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2.
Plast Reconstr Surg ; 146(4): 819-829, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32970003

RESUMO

BACKGROUND: Multilevel dysvascular injury of the hand can be treated with replantation or revision amputation. The authors compared both modalities regarding functional outcomes, patient-reported outcomes, and required resources, as relevant studies are scarce. METHODS: In this retrospective review of consecutive case series (replantation, n = 8; revision amputation, n = 11), clinical results and functional outcomes (including grip strength, range of motion, sensory recovery, and grip or pinch ability) were assessed. Patient-reported outcomes, required hospital resources, and treatment cost until 1 year after surgery were compared between both groups. RESULTS: Six patients used passive prostheses, two used body-powered prostheses, and three did not use a prosthesis in the revision amputation group. All patients in the replantation group could grip objects and had restored hands, with protective sensory recovery and substantial wrist motion, whereas six patients in the revision amputation group were unable to grip or pinch objects. Replantation was associated with superior patient-reported outcomes, but required more hospital resources and treatment costs. CONCLUSIONS: This study suggests that in the treatment of multilevel dysvascular injury of the hand, the surgical method should be chosen on a case-by-case basis. For better functional and patient-reported outcomes, replantation is preferred. Revision amputation can be performed in the absence of sufficient hospital resources and to reduce treatment cost. These findings can aid in the preoperative counseling of patients with multilevel dysvascular injury of the hand. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Traumatismos da Mão/cirurgia , Mãos/irrigação sanguínea , Mãos/cirurgia , Reoperação , Reimplante/métodos , Adulto , Idoso , Amputação/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
JBJS Case Connect ; 10(3): e2000377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960013

RESUMO

CASE: A 58-year-old man presented with acute respiratory distress syndrome and coagulopathy secondary to COVID-19. He developed acute compartment syndrome (ACS) of the left hand. He underwent a bedside 10-compartment decompression of the hand with volar forearm and carpal tunnel release while in the ICU. This report adds to the scarce body of literature regarding orthopaedic complications related to COVID-19. CONCLUSION: Coagulopathy secondary to COVID-19 can be a risk factor for the development of ACS. Frequent examinations of lines, restraints, and extremities are recommended. The COVID-19 pandemic presents unique challenges, necessitating clinical adjustments to best care for patients.


Assuntos
Cateterismo Periférico/efeitos adversos , Síndromes Compartimentais/etiologia , Infecções por Coronavirus/complicações , Mãos/irrigação sanguínea , Pneumonia Viral/complicações , Betacoronavirus , Síndromes Compartimentais/cirurgia , Infecções por Coronavirus/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/terapia , /virologia
5.
Asian Cardiovasc Thorac Ann ; 28(8): 470-475, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32674585

RESUMO

BACKGROUND: Recent studies have revealed that radial artery grafts have excellent patency rates. However, harvesting of the radial artery is generally limited to the non-dominant forearm. We would like to demonstrate the effectiveness and safety of bilateral radial artery harvesting. METHODS: We enrolled 173 patients undergoing coronary artery bypass. Bilateral RA were used in 64 cases and unilateral in 109. The primary endpoint was post-harvest forearm and hand complications. RESULTS: Forearm and hand complications occurred immediately postoperatively in 28.1% of the bilateral radial artery group, significantly more than in the unilateral radial artery group (8.3%). During follow-up, no overall difference was found in post-harvest forearm and hand complications. However, the forearm and hand perception score in the bilateral radial artery group was higher: 8.78 ± 1.45 vs. 8.35 ± 0.84 in the unilateral radial artery group. Subgroup analysis in the bilateral radial artery group revealed no significant difference in forearm and hand perception score between the dominant and non-dominant donor forearms (8.78 ± 1.45 in non-dominant and 8.66 ± 1.00 in dominant forearms). The bilateral radial artery group had more arterial coronary anastomoses, longer operative times, and longer cardiopulmonary bypass times. However, a backward multiple linear regression model revealed that only two factors related to operative time, these were the number of arterial distal coronary anastomosis and cardiopulmonary bypass time. CONCLUSIONS: This study demonstrated that bilateral radial artery conduits can be used effectively and safely with no difference in persistent complications related to the hands and forearms.


Assuntos
Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Antebraço/irrigação sanguínea , Mãos/irrigação sanguínea , Artéria Radial/transplante , Coleta de Tecidos e Órgãos , Idoso , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/fisiopatologia , Feminino , Traumatismos do Antebraço/etiologia , Traumatismos da Mão/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/efeitos adversos , Resultado do Tratamento
6.
Int. j. morphol ; 38(3): 592-595, June 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1098292

RESUMO

El arco palmar superficial (APS) resulta de la unión de la arteria ulnar y la rama palmar superficial de la arteria radial. Por su convexidad nacen las arterias digitales comunes. Esta descripción es la única que distintos autores han tomado como válida, por lo que se espera encontrarla durante la disección con mayor frecuencia. Esto no ha sido verificado en nuestra experiencia. Nos proponemos llevar a cabo una revisión de la descripción del APS poniéndolo en contraposición con las disecciones realizadas. Se disecaron y analizaron 61 manos cadavéricas. Estudio del arco palmar superficial: Variante clásica del APS: 23 casos (37,7 %). Variante no clásica del APS: 15 casos (24,6 %). Tipo A: 13 casos (86,7 %). Anastomosis entre arterias ulnar y metacarpiana dorsal del primer espacio. Tipo B: 2 casos (13,3 %). Anastomosis entre arterias ulnar y satélite del nervio mediano. Ausencia del arco: 23 casos (37,7 %) Tipo A: 19 casos (82,6 %). La arteria ulnar es la única estructura en el plano del APS. Tipo B: 3 casos (13 %). La arteria ulnar y la rama palmar superficial de la arteria radial están en el plano del APS sin anastomosarse entre sí. Tipo C: 1 caso (4,4 %). La arteria ulnar y la satélite del nervio mediano están en el plano del APS sin anastomosarse. Estudio de la quinta arteria digital palmar común: La quinta arteria digital palmar común se originó de las distintas variantes en 41 casos (67,2 %). Recomendamos al momento de la disección considerar que: la variante clásica no es la más frecuente de hallar; la ausencia del arco se verifica en el mismo porcentaje que la variante clásica; incluso cuando se comprueba la presencia del APS, el porcentaje de la variante no clásica es contundente; la quinta arteria digital palmar común es una rama colateral constante del APS.


The superficial palmar arch (SPA) is formed by the union of the ulnar artery and the superficial palmar branch of the radial artery. From its convexity four branches emerge, known as the common palmar digital arteries. We propose to carry out a review of the description of the SPA in contrast to the dissections carried out. Sixty-one hands were dissected and studied. Analysis of the SPA: Classic variant of the SPA: 23 cases (37.7 %). Nonclassic variant of the SPA: 15 cases (24.6 %). Type A: 13 cases (86.7 %). Anastomosis between the ulnar artery and the first dorsal metacarpal artery. Type B: 2 cases (13.3 %). Anastomosis between the ulnar artery and the satellite artery of the median nerve. Absence of the arch: 23 cases (37.7 %) Type A: 19 cases (82.6 %). The ulnar artery is the only one present in the plane of the SPA. Type B: 3 cases (13 %). The ulnar artery and the superficial palmar branch of the radial artery are in the plane of the superficial palmar arch, there is no anastomosis between them. Type C: 1 case (4.4 %). The ulnar artery and the satellite artery for the median nerve are in the plane of the SPA, there is no anastomosis between them. Analysis of the fifth common palmar digital artery: The fifth common palmar digital artery originates from the different variants in 41 cases (67.2 %). Based on the results, we recommend at the time of dissecting consider that: The classic variant is not the most frequent to find. The absence of the arch is verified in the same percentage rate as the classic variant. Even when the SPA is present, the percentage rate of the non-classic variant is significant. The fifth common palmar digital artery is a constant collateral branch of the superficial palmar arch.


Assuntos
Humanos , Masculino , Feminino , Adulto , Artéria Ulnar/anatomia & histologia , Mãos/irrigação sanguínea , Artéria Radial/anatomia & histologia , Variação Anatômica
7.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(3): 167-176, mayo-jun. 2020. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196337

RESUMO

ANTECEDENTES Y OBJETIVO: La anatomía vascular de la mano ya ha sido ampliamente descrita a nivel macroscópico. Sin embargo, existen muy pocos trabajos que estudien el patrón de normalidad de la vascularización in vivo y describan y analicen las arterias principales de la mano. El objetivo de este trabajo es realizar un estudio que sirva de referencia para los valores normales de tamaño y flujo de la arteria radial y ulnar a nivel de la muñeca y de las arterias digitales radiales y ulnares a nivel de los dedos. MATERIAL Y MÉTODO: Estudio descriptivo observacional de corte trasversal sobre 200 manos en 100 voluntarios sanos entre 20-30 años. Se realizó ecografía Doppler-color de las arterias ulnar y radial en la muñeca, así como de las arterias digitales radial y ulnar de cada dedo. Una vez tomadas las medidas se llevó a cabo un análisis comparativo de forma general y también teniendo en cuenta la lateralidad, la dominancia y el género. RESULTADOS: Se observó que existe un mayor tamaño de la arteria radial sobre la ulnar a nivel de la muñeca; sin embargo, es la arteria ulnar la que presentó dominancia de flujo a este nivel. A nivel de los dedos, en los tres primeros fue la arteria digital ulnar la que presentó un mayor tamaño y mayor flujo. No obstante, en el cuarto y quinto dedos fue la arteria digital radial la que presentó un mayor tamaño y dominancia de flujo. CONCLUSIÓN: Ha quedado confirmado que la dominancia de flujo, pero no de tamaño, a nivel de la muñeca es de la arteria ulnar. A nivel de los dedos, existe un mayor tamaño y flujo de las arterias en las zonas de los dedos más protegidas de las lesiones (arteria digital ulnar en los tres primeros y radial en el cuarto y quinto)


BACKGROUND AND AIM: The vascular anatomy of the hand has already been widely described macroscopically. However, there are very few papers that study the pattern of normality of in vivo vascularisation that describe and analyse the main arteries of the hand. The aim of this paper was to carry out a study to serve as a reference for the normal values of size and flow of the radial and ulnar artery at the level of the wrist, and the digital radial and ulnar arteries at the level of the fingers. MATERIAL AND METHOD: A descriptive observational cross-sectional study on 200 hands in 100 healthy volunteers aged between 20-30 years. Doppler-colour ultrasound was performed on the ulnar and radial arteries in the wrist, as well as on the radial and ulnar digital arteries in each finger. Once the measurements had been taken, a general comparative analysis was performed also taking laterality, dominance and gender into account. RESULTS: It was observed that the radial artery is larger in size than the ulnar at wrist level, however, it was the ulnar artery that showed flow dominance at this level. At finger level, the arteries are greater in size and flow in the areas of the fingers more protected from injury (digital ulnar artery in the first three and radial artery in the fourth and fifth digits)


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Mãos/anatomia & histologia , Mãos/irrigação sanguínea , Artéria Radial/anatomia & histologia , Artéria Ulnar/anatomia & histologia , Estudos Transversais
8.
Ann Vasc Surg ; 68: 569.e9-569.e11, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32278874

RESUMO

BACKGROUND: Vascular malformations of the hand are rare vascular malformations that are challenging to treat. METHODS: We present a case of a large vascular malformation with left hand pain and decreased sensation of the small and ring fingers. The lesion was treated operatively with surgical excision. RESULTS: The malformation was successfully removed surgically, and pain resolved and numbness recovered by 2 weeks after surgery. CONCLUSIONS: This is a rare case of large vascular malformation in the hand with compromised neurologic status. Surgical treatment provided complete relief of the disease, and the patient returned to normal daily activities.


Assuntos
Mãos/irrigação sanguínea , Mãos/inervação , Síndromes de Compressão Nervosa/etiologia , Nervo Ulnar/fisiopatologia , Malformações Vasculares/complicações , Feminino , Humanos , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico , Síndromes de Compressão Nervosa/fisiopatologia , Recuperação de Função Fisiológica , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/cirurgia
10.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041760

RESUMO

A 50-year-old woman with a history of Crohn's disease treated with adalimumab presented with left hand pain and duskiness. Angiogram showed non-filling of the radial and digital arteries of the hand. Antiphospholipid antibody testing was positive, leading to a diagnosis of antitumour necrosis factor-induced antiphospholipid syndrome. Adalimumab was discontinued, and she was treated with the vitamin K antagonist warfarin and low-dose aspirin. Upon resolution of the antiphospholipid antibodies, she was transitioned to aspirin alone without recurrence of thrombosis.


Assuntos
Adalimumab/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Síndrome Antifosfolipídica/induzido quimicamente , Mãos/irrigação sanguínea , Isquemia/induzido quimicamente , Doenças Vasculares Periféricas/induzido quimicamente , Aspirina/uso terapêutico , Doença de Crohn/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Varfarina/uso terapêutico
11.
Int. j. morphol ; 38(1): 109-113, Feb. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1056406

RESUMO

Se estudió el arco venoso dorsal de la mano (AVD) en una muestra de la población de Bucaramanga en 54 mujeres y 50 hombres. Las variables estudiadas en el AVD fueron: número de venas que lo forman, número de venas que recorren su interior, presencia de una vena que forme su parte lateral y medial, conformación cerrada o discontinua del AVD, si la vena metacarpiana del primer dedo se unía al AVD y contribuía a la formación de la vena cefálica, si la vena metacarpiana del quinto dedo se unía al AVD y contribuía a la formación de la vena basílica. También se revisó la concordancia entre la vena que escogían dos observadores independientes, como la más adecuada para venopunción. La comparación con los textos clásicos de anatomía evidenció concordancia en que cerca de la cabeza de los metacarpianos se forman venas metacarpianas dorsales, pero, no siempre estas venas se unen de forma completa para formar un "arco venoso cerrado" como lo describen los esquemas de la mayoría de los autores. Sólo un 41,8 % fueron AVD cerrados. Las venas metacarpianas del primer y del quinto dedo se unieron al AVD en un 44,23 % y un 89,42 % respectivamente. Este dato, sumado al hecho de que en el primer y quinto dedos pueden existir más de una vena que drene su sangre, las cuales no siempre se unen al AVD, ayudan a explicar la razón de porqué en otros estudios se describe ausencia de venas cefálica o basílica o presencia de varias venas cefálicas que permiten la formación de ciertos patrones de la fosa cubital. Se encontró concordancia del 78,85 % en cuanto a la vena escogida para posible venopunción y en el análisis bivariado, hubo asociación estadística de esta concordancia al cruzarla con el número de venas que recorren el interior del AVD.


The dorsal venous arch of the hand (AVD) was studied in a sample of the Bucaramanga population of 54 women and 50 men. The variables studied in the AVD were: Number of veins that form it, number of veins that run through its interior, presence of a vein that forms its lateral and medial part, closed or discontinuous conformation of the AVD, if the metacarpal vein of the first finger joined the AVD and contributed to the formation of the cephalic vein, if the metacarpal vein of the fifth finger joined the ADL and contributed to the formation of the basilic vein. The concordance between the vein chosen by two independent observers was also reviewed, as the most suitable for venipuncture. The comparison with the classic anatomy texts showed concordance in which dorsal metacarpal veins are formed near the metacarpal head, but these veins do not always unite completely to form a "closed venous arch" as described in metacarpal diagrams by most authors. Only 41.8 % were closed AVD. The metacarpal veins of the first and fifth toes joined the AVD in 44.23 % and 89.42 % respectively. This fact, in addition that in the first and fifth fingers, there may be more than one vein draining the blood, which do not always bind to the AVD, helps explain the reason other studies describe absence of cephalic veins, basilica or presence of several cephalic veins that allow the formation of certain patterns of the cubital fossa. There was 78.85 % agreement regarding the vein chosen for possible venipuncture and in the bivariate analysis, there was a statistical association of this concordance when crossing it with the number of veins that run through the interior of the AVD.


Assuntos
Humanos , Masculino , Feminino , Veias/anatomia & histologia , Mãos/irrigação sanguínea , Punções , Estudos Transversais , Colômbia
12.
Forensic Sci Int ; 307: 110115, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31918164

RESUMO

INTRODUCTION: In a case of child pornography, only the dorsum of the offender's hand was clearly visible. After identification of a suspect, the question arose of whether and how it is possible to identify or exclude the suspect as perpetrator according to the morphology of the hand vein pattern. MATERIAL AND METHODS: A simple approach to use the hand vein pattern in crime suspects as a tool for identification was tested. In this study, the hand vein patterns of 30 study participants were analysed from conventional frames on videography. A standardised grid system consisting of six lines and four sectors was applied on the dorsum of the hands. Vein branchings within the sectors and line crossings of the veins were counted, leading to a total of 11 variables for each hand. RESULTS: A positive identification of each of the 30 test participants was possible for each hand when taking only the first five variables into account. A random overlapping prediction was obtained by statistically simulating hand vein patterns of different numbers of persons using this sample. Considering the hand vein frequencies in this sample, the results indicate that the chance for two persons having the same pattern is smaller than 1:1000. CONCLUSIONS: It can be concluded that the introduced grid system approach can be an appropriate simple and non-costly tool for the analysis of the pattern of hand veins for identification purposes.


Assuntos
Mãos/irrigação sanguínea , Processamento de Imagem Assistida por Computador , Reconhecimento Automatizado de Padrão , Veias/anatomia & histologia , Gravação em Vídeo , Adulto , Idoso , Criança , Bem-Estar da Criança/legislação & jurisprudência , Literatura Erótica/legislação & jurisprudência , Feminino , Ciências Forenses/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
16.
Ann Vasc Surg ; 65: 33-39, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31726202

RESUMO

BACKGROUND: There is no currently accepted standard in safety evaluation for radial artery intervention. We sought to compare the accuracy of various subjective and objective screening techniques in predicting safety for radial artery intervention. METHODS: Fifty-four patients in a prospective cohort study at a single institution underwent subjective Allen's test, objective Barbeau test, and several objective hand ultrasound techniques to assess safety for radial artery intervention. These results were then compared to the gold standard of conventional hand angiography to document complete palmar arch. Statistical analysis including sensitivity, specificity, positive predictive values, negative predictive values, and accuracy were calculated. RESULTS: Compared to hand angiography, the subjective Allen's test and the objective Princeps Pollicis Artery ultrasound demonstrated the comparable levels of sensitivity (100% vs. 96.7%, respectively), specificity (100% vs. 100%, respectively), and accuracy (97.2% vs. 97.1%, respectively). The objective Barbeau test demonstrated similar results (sensitivity of 100%, accuracy of 98.2%) with the exception of a lower specificity (50%). CONCLUSIONS: There is no currently accepted standard in safety evaluation for radial artery intervention. However, preliminary data suggest that certain subjective and objective techniques such as Allen's testing, Princeps Pollicis artery ultrasound, and Barbeau testing are comparable options in predicting palmar arch patency.


Assuntos
Angiografia , Cateterismo Periférico , Mãos/irrigação sanguínea , Artéria Radial/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Periférico/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Punções , Reprodutibilidade dos Testes , Grau de Desobstrução Vascular , Adulto Jovem
17.
Surg Oncol ; 32: 49-56, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31751819

RESUMO

Reconstruction of scalp defects can be performed with local flaps for medium to large defects (2-25 cm2) and microvascular free flaps for extensive full-thickness scalp reconstruction greater than 25 cm2. Doppler flowmetry with its ability to exactly mark the course of arteries on the overlying skin, is a useful tool for the surgical planning of large local flaps. In our retrospective study conducted on 38 patients (all patients had malignancies or post-traumatic scalp defects), consisting of 39 total surgical procedures, we studied the impact of doppler ultrasonic flowmetry in the surgical planning for pedicled flaps in extensive full-thickness scalp reconstruction (>25 cm2) by evaluating overall flap survival rate. Nine different types of local flaps were employed in the scalp reconstruction: Superficial temporal artery (STA) pedicled rotation flap, STA pedicled transposition flap, STA islanded flap, bipedicled STA flap, bipedicled fronto-occipital flap, Supraorbital/Supratrochlear artery rotation flap, Supraorbital/Supratrochlear artery transposition flap, Occipital artery (OA) pedicled rotation flap, OA pedicled transposition flap. Before each surgical procedure a hand held doppler Huntleigh Diagnostic flowmeter with a 8 MHz probe was used to identify and follow the course of the arteries. Flap survival rate was 100%. No postoperative complications related to the flap were reported, while in two patients a partial skin graft failure occurred.


Assuntos
Mãos/irrigação sanguínea , Fluxometria por Laser-Doppler/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Cutâneas/patologia , Taxa de Sobrevida
19.
Surg Radiol Anat ; 42(3): 269-276, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31811352

RESUMO

PURPOSE: Soft-tissue defects of the thumb and index finger remain a challenge for plastic surgeons. Our purpose was to observe the morphological characteristics of the cutaneous vessels in the first web, to design a dorsal perforator flap based on the palmar artery in the first web and to propose its clinical application. METHODS: Thirty preserved hand specimens were dissected to observe the origin, course, branch and anastomosis of the dorsal perforators in the first web, and the dorsal perforator flap based on the palmar artery in the first web was designed. Clinically, seven cases of hand defects were reconstructed using this flap. RESULTS: The blood supply for the dorsum of the first web comprised the dorsal perforators from both the dorsal artery (the branch of the first dorsal metacarpal artery) and palmar artery (the radial palmar digital artery of the index finger and the ulnar palmar digital artery of the thumb). The first dorsal metacarpal artery constantly arose from the radial artery and was divided into the radial, ulnar and medial branches. The palmar artery sent out 1-2 perforators and formed a constant anastomosis with the medial branch of the first dorsal metacarpal artery to supply the dorsal skin of the first web. In clinical application, all the flaps survived completely without contracture of the first web or other complications and the donor regions all healed at the first stage. CONCLUSION: The dorsal perforator flap based on the palmar artery in the first web is useful to repair soft-tissue defects of the thumb, the proximal phalanx of the index finger and thenar region, leading to a satisfactory appearance and good functional and sensory recovery.


Assuntos
Traumatismos dos Dedos/cirurgia , Mãos/irrigação sanguínea , Retalho Perfurante/irrigação sanguínea , Artéria Radial/anatomia & histologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Cadáver , Sobrevivência de Enxerto , Mãos/cirurgia , Humanos , Retalho Perfurante/transplante , Artéria Radial/transplante , Resultado do Tratamento
20.
J Vasc Access ; 21(5): 790-794, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31686621

RESUMO

A radiocephalic arteriovenous fistula in the anatomical snuffbox (tabatière region) was first described in 1969 as the most peripheral site for arteriovenous fistula in the upper limb. In cases in which the internal diameter of the first dorsal metacarpal vein under avascularization is ⩾2.0 mm, we have adopted a new operative technique for creating a radial artery-first dorsal metacarpal vein arteriovenous fistula in the first interdigital space of the dorsal hand, which lies between the thumb and the index finger. This technique is the creation of the arteriovenous fistula using the first dorsal metacarpal vein and the most peripheral site in the upper limb. To our knowledge, no previous report has described the creation of a radial artery-first dorsal metacarpal vein arteriovenous fistula. We herein describe the steps of the technique and report its successful performance in a patient with chronic renal failure.


Assuntos
Derivação Arteriovenosa Cirúrgica , Mãos/irrigação sanguínea , Falência Renal Crônica/terapia , Ossos Metacarpais/irrigação sanguínea , Artéria Radial/cirurgia , Diálise Renal , Veias/cirurgia , Idoso , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Masculino , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Resultado do Tratamento , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
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