With careful patient selection, the antegrade homodigital neurovascular island flap is a reliable means of restoring the function of the fingertip after amputation injury with significant tissue loss. Flap survival, sensibility and mobile adjacent joint can be expected, even when performed as a secondary surgery and for patients with work-related injuries.
a b s t r a c tBackground/Purpose: Soft tissue loss over the ankle and heel is a challenging issue for reconstructive surgeons. The aim of this study is to present the technique of using sural neurocutaneous flap and analyse the results. Methods: From 2002 to 2014, 15 cases of sural flap were performed in the Department of Orthopaedics and Traumatology of United Christian Hospital, Hong Kong. All cases were handled by two hand surgeons. The outcomes and complications were reviewed retrospectively. Results: The aetiology included trauma (6 cases), neoplasm (4 cases), Achilles tendon repair wound complication (3 cases) and ulcer (2 cases). The age of patients ranged from 21 years to 82 years (average, 61.9 years). The size ranged from 12 cm 2 to 99 cm 2 . The mean follow-up period was 20 months. Eleven flaps healed successfully without significant complications. Conclusion: Sural neurocutaneous flap is a reliable flap design with constant vascular anatomy. There is minimal donor site morbidity, and no major vessels are sacrificed. It provides a durable, pain-free, functionally and aesthetically satisfying coverage for ankle and heel wounds.
a b s t r a c tMedian artery represents the persistence of part of the arterial axis of upper limb. We report a case of pseudoaneurysm formation from a palmar type median artery after a cut wrist injury. It is important to recognize this anatomical variant that can pose diagnostic difficulty in upper limb injury.
IntroductionMedian artery is a persistent part of the embryonic arterial axis of the upper limb, which normally regresses in the 2 nd embryonic month. Two types of median artery were described, namely, the palmar type and the antebrachial type. The Palmar type artery one that reaches the palm, whereas the antebrachial type median artery ends proximal to the wrist. Different complications including pronator syndrome, carpal tunnel syndrome, and compression of the anterior interosseous nerve and inadvertent cannulation of a median artery of a 1-year-old child 1 were reported.
Case ReportA 35-year-old man had a history of schizophrenia, presented with a volar left wrist swelling for 1 month in August 2006. He had a superficial cut injury of his left wrist with a cutter 1 month ago left untreated.On admission, physical examination showed a 1.5-cm pulsatile swelling at the volar aspect of his left wrist. Motor function and sensation were normal. Allen's tests confirmed the competence of ulnar and radial arteries.Ultrasonography confirmed the presence of a pseudoaneurysm of size 1.15 cm  0.93 cm  1.34 cm on the volar aspect of the patient's left wrist. There was active leakage of blood into the pseudoaneurysm cavity. Computed tomography angiogram (Figure 1) showed the presence of a median artery with a pseudoaneurysm arising from it. The ulnar artery appeared to be rudimentary, distal to the pseudoaneurysm.Surgical exploration (Figure 2A) confirmed the presence of a median artery. The ulnar artery lied just deep to the fascia of forearm. Palmaris longus was absent. There was a communicating branch connecting the ulnar and median arteries. The pseudoaneurysm shown in the angiogram was actually arising from the ulnar end of the communicating branch. The fingers flexors and the median nerve were intact. The pseudoaneurysm was ligated and excised with part of the adjacent ulnar artery. End-to-end anastomosis of the ulnar artery was performed without tension ( Figure 2B). The left hand circulation was good on follow up.
DiscussionThe reported incidence of palmar type of median artery ranged from 1.5% to 50%, whereas the incidence of antebrachial type ranged from 70% to 100%. The palmar type is of more clinical importance.Rodríguez-Nifedenführ et al 2 reported the incidence of palmar type median artery to be 20% in 120 cadavers. There was no significant difference in incidence between male and female as well as right and left side. Unilateral involvement was more common.The origin of palmar type median artery is most frequently located at caudal angle between the ulnar artery and the common interosseous artery. The median artery travels alongside the
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