Glomangiosarcoma of the hypothenar eminence: a case report.

Glomangiosarcoma is an exceptionally rare soft tissue tumor. It tends to appear as a painful nodule located in the subcutaneous tissue. There are only two cases described on the hand before instead of the benign glomus tumor is usually located at this level. Histochemically the glomangiosarcoma shows features that remind a benign glomus tumor, except for the malignant glomus tumor arising de novo. This neoplasm is considered a low grade malignant tumor with tendency to local recurrence, though metastasis have been reported. We report the case of a 36 year-old -woman with a glomangiosarcoma in a glomus tumor in the hypotenar eminence. The treatment was a local complete excision and there was no signs of recurrence after 18 months.

Selección de vasos receptores en reconstrucción microquirúrgica de cabeza y cuello. Análisis en 156 colgajos libres / Recipient vessel selection in head and neck microsurgical reconstruction. Study of 156 free flaps

El éxito de una reconstrucción microquirúrgica se subordina a una adecuada planificación. Escoger adecuadamente los vasos que nutrirán nuestro colgajo libre es primordial. Para este trabajo seleccionamos 150 pacientes en los que se realizaron 156 colgajos libres en el área de cabeza y cuello. La proporción varón/mujer fue de 5:1 y la edad media de 56 años. La etiología más frecuente del defecto fue tumoral. Cincuenta colgajos se realizaron de forma inmediata al defecto (33.3%) y en 100 casos (66.6%) de forma secundaria. La arteria receptora más usada fue la tiroidea superior seguida de la facial. Se suturaron un total de 223 venas; la más frecuente fue la vena facial seguida de la yugular externa. Se realizaron, asímismo, 4 injertos venosos y 2 transposiciones de vena cefálica. La tasa global de supervivencia fue del 93%. Hubo 11 necrosis totales, 3 (1.9%) necrosis parciales y 3 (1.9%) muertes postoperatorias en el hospital (AU)

The success of a microsurgical reconstruction is subordinated to an appropriate planning. Recipient vessel selection of our free flap is primordial. For this work we select 150 patients who underwent 156 free flaps for head and neck reconstruction. The proportion male/female was of 5:1 with an average age of 56 years. Tumoral defects are the most common etiology. Fifty (33.3%) free flaps were performed inmediately and 100 (66.6%) were performed secondarily. Recipient artery selection in order of frequency included the superior thyroid artery followed by the facial artery. We performed 223 venous anastomosis; end-to-end anastomosis to the facial vein and external yugular vein was the most common method of venous revascularization. Four flaps required an interposition vein graft and we performed two cephalic vein transpositions. The overall success rate was of 93%. Eleven flaps failed and there were 3 cases (1.9%) of partial free flap necrosis. Three patients (1.9%) died postoperatively in the hospital (AU)

Reconstrucción de la zona Donante del Colgajo de Antebrazo Libre radial mednate Colgajo de avance – rotación cubita / Reconstruction of the Radial Forearm Free Flap with Ulnar Rotation

En la clínica diaria, ha sido criticado en muchas ocasiones por las potenciales complicaciones de su zona donante. Estas son: fallo del injerto de piel, retardo de cicatrización, exposiciones y adherencias tendinosas. Describimos un método rápido y seguro para el cierre del defecto con un colgajo cubital de avance ­ rotación. Lo hemos usado en 9 pacientes, sobre 66 colgajos radiales realizados, para reconstrucción faringoesofágica, postmaxilectomía y paladar. En todos los casos los tendones flexores en la muñeca han sido satisfactoriamente cubiertos. Gracias a la movilización precoz que permite esta técnica, no ha habido rigideces ni adherencias tendinosas, con balance articular normal en todos los pacientes. Como complicaciones puede haber linfedema temporal y alteraciones sensitivas en la superficie volar de antebrazo. El cierre de la zona donante del colgajo "chino" libre mediante colgajo cubital resuelve satisfactoriamente las potenciales complicaciones de rigideces, exposición tendinosa y disfunción manual que se pueden dar con otras técnicas de cobertura (AU)

Been criticized for the poor quelity of its donor site. Potencial problems include skin graft failure, deleyed wound healing, and Rendon exposure and adhesion. A quick and safe method of closure of the large donor site defect creared by the harvest of a RFFF for head and neck reconstruction is described, This flap has been used in 9 of 66 patients who underwent RFFF reconstruction of the pharyngoesophagus, posnnaxillectomy and palate. In all cases the flexor tendons at the wrist were successfully covered. All patients obtained a full range of motion in the wrist and hand without tendon adhesión. The procedure required significant skin mobilization with the potencial disadvantages of denervation of the volar forearm and temporary Iymphedema, Closure of the RFFF donar site with an ulnar rotation­advancement flap can avoid problerns of delayed healing, tendon adhesion, and wrist stiffness (AU)

Compression of the median nerve by an anomalous palmaris longus tendon: a case report.

A report on compression of the median nerve in distal forearm and wrist by an accessory muscle (the palmaris bitendinous) is described. Its position, deep to the palmaris longus, and distal insertion on the deep surface of the superficial aponeurosis were similar to palmaris profundus. Nevertheless, both its tendinous-musculo-tendinous structure and the origin from the dorsal epimysium of the palmaris longus muscle belly were unlike palmaris profundus.

[The selection of cervical vessels recipients in reconstructive surgery of head and neck with free flaps]. / Elección de vasos receptores cervicales en la cirugía reconstructiva de cabeza y cuello con colgajos libres.

One of the most important parameters for success in free tissue transfer to the head and neck are a proper and careful recipient vessel dissection and meticulous vascular microanastomotic technique. The principle that govern vessel positioning in the head and neck are more complex than those used in extremity free flap transfers. In this report the vascular selection as well as technical details are discussed, based on the literature data and our own experience in 20 patients.