Background: The aim of this study was to clarify the arterial supply of the skin covering the prominent part of the thenar eminence in order to (Folia Morphol 2017; 76, 2: 232-238)
Knowledge of the SPB dominance, and existence of anastomotic vessels in its field of supply are of importance to avoid the risk of possible ischemic sequelae in the hand associated with harvesting the RA.
Kratak sadržaj Uvod. Uspješnost izvođenja vaskularnih rekonstrukcija, naročito velikih abdominalnih i torakalnih krvnih sudova, nije promijenila stavove većine onkoloških hirurga koji smatraju da je tumorska invazija vaskularnih struk-tura relativna kontraindikacija za uklanjanje tumora. Cilj rada je pokazati da operacije retroperitonealnih tumora koji su u koliziji sa velikim krvnim sudovima imaju prihvatljiv perioperativni morbiditet i mortalitet u ranom postoperativnom toku i zadovoljavajuće udaljene rezultate. Metode. Rad predstavlja prospektivnu studiju koja obuhvata 46 bolesnika (31 muškarac) starosti između 29 i 84 godina (prosječna starost 58 godina) kod kojih je urađena resekcija i rekonstrukcija visceralnih krvnih sudova retroperitoneuma, tokom hirurške resekcije primarnih i sekundarnih tumora retroperitoneuma. Glavni rezultati mjerenja u ovoj studiji su rani (<30 dana) morbiditet i mortalitet, kasni (>30 dana) vaskularni morbiditet i mortalitet, primarna prohodnost vaskularne rekonstrukcije i preživljavanje. Rezultati. Resekcija donje šuplje vene sa rekonstrukcijom PTFE graftom izvedena је kod 4 bolesnika, а aortna resekcija sa rekonstrukcijom graftom kod 2 bolesnika. Rekonstrukcija portne vene bila je izvedena tokom resekcije neoplazmi pankreasa i neoplazme jetre u 3 bolesnika. Resekcija i rekonstruk-cija gornje mezenterične arterije kod 2 bolesnika, zajedničke ilijačne arterije kod 2, zajedničke ilijačne vene u 3 bolesnika. Lijenalna, femoralna i donja mezenterična arterija rekonstruisane su kod 3 bolesnika. Tridesetodnevni mortalitet bio je 8,7% (4 bolesnika). Opšti tridesetodnevni morbiditet bio je 17,39%, dok rani vaskularni morbiditet uključuje krvarenje na arterijskoj ili venskoj anastomozi kod 2 bolesnika i ranu trombozu vaskularnog grafta kod 2 bolesnika. Primarna prohodnost vaskularne rekonstrukcije za 12 mjeseci bila je 80%, a preživljavanje 56,5%. Tokom perioda praćenja 26 bolesnika je bilo živo, bez recidiva osnovne bolesti. Kumulativna stopa preživljavanja bila je 64,3% i 48,2% za 1 i 3 godine. Zaključak. Istovremene rekonstruktivne vaskularne procedure dozvoljavaju resekciju tumora koji zahvataju vaskularne strukture sa prihvatljivim ranim i kasnim morbiditetom i mortalitetom. Ključne riječi: retroperitonealni tumor, tumorska invazija, krvni sudovi, vaskularna rekonstrukcija Adresa autora: Doc. dr Radmil Marić Studentska 7 b 73300 Foča rmaricr@yahoo.com
<p><strong>Introduction.</strong> The hypothenar&rsquo;s skin is nourished by perforant cutaneous branches which pass across muscle, fascia and palmar aponeurosis. The aim of this work was determination of anatomic characteristics of vascular cutaneous territory of hypotenars as the basis for raising the flaps for the purpose of reconstruction of the defects on the hand. <strong>Methods.</strong> Micro morphological and morphometric researches have been done on 30 hands of cadavers of both sexes without pathological changes on the blood vessels of the hand. We selectively injected 10% dissolved douche gelatin in two colors into blood vessels of 10 hands . By injecting metyl-metacrylate into the arterial system of 20 hands and by corrosion in 40% solution KOH, we got plastic castings of the arterial network that we have used as the basis for all measures and space analyses in our research. <strong>Results.</strong> The trunk of the ulnar artery gives 3-6 cutaneous branches, average 4.1+/- 1.07, and their diameter was about 0.40 to 0.85 mm. Ulnar palmar digital artery of the little finger gives 5 to 9 cutaneous branches, average 7.6. Their diameter was from 0.35 to 0.70 mm. Superficial branch of deep palmar branch of the ulnar artery gives sprigs that vascularize the hypotenar&rsquo;s skin, and they reach the skin through abductor digiti minimi muscle and flexor digiti minimi brevis muscle. That one gives from 2 to5 perforators for the skin of approximately half of the hypotenars, on average 3.70. Their diameter was from 0.25 to 0.70 mm. Cutaneous branches of the superficial palmar arch were reaching either through palmar aponeurosis or by its ulnar border in order to vascularize the radial border of the hypotenar eminence. <strong>Conclusion.</strong> Hypotenar&rsquo;s skin is nourished by perforant cutaneous of ulnar artery trunk branches, ulnar palmar digital artery of the little finger, deep palmar branch of the ulnar artery and superficial palmar arch. Cutaneous branches of these arteries establish anasthomosises at all levels.</p>
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