Vascularization of the lateral and medial antebrachial cutaneous nerves by cutaneous perforator arteries: An anatomical study.

The forearm is an interesting donor site for non-vascularized nerve grafts, especially hand surgeons. Very few studies have described the use of the lateral and medial antebrachial cutaneous nerves (LABCN and MABCN, respectively) as vascularized nerve grafts (VNGs). The aim of this anatomical study was to analyze the characteristics and vascularization of these nerves to describe new potential donor sites for VNGs. Twelve forearms were dissected from fresh cadavers injected with red latex. The number of terminal branches, lengths, and proximal and distal diameters of both the LABCN and MABCN were studied. An anatomical description of the cutaneous perforator arteries from the radial and ulnar arteries that vascularized the nerve was also recorded: number of perforators, length, type of perforator (septo- or musculocutaneous), and location within the forearm (proximal, middle, and distal third). In over 80% of the specimens, the cutaneous perforator arteries from the radial and ulnar artery vascularized the LABCN and the MABCN, respectively. These arteries, found mostly in the proximal third of the forearm, had diameters >0.5mm. Most of them came from the radial and ulnar arteries (for LABCN and MABCN vascularization, respectively). In over 75% of the specimens, the nutrient arteries of both nerves also vascularized the superficial veins and the skin. We found that these nerves are vascularized by perforators arteries, which also participate in vein and skin vascularization. Altogether, this anatomical study shows that reconstructive surgeons could use new VNGs based on the perforator artery of the forearm.

Elastic retrograde intramedullary percutaneous pinning for fifth metacarpal neck fractures: A series of 32 patients.

The aim of our study was to evaluate an original surgical technique for the treatment of fifth metacarpal neck fractures: elastic retrograde intramedullary percutaneous pinning (ERIPP). From January 2014 to January 2016, patients with a fifth metacarpal neck fracture with greater than 30° volar displacement and/or clinodactyly were included. All patients underwent an ERIPP procedure. With this technique, K-wires are used as joysticks to assist reduction when the Jahss maneuver is insufficient. Clinical evaluation incorporated the DASH score, range of motion and grip strength at 3months. Radiographic evaluation comprised apex dorsal angulation and metacarpal shortening at 1month and 3months. Thirty-two patients were included in the study. All fractures were healed after a mean of 5 weeks (range 4-7). The DASH score was less than 30 for all patients, indicating an absence of disability. There were no differences in grip strength at 3months between the injured and the contralateral hand. There was less than 10° extension deficit in the metacarpophalangeal joint. In our experience, retrograde percutaneous pinning is a stable, compressive fixation method with effective reduction of displaced fifth metacarpal neck fractures. However, this result needs to be confirmed in comparative studies.

[Sentinel node detection using optonuclear probe (gamma and fluorescence) after green indocyanine and radio-isotope injections]. / Détection du ganglion sentinelle dans le cancer du sein par sonde opto-nucléaire après injection de vert indocyanine et de technétium 99m.

OBJECTIVE: Assess the biopsy's feasibility of the sentinel lymph node biopsy (SLNB) using optonuclear probe after of indocyanine green (ICG) and radio-isotope (RI) injections. METHODS: Twenty-one patients with a localized breast cancer and unsuspicious axillary nodes underwent a SLNB after both injections of ICG and radio-isotope. RESULTS: One or more SLN were identified on the 21 patients (identification rate of 100%). The median number SLN was 2 (1-3). Twenty SLN were both radio-actives and fluorescents (54.1%), 11 fluorescent only (29.7%) and 6 were only radio-actives (16.2%). Seven patients had a metastatic SLN (8 SLN overall). Among them, only one had a micrometastasic SLN, 5 others had a macrometastatic SLN and one patient had two macrometastatic SLNs. Among the 8 metastatic SLN, 5 were both fluorescent and radioactive, 2 were only fluorescent and 1 was only radioactive. CONCLUSION: Detection SLN using optonuclear probe after indocyanine green and radio-isotope injections is effective and could be, after validation by randomized trial, a reliable alternative to the blue dye injection for teams who consider that combined detection as the reference.