma tendência crescente do uso de modelos e simuladores para o treino de habilidades operacionais, principalmente na prática de técnicas ortopédicas básicas, que permite aos acadêmicos maximizarem as oportunidades de aprendizado e contribui para melhorar a qualidade de atendimento dos futuros pacientes atendidos. A simulação realística, no entanto, tem como grande limitação os altos custos. Objetivo: Desenvolver um simulador ortopédico de baixo custo para a prática de habilidades de redução incruenta do antebraço pediátrico no cenário pré-clínico. Métodos: Desenvolveu-se um modelo de braço e antebraço com fratura no terço médio, que foi avaliado por médicos ortopedistas, residentes e acadêmicos de medicina quanto à capacidade do simulador de reproduzir a redução da fratura. Resultados: O simulador desenvolvido teve custo significativamente inferior aos existentes na literatura. Os participantes concordaram que o modelo teve um bom desempenho e que a manipulação foi condizente com a realidade de redução de fratura incruenta do antebraço pediátrico. Conclusão: Os resultados levam a crer que esse modelo pode ser usado para ensinar a redução incruenta de fratura no terço médio do antebraço para residentes de ortopedia e acadêmicos de medicina. Nível de Evidência III, Estudo de Caso-Controle.

Radiological Criteria for Acceptable Alignment in Paediatric Mid-Shaft Forearm Fractures: A Systematic Review

@#Introduction: Forearm fractures are common in children. The remodelling capacity of growing long bones in children makes these potentially forgiving injuries, recovering with good outcomes despite minimal intervention. Clinicians rely on radiological characteristics that vary with age to guide treatment decisions and minimise adverse sequelae. The purpose of this review was to consolidate the evidence base of radiological indications for intervention in paediatric midshaft forearm fractures. Materials and methods: The preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed for this review. Citable research output reporting radiological criteria for mid-shaft forearm fractures in paediatric patients (age ≤16 years) was screened and analysed to ascertain acceptable radiological criteria for nonoperative management. Results: A total of 2,059 papers were initially identified; 14 were selected following screening. Sagittal angulation >15°, coronal angulation >10°, and/or >50% (or >1cm) translation were the most common radiological indications for intervention in children aged 0 to 10 years. For children over 10 years of age, the most common radiological indication for intervention was sagittal angulation >10°, coronal angulation >10°, and/or >50% (or >1cm) translation. Conclusion: This study revealed a scarcity of high-quality evidence to guide management and significant variation in outcome reporting throughout the published literature. Since Noonan and Price's 1998 recommendations, there has been no significant evolution in the evidence-base guided threshold for intervention in paediatric mid-shaft forearm fractures. There remains a pressing need for a robust multicentre observational study using the patient-reported outcome measurement information system (PROMIS) to address this complex and controversial area of uncertainty in paediatric trauma management.

Analysis of emergency reconstruction of forearm Gustilo III B and III C fracture with complex tissue defect: outcomes and related factors / 中华显微外科杂志

Objective:To discuss outcomes of emergency repairing for Gustilo III B and III C fractures of forearm with complicated tissue defects and the related influence factors.Methods:From January 2014 to Feburary 2022, data of 98 cases of Gustilo III B and III C fractures with large compound defects of soft tissue, blood vessel, bone, tendon or muscle from elbow to wrist were collected. Primary debridement, bone fixation, wound coverage by free flap, bone transfer(or bone cement filling) or dynamic reconstruction of muscle were completed with emergency surgery in Department of Hand and Foot Microsurgery, Xi'an Fengcheng Hospital. Postoperative follow-ups were conducted through outpatient clinic visits, telephone and WeChat reviews. Video clips, questionnaires and the latest information of patients were also analysed. Rank sum test and Chi-square test were used to examine the relationship between independent variables such as general condition, disease condition and surgical procedures of chimeric tissue transfer group and simple flap transfer group, together with dependent variables such as limb salvage, number of surgery, wound healing, function scores, and complications. P<0.05 were further included in the regression equation to discover the relationship between multiple independent variables and dependent variables. Results:Follow-up lasted for 6-96 months, with an average of 71.1 months. In the chimeric group, the limb salvage rate was at 95.1%, with an infection rate of 8.50% and an average number of surgery was 2.13±0.89. In the simple flap transfer group, the limb salvage rate was at 87.5%, with an infection rate of 15.38% and an average number of surgery was 2.62±0.64. The good rate of Anderson score was 65.3% and the average score of Disability of the Arm, Shoulder and Hand(DASH) was 32.9(0-60) points for all the patients. There were significant differences in dependent variables of limb salvage and infection rate between the 2 groups ( P<0.05). Ischemia time and method of bone fixation led to significant differences in number of surgery ( P<0.05). Methods of bone fixation and the types of flap made significant differences in wound healing ( P<0.05). Underlying disease, bonedefect, Gustilo classification and method of bone fixation all contributed to the significant differences in function score ( P<0.05 or P<0.01) . Conclusion:Emergency surgery for repair of serious injury of forearm has a relatively high limb salvage rate and good functional effects. The limb salvage rate is not correlated with independent variables such as severity of injury, Mangledextremity Severity Score (MESS) and ischemia time, while transfer of a simple flap or a chimeric flap is significantly correlated with the limb salvage rate, infection and wound healing. The severity of injury, ischemia time and bone defect are correlated with functional assessment, number of surgery and bone healing.

A randomized crossover study of elbow-forearm support and traditional shoulder sling in the treatment of shoulder subluxation after stroke / 中华物理医学与康复杂志

Objective:To compare the immediate effectiveness of elbow forearm support with that of a traditional shoulder sling in reducing glenohumeral subluxation (GHS) after a stroke.Methods:Eight stroke survivors with GHS were randomized to receive either 30 minutes of intervention of an elbow forearm support treatment or a traditional shoulder sling treatment twice within 24 hours. Their healthy and affected shoulders were X-rayed before and right after the treatment is ongoing as well as after the end of the 30 min of treatment. The vertical (VD) and horizontal (HD) distances from the lower edge of the acromion to the center of the humeral head were measured. The satisfaction of the patients and their relatives was surveyed.Results:The average VD and HD improved significantly more after wearing the elbow forearm support. Moreover, the patients and their relatives expressed greater satisfaction with the elbow forearm support.Conclusion:Either an elbow forearm support or a traditional shoulder sling will have an immediate effect in reducing shoulder subluxation, but the elbow forearm support is more effective and gives greater satisfaction.

Rehabilitación propioceptiva del síndrome de hombro doloroso / Proprioceptive rehabilitation of painful shoulder syndrome / Reabilitação proprioceptiva da síndrome do ombro doloroso

El hombro es una de las regiones anatómicas de mayor movilidad en la vida cotidiana, siendo una de las causas de consulta más frecuentes en el área de fisioterapia para su rehabilitación, pues la primera línea de acción es el tratamiento conservador del hombro; por ello, es de suma importancia conocer y evaluar el complejo articular del hombro, así como también de la región cervicotorácica, con los resultados de la valoración establecer una estrategia de tratamiento que pueden ir desde la terapia manual, el masaje terapéutico, cambios de temperatura hasta el empleo de otros agentes físicos. Paciente femenino de 42 años, con ocupación de asistente odontológica; no reporta discapacidad previa. Como antecedente médico se presenta accidente de tránsito en motocicleta sin producir fractura de hueso ni luxación, ocurrido ocho años antes de la consulta en fisiatría, la paciente tiene afectado el desarrollo de las actividades de la vida cotidiana. Recibió serie de tratamientos durante 10 sesiones, en las cuales se aplican agentes físicos, dado que anteriormente recibió tratamiento farmacológico sin resultados favorables. Se aplica protocolo de rehabilitación fundamentado en las técnicas de propiocepción y al finalizar la terapia la paciente reporta dolor leve, y mejora en la realización de actividades de la vida diaria.

The shoulder is one of the anatomical regions of greater mobility in daily life, being one of the most frequent causes of consultation in the area of physiotherapy for rehabilitation, since the first line of action is the conservative treatment of the shoulder; therefore, it is of utmost importance to know and evaluate the articular complex of the shoulder, as well as the cervicothoracic region, with the results of the assessment to establish a treatment strategy that can range from manual therapy, therapeutic massage, temperature changes to the use of other physical agents. Female patient, 42 years old, with occupation as a dental assistant; she reports no previous disability. As medical history, she had a traffic accident on a motorcycle without bone fracture or dislocation, which occurred eight years before the physiatry consultation, the patient has affected the development of activities of daily living. She received a series of treatments during 10 sessions, in which physical agents are applied, since she had previously received pharmacological treatment without favorable results. Rehabilitation protocol based on proprioception techniques is applied and at the end of therapy the patient reports mild pain and improvement in the performance of activities of daily living.

O ombro é uma das regiões anatômicas de maior mobilidade na vida diária, sendo uma das causas mais freqüentes de consulta na área de fisioterapia para reabilitação, pois a primeira linha de ação é o tratamento conservador do ombro; portanto, é extremamente importante conhecer e avaliar o complexo articular do ombro, bem como a região cervicotorácica, com os resultados da avaliação para estabelecer uma estratégia de tratamento que pode variar desde a terapia manual, massagem terapêutica, mudanças de temperatura até o uso de outros agentes físicos. Paciente do sexo feminino, 42 anos de idade, trabalhando como assistente odontológica; nenhuma deficiência anterior foi relatada. O histórico médico inclui um acidente de trânsito em uma motocicleta sem fratura ou deslocamento ósseo, que ocorreu oito anos antes da consulta ao fisiatra; as atividades de vida diária do paciente são afetadas. Ela recebeu uma série de tratamentos durante 10 sessões, nas quais foram aplicados agentes físicos, já que ela havia recebido anteriormente tratamento farmacológico sem resultados favoráveis. Um protocolo de reabilitação baseado em técnicas de propriocepção foi aplicado e ao final da terapia o paciente relatou dor leve e melhora no desempenho das atividades da vida diária.

Fístula arteriovenosa con elevación de la vena basílica. Reporte de casos / Arteriovenous fistula with basilic vein elevation. Case series

RESUMEN Las fístulas arteriovenosas (FAV) se requieren para hemodiálisis permanente. Las recomendaciones de acceso preferidas son radio cefálica, braquiocefálica, braquio-basilica con elevación o transposición y tunelización. El objetivo de este trabajo fue presentar la experiencia con la creación de FAV con vena basílica elevada. Entre junio 2017 y marzo 2020, se realizaron trece FAV braquio-basílicas con técnica de elevación de acuerdo al registro de cirugías realizadas por la Unidad, siete hombres y seis mujeres. La edad media fue 65,7 años. En el post operatorio temprano hubo hematomas de antebrazo en dos casos, infección de herida en dos casos, así como un caso de edema. En el periodo de seguimiento, tres no maduraron, y tres pacientes fallecieron; mientras que las FAV restantes aún están funcionando. En conclusión, la FAV braquio-basilica con vena elevada es una alternativa en pacientes que ya han agotado otras opciones.

ABSTRACT Arteriovenous fistula (AVF) is necessary for hemodialysis access. The preferred configurations are radial-cephalic, brachial-cephalic, and brachial-basilic with elevation or transposition and tunneling. The purpose of this study was to present our experience for creating arteriovenous fistulae using the elevation of the basilic vein technique. Between June 2017 and March 2020, thirteen brachial-basilic fistulae with elevation of the basilic vein were performed in seven male and six female subjects. Their mean age was 65.7 years. During the early post-op period, there were two cases of forearm hematoma, wound infection in two cases, and edema in one case. During the follow-up period, three fistulae did not have a good progression, and three patients died; the remaining AVFs are still working. In conclusion, brachial-basilic AVF with elevation of the basilic vein is an alternative in patients who have already exhausted other access options.

Reconstrução do antebraço com matriz dérmica acelular após excisão de neurofibroma plexiforme gigante: relato de casos / Forearm reconstruction with acellular dermal matrix after giant plexiform neurofibroma excision: case reports

Introdução: O neurinoma plexiforme gigante é um neuroectoderma e uma doença hereditária. É um tumor cutâneo incomum associado à NF1, caracterizado como um tumor benigno da bainha do nervo periférico envolvendo múltiplos fascículos nervosos. Os objetivos da reconstrução da cobertura do antebraço são proteger as estruturas que vão até o punho e a mão e evitar cicatrizes que levem à perda de movimento. Tanto o antebraço quanto a mão desempenham papéis funcionais e sociais. O manejo bem-sucedido de feridas complexas é necessário para a reabilitação funcional geral desses pacientes. Relato do Caso: Paciente do sexo feminino, 31 anos, apresentou-se na divisão de cirurgia plástica com neurofibroma plexiforme gigante no antebraço direito. Após ressecção cuidadosa, todos os tendões anteriores do antebraço foram expostos. O defeito foi coberto com Pelnac T enxertável (espessura de 3mm e tamanho 12 X 24cm2), fixados com pontos monocryl 4-0. Após 10 dias, a matriz dérmica acelular foi removida e um enxerto de malha de pele de espessura parcial foi colocado. No dia 7, a matriz dérmica acelular apresentou bons sinais de ingestão. No dia 17, observamos uma sobrevida do enxerto de 95%. No seguimento de 3 meses, a reconstrução estava estável, sem defeitos de contorno, a mão apresentava amplitude de movimento completa e o paciente não apresentava problemas nas atividades diárias. Conclusões: A matriz dérmica acelular parece ser uma opção útil na cobertura de defeitos complexos no antebraço, permitindo menor morbidade e rápida recuperação funcional.

Introduction: Giant plexiform neurinoma is a neuroectoderm and inherited disease. It is an uncommon skin tumor associated with NF1, characterized as a benign peripheral nerve sheath tumor surrounding multiple nervous fascicles. The goals of forearm coverage reconstruction are to protect the structures running to the wrist and hand and prevent scarring that leads to movement loss. Both forearm and hand play functional and social roles. Successful management of complex wounds is necessary for the overall functional rehabilitation of these patients. Case Report: A 31-year-old woman presented at the plastic surgery division with a giant plexiform neurofibroma in the right forearm. After careful resection, all anterior forearm tendons were exposed. The defect was covered with graftable Pelnac T (thickness of 3mm and sizing 12 X 24cm2), fixed with 4-0 monocryl sutures. After 10 days, the acellular dermal matrix silicone layer was removed, and a split-thickness skin meshed graft was placed. On day 7, the acellular dermal matrix showed good signs of intake. On day 17, we observed a 95% graft survival. At the 3-month follow-up, reconstruction was stable without contouring defects, the hand had full range of motion, and the patient had no problems in daily activities. Conclusions: Acellular dermal matrix appears to be a useful option in covering complex defects in the forearm, allowing for less morbidity and rapid functional recovery.

Does ulna fixation alter the outcome for distal-third forearm fractures in children? / A fixação da ulna altera o desfecho das fraturas do terço distal do antebraço?

ABSTRACT Introduction Fractures of the distal third of the forearm are common in the pediatric population. Conservative treatment of an ipsilateral fracture of the distal ulna metaphysis is one of the risk factors for loss of reduction. Percutaneous fixation of the fracture with K-wires is recommended. This study aims to evaluate the outcome of percutaneous fixation of both bones performed as the primary treatment. Materials and Methods A randomized, open, prospective, clinical trial was conducted, including skeletally immature patients who underwent surgery for fractures of the distal radius and ulna. They were randomized into two groups, one with fixation only of the radius fracture and the other with fixation of both the radius and the ulna fractures, and they were followed clinically and radiologically for up to 12 weeks postoperatively. Results Sixteen children were selected. In the intraoperative period, fluoroscopy was activated for a longer time when fixing the ulna (p = 0.011) and the surgical time was longer in this group (p = 0.014). In the postoperative evaluations, the group whose surgery involved the fixation of both bones had a lower postoperative pain score (p <0.001) and less time away from school (p <0.001). Conclusions In this study, postoperative pain and absence from school were both less when fixation of the radius and ulna was performed. Evidence Level II; Randomized Controlled Study.

RESUMO Introdução As fraturas do terço distal do antebraço são comuns na população pediátrica. O tratamento conservador da fratura ipsilateral da metáfise distal da ulna é um dos fatores de risco para a perda da redução. Recomenda-se a fixação percutânea da fratura com fios K. Este estudo tem como objetivo avaliar o resultado da fixação percutânea de ambos os ossos realizada como tratamento primário. Materiais e Métodos Foi realizado um estudo clínico randomizado, aberto e prospectivo, que incluiu pacientes com esqueleto imaturo que foram submetidos à cirurgia para fraturas da parte distal do rádio e a ulna. Os participantes foram randomizados em dois grupos, um com fixação apenas da fratura do rádio e outro com fixação das fraturas do rádio e da ulna, e foram acompanhados clínica e radiologicamente por até 12 semanas de pós-operatório. Resultados Dezesseis crianças foram selecionadas. No intraoperatório, a fluoroscopia foi ativada por mais tempo na fixação da ulna (p = 0,011) e o tempo cirúrgico foi maior nesse grupo (p = 0,014). Nas avaliações pós-operatórias, o grupo cuja cirurgia envolveu a fixação de ambos os ossos teve escore de dor menor depois da cirurgia (p < 0,001) e menos tempo de afastamento da escola (p < 0,001). Conclusões Neste estudo, a dor pós-operatória e o afastamento da escola foram menores quando se realizou fixação do rádio e da ulna. Nível de Evidência II; Estudo randomizado controlado.

Application of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection / 中华肿瘤杂志

Objective: To evaluate the effect of trifoliate flap design of radial forearm flap in reconstruction of defects after mouth floor cancer resection. Methods: From June 2016 to December 2019, 12 patients with defect after resection of mouth floor cancer were treated with trifoliate flap design of radial forearm flap. All of these patients were T2 stage, included 9 well-differentiated squamous cell carcinoma (SCC) and 3 moderate differentiated SCC. The defect size ranged from 8.0 cm×6.0 cm to 5.0 cm×4.5 cm after resection of tumor and neck dissection. All defects were repaired with trifoliate flap design of radial forearm flap. The flap size ranged from 8.0 cm×2.0 cm to 4.0 cm×1.5 cm, the donor site was sutured directly on Z plasty. Results: All flaps completely survived well. Both the wound and the donor site were stage Ⅰ healing. With the average follow-up of 38.6 months, the swallowing and speech function were satisfactory. Conclusions: Trifoliate flap design of radial forearm flap can effectively repair the postoperative defect of mouth floor cancer, and the donor site can be directly sutured on Z plasty. This technique can avoid forearm scar caused by skin grafting and the formation of the second donor site.

Efficacy of ultrasound-guided modified brachial plexus block at costoclavicular space for forearm surgery / 中华麻醉学杂志

Objective:To evaluate the efficacy of ultrasound-guided modified brachial plexus block at costoclavicular space (CCS) for forearm surgery.Methods:Eighty patients of both sexes, aged 18-75 yr, with body mass index of 18-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, scheduled for elective forearm surgery from September 2020 to May 2021 in our hospital, were randomized into 2 groups ( n=40 each) using a random number table method: single-injection control group (group C) and double-injection modified group (group T). Single-injection was performed in the anterior chamber of CCS in group C, double-injection was performed in the anterior and posterior chambers of CCS in group T, and the solution injected in both groups was a mixture (20 ml) of 1.0% lidocaine and 0.375% ropivacaine.The effect of block, onset time of block, completion time of block and duration of block for each nerve branch and anesthesia-related adverse reactions were recorded at 5, 10, 15, 20, 25 and 30 min after injection of local anesthesia. Results:Compared with group C, the rate of motor block of radial nerve at 5-20 min after injection of local anesthesia, the rate of sensory block of musculocutaneous nerve and radial nerve at 10 and 15 min after injection of local anesthesia, the rate of motor block of median nerve at 15-30 min after injection of local anesthesia and the rate of sensory and motor block of ulnar nerve at 20-30 min after injection of local anesthesia were significantly increased, and the onset time and completion time of block were shortened in group T ( P<0.05). There was no significant difference between the two groups in the duration of block and anesthesia-related adverse reactions ( P>0.05). Conclusions:Ultrasound-guided modified brachial plexus block at CCS provides better efficacy for forearm surgery.

Efficacy of radial shockwave therapy for promoting healing of delayed of forearm fractures in children with ultrasonic guidance / 中华骨科杂志

Objective:To explore the clinical effect of radial extracorporeal shockwave therapy on delayed union of forearm fractures in children with ultrasonic guidance.Methods:A retrospective analysis of information on 18 children with delayed forearm fracture union who received ultrasonic guided extracorporeal shockwave therapy from February 2018 to June 2019 was conducted. Among them, there were 14 males and 4 females; Age: 9.44±3.75 years (range, 3-15 years); All the children were closed forearm fractures, including 13 cases of ulna and 5 cases of radius. Initial fixation methods: intramedullary nails fixation in 8 cases, Kirschner wire fixation in 4 cases, steel plate fixation in 2 cases, external fixation in 2 cases, conservative treatment in 2 cases; The classification of fracture nonunion were: 14 cases of hypertrophy, 4 cases of atrophy; The course of disease was 4.0 (3.0, 6.0) months. The front and lateral X-ray films of the affected side forearm were taken before treatment, 3 months and 6 months after treatment. The scores of callus condition were performed using Lane-Sandhu X-ray scoring standard and Fernandez-Esteve X-ray evaluation standard of callus grade.Results:All children completed treatment and were followed up for 6 months. The bone healing standard was the disappearance of the fracture line shown by anterior and lateral X-ray films. Within 6 months after treatment, 11 patients got bone union. The healing rate was 61.11% (11/18). The average of Lane-Sandhu X-ray scores before treatment, 3 months and 6 months after treatment were 3.0 (1.0, 4.0), 6.0 (4.0, 8.0) and 10.0 (5.0, 12.0), respectively, there were statistically significant differences in pairwise comparisons at each time point. And the average scores of Fernandez-Esteve X-ray evaluation standard for callus grade were 1.0 (1.0, 2.0), 3.0 (2.0, 4.0), and 4.0 (3.0, 4.0), respectively, there were statistically significant differences from 3 months and 6 months after treatment to preoperative group, while there was no statistically significant difference between 3 months and 6 months after treatment. The mixed effects model analysis results showed that only the Lane Sandhu X-ray score and Fernandez Esteve X-ray standard score of callus grade at different follow-up time points were significantly different. There was no statistically significant difference in age, gender, number of shockwave treatments and interval time from the first treatment after the initial fixation.Conclusion:The radial extracorporeal shockwave therapy can effectively treat the delayed healing of forearm fractures in children; the X-ray score has been significantly improved. The treatment is highly accepted by children and their parents, and can be used as one of the methods to treat delayed healing of fractures in children in the future.

Three-dimensional analysis of the gap space under forearm casts / 中华创伤杂志(英文版)

PURPOSE@#Secondary displacement represents a frequent complication of conservative treatment of fractures, particularly of the distal radius. The gap space between skin and cast may lead to a certain degree movements and this increased mobility might favor redisplacement. The aim of this study was to develop a new 3D method, to measure the gap space in all 3 geometrical planes, and to validate this new technique in a clinical setting of distal radius fractures.@*METHODS@#This study applies 3D imaging to measure the space between plaster and skin as a potential factor of secondary displacement and therefore the failure of conservative treatment. We developed and validated a new methodology to analyze and compare different forearm casts made of plaster of Paris and fiberglass. An unpaired t-test was performed to document differences between the investigated parameters between plaster of Paris and fiberglass casts. The significance level was set at p < 0.05.@*RESULTS@#In a series of 15 cases, we found the width of the gap space to average 4 mm, being slightly inferior on the radial side. Comparing the two different casting materials, plaster of Paris and fiberglass, we found a significantly larger variance of space under casts made of the first material (p=0.39). A roughness analysis showed also a markedly significantly higher irregularity of the undersurface of plaster of Paris as compared with fiberglass.@*CONCLUSION@#This study allows for a better understanding of the nature of the "gap space" between cast and skin and will contribute to develop and improve new immobilization techniques and materials.

Emergency one-stage transfer of Flow-through chimeric anterolateral thigh perforator tissue flap in repair of Gustilo III C wrist injury of a child: A case report / 中华显微外科杂志

In September 2020, a child with open wrist fracture and severe soft tissue injury was admitted in the Department of Hand and Foot Microsurgery, Xi'an Fengcheng Hospital. In the emergency surgery, the fracture was fixed, the vascular, nerve and tendon were repaired, and Flow-through chimeric anterolateral thigh perforator tissue flap was used to cover the wound. The chimeric tissue flap and the wrist survived in first stage as well as the wound healing. At 1 year of follow-up, the flap was not bloated and the protective sensation was restored. The flexion and extension and the rotation of left wrist were good. The pinch, flexion and extension of all digits of the left hand recovered well.

Repair the large area soft tissue defect of forearm with free bilateral anterolateral thigh flaps in series / 中华显微外科杂志

Objective:To investigate the clinical effect of using free bilateral anterolateral thigh flaps(ALTF) in series to repair large area soft tissue defects of forearm.Methods:The clinical data of 11 patients with large soft tissue defects of forearm admitted in the Department of Plastic(Repair and Reconstruction) Surgery, Lishui Hospital of Zhejiang University from March 2014 to December 2021 were retrospectively analyzed, including 8 males and 3 females. Aged 36 to 68 years old, with an average of 48 years old. VSD treatment was performed after debridement, and until fresh removed 3 to 5 days after the operation. Until the wound was fresh. The wound was repaired with free bilateral ALTF in series until fresh. The size of the forearm wound was 18 cm×15 cm-28 cm×13 cm. The cut area of a single flap was 10 cm×8 cm-20 cm×13 cm. The series of bilateral flaps: One of the flaps was used as the proximal flap, and its vascular pedicle was anastomosed with the arteries and veins of the recipient area. The other flap was used as the distal flap, and the arteries and veins between the 2 ALTFs on both sides were anastomosed. The vascular pedicle beyond the distal flap was ligated or anastomosed to the distal end of the ulnar artery or the distal end of the radial artery. The flap and the surrounding skin of the recipient area were sutured immediately. The donor sites of the flap was closed directly. Periodic and regular outpatient follow-up was performed after operation and the clinical efficacy was analyzed.Results:All the flaps successfully survived after the surgery. The postoperative follow-up lasted for 6-18 months, 12 months in average. The flaps survived well with good soft texture, without swelling, the capillary reaction time was normal, without surface ulceration, in rosy colour and restored protective sensations. The hand function of the affected limb recovered well. The wound at donor sites healed well without complications. At the last follow-up, the hand function of the affected limb was evaluated by the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, the result was 7 in excellent and 4 in good. The patients were satisfied with the flap and the therapeutic effect.Conclusion:The free bilateral ALTF in series can be used to repair a wound surface with large area, and the donor site can be closed at the same time. It is an effective method to repair large soft tissue defect of forearm.

Application of posterior tibial artery perforator flap with great saphenous vein in treatment of forearm degloving injury and reconstruction of venous circulation of dorsal hand / 中华显微外科杂志

Objective:To explore the clinical application of the posterior tibial artery perforator flap with the great saphenous vein (GSV) in the treatment of severe degloving injury of the forearm.Methods:From June 2015 to October 2020, 5 patinets (4 males and 1 female, aged 20-46 years old, mean age 37 years old) were treated in the Department of Hand Surgery of Yantaishan Hospital in Yantai. Aposterior tibial artery perforator flap with GSV was used to repair the partial wound of the injured forearm, together with the establishment of venous circulation of dorsal hand for all 5 patients. All the patients suffered from severe forearm degloving injury. Of which, 3 accompanied with ulna radius fracture, 2 with ulnar and radial artery injury and 2 with blood supply insufficiency in the injured fingers. The sizes of soft-tissue defect were 26 cm×18 cm-32 cm×25 cm. The sizes of the posterior tibial artery perforator flap with GSV ranged from 12 cm×5 cm to 33 cm×6 cm. The anastomoses were performed on the perforating artery and the radial artery. The GSV was anastomosed with cephalic vein with bridging anastomosis to re-establish the venous circulation of dorsal hand. Combined anterolateral thigh flaps (ALTF) were used to repair the rest wound of injured limbs in 4 patients, and the combined pedicled abdominal flap was used in 1 patient. The donor site of calf flap was sutured directly, and the skin of upper limb was thinned into medium thick to cover the thigh flap donor site, which was packed with pressure dressing. Regular follow-up reviews were carried out by outpatient clinic, telephone, WeChat APP or home-visit after the operation to observe the survival of flaps, the swelling of the distal end of injured limb, functional recovery and healing at the donor site. Functional recovery was evaluated according to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association.Results:All the grafted flaps in 5 patients survived. Necrosis at epidermal edge occurred in 1 calf flap, and achieved secondary healing after dress changing for 4 weeks. There was neither arterial nor venous crisis in all flaps. The oedema of the hand disappeared within 4-8 weeks, with clear dermatoglyph. There was no obvious enlarged circumference of thumb and fingers. The follow-up was carried out for 8-20 months, with 11 months in average. The flaps were elastic in good colour, and full texture without pigmentation. The donor site of the calf flap showed a linear scar. No swollen was seen in the hands of the injured forearm and the feet of donor lower legs. The range of motion of phalangeal joints was good. Recovery of finger sensation achieved at S 4. The recovery of the sensation of posterior tibial artery perforator flap reached S 3 in 2 patients and S 2 in 3 patients. Assessment of the Upper Limb Function using the Standard Issued by the Hand Surgery Society of Chinese Medical Association rated excellent in 3 patients and good in 2 patients. Conclusion:The posterior tibial artery perforator flap with GSV has a reliable blood supply with a small damage to the donor site. This flap is ideal for repair of severe degloving injury of forearm and meanwhile to achieve the re-establishment of venous circulation in dorsal hand.