ObjectiveDemonstrate that the tendon of palmar long can be estimated in relation to its length and width before using it as a graft in surgical procedure.MethodsThere were examined 60 forearms of 30 corpses of black ethnicity; measure the length and width of the tendon of the palmaris longus muscle and compared the length of the forearm.ResultsThere are notes their absence unilateral right in two female corpses. The medium length and width were more or less respectively 11.9, 15.2 mm and 4.1 + 1.5 mm. The total average forearm length of 275.4 was more or less 17.9 mm.ConclusionThere is a significant relationship between the length of the tendon and the length of the forearm; so we can evaluate the size of the tendon of the palmaris longus muscle when it is necessary to use it for grafts. Levels of Evidence IV, Case series.

ObjectiveTo assess the homodigital flap surgical procedure, as well as the function of the finger, pain, sensation, esthetics, and patient satisfaction.MethodRetrospective analysis of records and questionnaires of patients who underwent this surgical technique between the months of May 2013 and October 2016. Eight were included in the study, with an average follow-up period of 23 months. Patients with digital pulp lesions of the thumbs and those who did not perform rehabilitation were excluded. All underwent the two-point discrimination test, the Semmes–Weinstein test, and range of motion evaluation. The age varied from 22 to 59 years (average of 32.9), six (75%) being male patients.ResultsThree patients (37.5%) had involvement of the right hand and five of the left (62.5%). Regarding the etiology, seven suffered injury and one a chemical burn. The average distance obtained from the two-point discrimination test was 7.3 mm. All patients who underwent the Semmes–Weinstein test obtained response to the purple filament. The average sum of the range of motion of the affected digit was 98.9%. The flap area was on average 294.4 mm2. The return to work averaged seven weeks. A positive Tinel sign was found in the donating area and two reported intolerance to cold. Partial or total necrosis of the flap was not observed.ConclusionThe homodigital flap technique presented satisfactory esthetics and functional results regarding feasibility, sensation, and digital mobility in pulp lesions.

Treatment of radius distal third fracture through external fixation and bone graft SUMMARYThe author presents a prospective study in which he uses the external fixation method associated with the autogenous bone graft for the management of articular and metacarpal distal radius fractures. Thirty-six patients with a mean age of 52,2 years were treated. The follow-up had an average duration of 36,2 months. The stability of the reduction and its maintenance were assured by the external fixation with the autogenous bone graft. In the patients who underwent a densitometric analysis of the bone mass, the presence of the autogenous mass showed statistically steady in the long run. With this technique the rehabilitation could be antecipated and began in the immediate postoperative period, thus favoring the mobilization. In the fourth week the external fixation device is removed, this restoring the free movement of the wrist, except for the extension which is hampered by a splint of dorsal situation for two additional weeks. In the review of the data resulting from the treatment the anatomical and functional features were considered. The anatomical findings were obtained from radiographic examinations on the patients. The analysis of these outcomes were based on the Scheck method (1962) and were graded excellent in 72% of the cases, and good in 28%, satisfactory as a whole. The data related to the function obtained were evaluated based on the Green And O'Brien system (1978) modified by Cooney et al.(1987). In the 24 th week, 14% were considered unsatisfactory and 86% satisfactory. At 12 months and in December,1999, they were considere satisfactory as a whole. The complications detected during the treatment were: pin site infections in 8,31% of the cases, and transient symptoms of post-traumatic sympathetic dystrophy in 8,33%, all of them thoroughly resolved with appropriate therapy. In 33% of the patients there were also identified signs of post-traumatic pseudoarthrosis of the ulnal styloid process which however evolved asymptomatically in all cases under review. K K K

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Resumo Objetivo Avaliar quais as condições que o cirurgião de mão no Brasil tem encontrado na prática clínica para a realização de procedimentos microvasculares. Métodos Pesquisa clínica primária prospectiva, observacional, transversal e analítica; realizada no 37° Congresso Brasileiro de Cirurgia de Mão, de 30 de março a 1 de abril de 2017, em Belo Horizonte. Por meio de aplicação de questionário a médicos do Congresso, com 12 perguntas, respostas objetivas, fechadas ou de múltipla escolha; envolveram a região geográfica, o tipo de instituição, se pública e/ou privada, seu treinamento microcirúrgico, tempo de formação, condições técnicas, presença de equipe de retaguarda para urgências e remuneração. Resultados Um total de 143 médicos foram entrevistados, 65,7% atuavam na região sudeste;13,3% na região nordeste; 11,9% na região sul; 6,3% na região centro-oeste; e 2,8% na região norte. Do total de cirurgiões, 43,4%, atuavam há < 5 anos; 16,8% de 5 a 10 anos; 23,8% de 10 a 20 anos; e 23% há > 20 anos. Do total de cirurgiões, 7,0% não tiveram treinamento em cirurgias microvasculares; 63,6% realizaram treinamento na residência médica, 30,8% em outra instituição, e 7,7%, outro país. Do total de cirurgiões, 5,6% trabalhavam em hospitais públicos, 14,7% em hospitais privados, e 76,9% em ambos. Do total de cirurgiões, 1,8% consideravam adequada a remuneração nas instituições públicas e 5,0% nas instituições privadas; 98,2% consideraram inadequadas as remunerações nas instituições públicas e 95,0% nas instituições privadas. Conclusão A maioria obteve treinamento em microcirurgia, não fazia reimplantes, considerava a remuneração inadequada, e não dispunha de equipe de sobreaviso. Há escassez e má distribuição de cirurgiões de mão com habilidade microcirúrgica nas emergências e baixo valor de reembolso.