Rare Tumors Causing Median Nerve Compression in Adults-A Narrative Review.

The median nerve can be compressed due to a tumor along the course of the median nerve, causing typical compression symptoms or even persistence or recurrence after an operation. The aim of this review is to provide a comprehensive overview of rare tumors described in recent publications that cause median nerve compression and to evaluate treatment options. The PubMed, Embase, and Web of Science databases were searched for studies describing median nerve compression due to a tumor in adults, published from the year 2000 and written in English. From 94 studies, information of approximately 100 patients have been obtained. Results The rare tumors causing compression were in 32 patients located at the carpal tunnel, in 21 cases in the palm of the hand, and 28 proximal from the carpal tunnel. In the other cases the compression site extended over a longer trajectory. There were 37 different histological types of lesions. Complete resection of the tumor was possible in 58 cases. A total of 8 patients presented for the second time after receiving initial therapy. During follow-up, three cases of recurrence were reported with a mean follow-up period of 11 months. The most common published cause of median nerve compression is the lipofibromatous hamartoma. Besides the typical sensory and motor symptoms of median nerve compression, a thorough physical examination of the complete upper extremity is necessary to find any swelling or triggering that might raise suspicion of the presence of a tumor.

Alternative imaging technologies for perforator mapping in free flap breast reconstructive surgery - A comprehensive overview of the current literature.

BACKGROUND: The use of perforator mapping has become routine for many microsurgeons in the planning and performing of free flaps in breast reconstructions. Within this field, the number of available technologies and their quality has rapidly evolved over time. This study presents an up-to-date review on the spectrum of alternative perforator mapping modalities and the efficiency and utilization in the practice of free flap breast reconstructive surgery. METHODS: Extensive searches of the PubMed and Embase databases were performed. Articles containing free flap tissue transfer in breast reconstruction and a perforator imaging modality were included. Qualitative and descriptive analyses of the outcomes were performed, and the quality of the evidence was appraised. RESULTS: One hundred and sixty-eight articles were included. Besides the routinely used handheld Doppler, CT angiography, and MR angiography, seven alternative technologies (38 studies) have been found; color Doppler fluorescent angiography, dynamic infrared thermography, image-guided stereotaxy, template, 3D printed model, and augmented reality. The modalities were classified based on their concept of imaging as volumetric perforator imaging, real-time perforator imaging, and complementary techniques. A poor level of evidence for each alternative modality was found. CONCLUSION: An overview of alternative imaging techniques available to pre- and intraoperatively map perforator locations have been given. Several novel promising techniques have been identified, all to be used in conjunction with volumetric imaging. This overview provides a perspective on the future field of imaging in reconstructive surgery.

Anatomic Variations and Malformations as Rare Causes of Median Nerve Compression in Adults: A Narrative Review.

OBJECTIVE: The median nerve can become compressed at multiple points in the arm, causing carpal tunnel-, pronator-, anterior interosseous-, or lacertus syndrome. Anatomical variations are potential reasons of persisting or recurrent symptoms of median nerve compression and are often recognized late. The objective of this study is to provide a comprehensive list of rare anatomical variations and malformations causing median nerve compression. METHODS: A total of 62 studies describing median nerve compression due to an anatomical structure in adults published from 2000 in English were included. The findings were: 35 tenomuscular, 16 vascular causes, and 4 cases with nerve involvement. Only 1 osseous and 18 combined anomalies caused compression. In 18 cases, the anomaly was found in the proximal forearm. RESULTS: In 44 cases, the median nerve was surgical released and 35 anomalies were completely resected. Persistent or recurrent symptoms were present in 13 cases. During follow-up, 1 case of recurrence was reported.Standard operative option for median nerve compression consists of an open median nerve release. CONCLUSIONS: In case of persistent or recurrent carpal tunnel syndrome, unilateral symptoms, the presence of a palpable mass, manifestation of symptoms at young age and pain in the forearm or upper arm, the surgeon has to rule out the presence of an anatomical anomaly. Complete resection of the anomaly is not always necessary. The surgeon should be aware of potential anomalies to avoid inadvertent damage at surgery.

The inter-rater and test-retest reliability of skin thickness and skin elasticity measurements by the DermaLab Combo in healthy participants.

BACKGROUND: For several purposes, skin parameters like thickness and elasticity can be measured. However, little is known about the accuracy of those measurements. AIM: The aim of this study was to determine the intrarater and test-retest reliability of skin thickness and elasticity measurements performed with the DermaLab Combo®. METHODS: A total of 49 participants were included in this study. Skin thickness and elasticity were measured at six defined locations on the dominant arm. Measurements were repeated two times by the same observer to determine the test-retest reliability. To determine the inter-rater reliability, a second observer repeated the measurements once. RESULTS: Inter-rater and test-retest reliability for elasticity measurements fluctuates per location and per parameter: Inter-rater intraclass correlation coefficient (ICC) ranged from 0.23 to 0.80, and test-retest ICC ranged from 0.25 to 0.84. Skin thickness was measured reliable by every observer on every location, with a test-retest ICC ranging from 0.71 to 0.83 and an inter-rater ICC ranging from 0.69 to 0.80. CONCLUSION: The DermaLab Combo® showed a good inter-rater reliability when measuring skin thickness and elasticity. Not all locations are suitable for reliable inter-rater or test-retest measurements. The device is difficult to use by inexperienced users, as the echo probe is sensitive to small movements.