Palmar Branch Of Radial Artery Research Articles

Observation of the Absence of Ulnar Artery in a Patient Planned to Free Dorsoulnar Artery Perforator Flap for Finger Defect: Is Preoperative Doppler evaluation of Perforator Alone Sufficient?

Abstract Background Volar finger defects where critical structures exposed are always challenging for plastic surgeons. In these types of defects, local flaps, cross finger flaps, abdominal flaps, and free flaps are used. Free dorsoulnar artery perforator (DUAP) flaps and superficial palmar branch of radial artery (SPBRA) flaps are also used. In this case, we present a patient who was scheduled to receive a DUAP flap to address defect on the second finger of right hand; however, we repaired the defect with a SPBRA flap because intraoperative absence of the ulnar artery was observed. Materials and Methods A 34-year-old male patient was admitted with a wound that exposed the tendon and neurovascular bundle on the volar side of the second finger of the right hand. A free DUAP flap was planned for the patient. A perforator was detected during the preoperative Doppler ultrasound examination. While dissecting the perforator, we noted the absence of an ulnar artery proximal to the perforator vessel. The elevated SPBRA flap from same extremity and the defect were closed. Results Postoperative computer tomography showed an absence of the ulnar artery distal to the right antecubital region. No complications were seen in the donor and recipient areas. Long-term motor movements were natural, and the patient's quality of life was good. Conclusion Determining the perforator site using Doppler alone may not be sufficient in preoperative evaluation of patients scheduled to receive DUAP flaps. Performing an Allen test and using advanced imaging methods can prevent surgeons from encountering a bad surprise.

VARIATIONS OF THE SUPERFICIAL PALMAR ARCH: A CLINICO-ANATOMICAL CONSIDERATION

Introduction: The superficial palmar arch plays a vital role in the blood supply to the hand. The knowledge of variations in the pattern of superficial palmar arch and its branches, and caliber of these arteries, has become more important for surgeons in reconstructive hand surgeries and radial artery harvesting for myocardial revascularization. The aim of this study was to observe the variations and measure the diameter of contributing arteries of the arches. Materials and methods: In the present study, thirty hands from formalin fixed adult human cadavers were dissected. Normal pattern as well as variations in the arteries contributing to the arch, completeness of arch, and the branching pattern were observed and noted. With the help of a digital caliper, the diameters of ulnar and radial arteries and median artery were taken at the level of the wrist and statistical analysis of the results was done. Results: It was observed that in 96.7 % cases, the superficial palmar arch was complete where there was anastomosis between the arteries forming the arch. In 3.3% cases, the arch was incomplete. The complete arch was divided into radioulnar (36.7%), ulnar (56.7%) and medianoulnar (3.3%) types. The diameter of superficial palmar branch of radial artery was found to be significantly less than the diameter of ulnar artery. (p=0.003). Conclusion: The data obtained on variations and morphometry of superficial palmar arches will certainly be useful in planning and choosing appropriate and safe surgical procedures to prevent inadvertent outcome. KEY WORDS: Palmar arch, blood supply, Hand, radial artery, myocardial revascularization.

Repairing dorsal complex tissue defect of finger with flaps based on superficial palmar branch of radial artery with palmaris longus tendon

Objective To explore the clinical effects in repairing dorsal complex tissue defect of finger with the flap based on superficial palmar branch of radial artery (SPBRA) with palmaris longus tendon. Methods From May, 2011 to October, 2017, dorsal complex tissue defects of 15 fingers and thumbs in 15 patients were treated by the flaps which were based on SPBRA with palmaris longus tendon. There were 10 males and 5 females, in an average of 35.8 (19-51) years. All the defects (3 thumbs, 5 index, 2 middle and 5 ring fingers) were dorsal complex tissue defects and all had extensor tendon defects. The areas of soft tissue defect measured 2.0 cm×1.5 cm to 4.0 cm×2.0 cm. The lengths of tendon defect measured 2.0-4.0 cm. All patients received emergency surgery. The time before the surgery was 1.5-3.0 hours. The surgery time was 3.0-4.5 hours, 3.6 hours in an average. Postoperative regular follow-up. Results All of the wounds healed in stage I and all flaps survived. Texture of the flaps was soft with rosy color. No obvious swelling occurred. All the donor sites healed in stage I. The patients were followed-up for 4-18 months, 8 months in an average. The appearance and function of the repaired fingers and thumbs were satisfactory. The pain, temperature and touch sensations were good. The color of flaps was similar to the normal finger without swelling. The wear resistance of the flaps was good. Thin-line scars were in the wrist donor sites without contracture. The range of motion of active palmar flexion of the wrist was from 0° to 80° and active hyperextension was from 0° to 70°. No obvious limitation was found. Conclusion It is able to achieve a satisfactory clinical effects by using the flap that is based on SPBRA with palmaris longus tendon in repairing the dorsal complex tissue defect of hand. The advantages of the technique are that the donor site is concealed. The wound is small, and the flap is easy to be harvested and anastomosed. Key words: Superficial palmar branch of radial artery flaps; Complex tissue flaps; Palmaris longus tendons; Finger; Repair

Comparison of therapeutic efficacy between venous flap and the flap with superficial palmar branch of radial artery in reconstruction of the defect of finger with segmental defect of proper digital artery

Objective To compare the effectiveness of venous flap and the flap based on superficial palmar branch of radial artery (SPBRA) in the reconstruction of the defect of finger with segmental defect of proper digital artery. Methods From July, 2014 to March, 2018, 40 patients with soft tissue defects of finger and the proper arteries were treated by the venous flaps (18 cases, group A) and the flaps based on SPBRA (22 cases, group B). The operative time, postoperative 2-PD of the flaps, appearance, patient satisfaction, flaps donor site complications, flaps survival rate and the motion of digital joints were observed and compared by software SPSS 17.0. P<0.05 was considered statistically significant. Results Forty flaps all survived, and the wounds healed primarily. The operative time of group A was (78.89±7.36) min, which was shorter than that of group B (97.27±9.26) min, with statistically significant difference (P 0.05). Conclusion A higher survival rate and satisfactory clinical efficacy can be achieved by the venous flaps and the flap based on SPBRA while the area of defect in hand soft tissue, where there exists a segmental defect of proper arteries, is small. In terms of the recovery of sensing, the first choice is the flap based on SPBRA. In considering of the difficulty in surgical operation, the venous flap is a relatively simple procedure. Key words: Superficial palmar branch of radial artery; Venous flap; Finger injuries; Microsurgical operation

Using Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel

Objective To evaluate the surgical technique and clinical effect of applying Flow-through flap pedicled with superficial palmar branch of radial artery for bridging finger replantation complex defect of soft tissue and vessel. Methods From February, 2013 to March, 2018, 9 cases of severed fingers composited defect of soft tissue and vessel were treated with Flow-through flap pedicled with superficial palmar branch of radial artery. The flap was designed from the proximal end of rasceta and the donor sites were sutured directly. The size of flaps was 3.0 cm ×1.5 cm-4.0 cm×2.2 cm. The superficial branch of the radial artery in the flap was used to bridge the finger artery. And the vein of proximal and distal ends in the finger was bridged by the subcutaneous vein. The proper palmar digital nerve defect was bridged by palm skin graft of median nerve. The appearance, feeling and joint function of fingers was followed-up regularly after operation. Results All transfering flaps survived and all cases were followed-up for 7 to 33 months. The donor sites got primary healing with straight scars. The appearance and texture of the flaps were satisfactory. Two-point discrimination ranged from 8 to 11 mm. The pain sensation, warmth sensation and touch sensation of the flaps got better. And the appearance and functions of severed fingers recovered well. Conclusion The Flow-through flap pedicled with superficial palmar branch of radial artery is easy to harvest and anastomose, which is masked and a small incision for the donor site. It is an ideal method for bridging severed fingers and repairing of finger wound. Key words: Surgical flap; Superficial palmar branch of the radial artery; Flow-through; Replantation of severed digits

Chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing complex tissue defect of the thumb

Objective To investigate the surgical method and clinical effect of chimeric flap pedicled with the palmar branch of the radial artery from the wrist crease area for repairing the complex defect of the thumb. Methods Data of 11 cases with thumb complex tissue defects admitted during June 2013 to June 2015 were retrospectively analyzed. There were 7 males and 4 females, aged from 16 to 56 years, with an average age of 31.5 years. The soft tissue defect of the affected finger ranged from 3.0 cm×1.3 cm to 6.3 cm×2.0 cm, and the bone defect ranged from 1.3 cm×0.8 cm×0.4 cm to 2.8 cm×1.3 cm×0.8 cm. All the cases were repaired by chimeric flap pedicled with the superficial palmar branch of radial artery of the wrist crease area. The chimeric flap was transferred through the thenar part of the subcutaneous tunnel to the thumb surface to repair the defect of the composite tissue. The flap area ranged from 4.0 cm×1.5 cm to 7.0 cm×3.0 cm and the bone flap size ranged from 1.5 cm×1.0 cm×0.5 cm to 3.0 cm×1.5 cm×1.0 cm. The function of the finger was evaluated postoperatively according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association. Results All 11 cases of wrist transverse bone flap survived. The average healing time of the bone flap was 1.6 (range, 1.5-3) months, and the bone graft was not absorbed. The function and appearance of the finger was good with only a linear scar; 6 months after surgery, the two-point discrimination on average was 7.1 mm (range, 5.5-9.0 mm). At the latest follow-up according to the upper extremity functional tentative evaluation criteria of thumb and finger reconstruction by Hand Surgery of Chinese Medical Association, finger function were excellent in 9 cases, good in 1 case, with the excellent rate of 90.9% (10/11). Conclusion The chimeric bone flap pedicled with the superficial palmar branch of radial artery can repair skin, soft tissue and bone defects of thumb simultaneously. It has the advantages of simple operation, safe blood supply, speeding up fracture healing, good functional recovery and concealed scar in donor area. It is a new choice to repair the complex tissue defect of thumb. Key words: Finger injuries; Surgical flaps; Microsurgery

P5517Presentation of a novel access route (snuff box/deep palmar branch of radial artery) for coronary angiography and intervention

P5517Presentation of a novel access route (snuff box/deep palmar branch of radial artery) for coronary angiography and intervention

Clinincal research for superficial palmar branch of radial artery flaps with anastomosed accompanying vein to treat soft tissues defec

Objective To investigate the clinincal curative effects of superficial palmar branch of radial artery(SPBRA) flaps with anastomosed accompanying vein repairing soft tissues defects in fingers. Methods From January, 2016 to June, 2017, 10 cases with soft tissues defects received the operation of superficial palmar branch of radial artery flaps transplantation. In the process of operation, the superficial palmar branch of radial artery(SPBRA) was carefully separated, accompanying vein and superficial vein. The SPBRA was anastomosed with the proper digital artery, while the accompanying vein of superficial palmar branch and superficial vein were anastomosed with the palm vein. The nerve supplied this flap was anastomosed with the proper digital nerve. Mesured the range of motion and two-points discrimination of fingers with following-up. Regular followed-up was performed after operation. Results All patients were followed-up ranged from 6 to 24 months, averaged of 13.8 months. All flaps survived. The shape of flaps was plump and the two-points discriminations ranged from 8 to 12mm. Conclusion Using SPBRA flaps with anastomosed accompanying vein to repair soft tissues defects in fingers, there were minor damage to donor and recipient sites, and the shape and sense of recipient site was perfect. It is a promising treatment choice for patients with soft tissues defects in fingers. Key words: Superficial palmar branch of radial artery; Surgical flap; Finger; Soft tissues defects

Reconstruction of finger composite defects with perforator free flap from the superficial palmar branch of radial artery

Background: Relatively rare scarce number of flaps are used to repair composite defects occurring as a consequence of finger injuries. The main objective in this study is reconstruction of the composite defects of the fingers to share in our study; we aimed to transfer our the experience with the use of the free perforator flap of the radial artery superficial palmar branch (SUPBRA). Materials and Methods: A total of 10 (three women and seven men; age between range, 18 and 47 years) patients who had undergone free composite SUBPRA flap reconstruction, operations between 2010 and 2013 were included in the study. Defect sizes ranged between from 2 cm × 3 cm to 3 cm × 5 cm. The patients were followed up postoperatively for a median an average period of 11.5 (six‑18 months) months. All patients were assessed with static and dynamic two‑point discrimination tests, Semmes‑Weinstein monofilament test, cold intolerance test, time of returning to work, the active total range of motion of the injured fingers, cosmetic appearance of the donor/recipient sites and were also assessed for neuroma the development of neuroma on the donor site. Results: All composite free flaps survived completely, and the follow‑up duration was 11.5 months. The average median operative time was 194 min (180–260 min) and the patients returned to their work their normal life after an average of 13 weeks (11–21). Any complication concerning with donor sites and wrist movements when primary closures were performed was observed. Conclusion: Free SUBPRA flap can be elevated from ipsilateral extremity under regional anesthesia which can be easily used for the reconstruction of composite defects with an advantage of providing a relatively hairless and thinner coverage. Therefore, it can be a perfect alternative for the repair of composite tissue defects encountered in the practice of hand surgery. Keywords: Composite defect, finger injuries, free flap, SUBPRA

The free flap from the superficial palmar branch of radial artery innervated by the lateral cutaneous nerve of the forearm repair the defects of finger pulp

Objective To explore the outcomes of free flap from the radial artery superficial palmar branch (RASP) innervated by the lateral cutaneous nerve of the forearm for repairing the defects of finger pulp. Methods From April, 2013 to February, 2015, 20 fingers in 20 cases were treated with free flap from RASP innervated by the later-al cutaneous nerve of the forearm. The area of flap was from 1.8 cm×2.0 cm to 2.0 cm×4.0 cm. Postoperative follow up was done termly. Results All 20 flaps survived. All cases were followed-up for 7-20 months(averag, 12 months). The flaps appeared well with good texture. The two-point discrimination was from 7 mm to 12 mm, and graded with S3 and S3+ sensation.There was little scar noted at the donor site in the wrist.There was no influence of hand and wrist func-tion. Conclusion The method of using free flap from SASP innervated by the lateral cutaneous nerve of the forearm to repair the defects of finger pulp has good clinical effect. Key words: Free flap; Superficial palmar branch, radial artery; Lateral cutaneous nerve of the forearm; Finger; Injury

Repairing the defected volar finger with the free micro-flap based on the superficial palmar branch of radial artery

Objective To discuss the clinical application of free micro-flap based on the superficial palmar branch of radial artery (SPBRA) to repair the palmar soft tissue defect of the finger. Methods From October, 2012 to September, 2015, this flap was used in 25 patients to repair the palmar soft tissue defect of the finger. The artery, the vein and the never in the flaps was anastomosed respectively with that in the recipient site. The donor area was sutured directly. Results All patients were followed-up for a mean of 11 months (range, 6-20 months). All 25 flaps survived. The character of flap was good, the appearance and sensitive function obtained satisfactory resume. At the last follow-up, the two-point discrimination was 5-10mm on the affected side. According to the Standard of Evaluation of Thumb-Finger Reconstruction of the Chinese Medical Association, there were excellent in 17 cases, and good in 8 cases. The wounds of donor site healed by 1st intention with no visible scars. The function of thumb was not damaged. Conclusion The free micro-flap based on the SPBRA is feasible for soft-tissue defects of finger bacause the undamaged major blood vessels of donor site, the inconspicuous scar, and the good appearance and sensitive function of repaired fingers. Key words: Radial artery, superficial dorsal branch; Finger, palm; Thenar eminence; Repair; Microsurgical technique

Clinical effects of repair of wounds in fingers after electrical burn with wrist perforator free flaps

Objective: To explore the clinical effects of repair of wounds in the fingers after electrical burn with wrist perforator free flaps. Methods: Twelve patients (13 fingers) with electrical burn were hospitalized in our burn ward from January 2016 to January 2017. After radical debridement, the size of wounds ranged from 5.0 cm×2.0 cm to 10.0 cm×7.0 cm. Wounds with size below or equal to 6.0 cm ×2.5 cm were repaired with free flaps based on the superficial palmar branch of radial artery, with flap area ranging from 2.5 cm×2.2 cm to 6.0 cm×4.5 cm. The superficial palmar branch of radial artery, subcutaneous vein, and palmar cutaneous branch of the median nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly. Wounds with size larger than 6.0 cm×2.5 cm were repaired with free flaps based on the dorsal carpal branch of ulnar artery, with flap area ranging from 4.5 cm×3.0 cm to 12.0 cm×8.5 cm. The dorsal carpal branch of ulnar artery, subcutaneous vein, and medial antebrachial cutaneous nerve underwent end-to-end anastomosis with digital proper artery, dorsal superficial vein, and digital proper nerve in the finger, respectively. The donor sites were sutured directly or covered by full-thickness skin graft from abdomen. Results: Five free flaps based on the superficial palmar branch of radial artery and 8 free flaps based on the dorsal carpal branch of ulnar artery were used in the patients. In one week after surgery, 12 flaps survived completely, while one free flap based on the dorsal carpal branch of ulnar artery suffered from slight infection, after depressing change, it survived in the end. After the follow-up of half a year, the flaps were full in shape and the distance of two-point discrimination of ranged from 4.0 to 7.0 mm. The fingers showed good functional recovery and no deformity. The grade of function of the fingers was excellent in 10 cases and good in 3 cases. There were small incision scars in donor sites. Conclusions: The wrist perforator free flap is safe and reliable for repairing electrical burn wound of finger. The wounded finger shows good appearance and function after operation.

Superficial palmar branch of radial artery for coverage of soft tissue defects of finger pulp

目的 探讨应用桡动脉掌浅支皮瓣游离移植修复手指指腹软组织缺损的手术方法及治疗效果。 方法 自2013年10月至2016年1月，我们采用桡动脉掌浅支皮瓣游离移植修复手指指腹软组织缺损患者28例。皮瓣切取面积为1.8 cm×2.2 cm~2.2 cm×2.8 cm。 结果 本组28例皮瓣全部成活，其中1例出现皮瓣远端表皮坏死，经创面换药治疗后愈合，供受区均未并发深部感染。腕部皮瓣供区全部直接缝合。术后随访时间为5~18个月，平均9个月，皮瓣质地优良，外形满意，两点分辨觉达8~11 mm，患指功能根据中华医学会手外科学会上肢部分功能评定试用标准评定：优17例，良9例，可2例。皮瓣供区无疼痛，无严重瘢痕增生，腕关节屈伸活动良好。 结论 应用桡动脉掌浅支皮瓣游离移植修复手指指腹软组织缺损，皮瓣外形满意，供区相对隐蔽且损伤小，是一种较为理想的手术方式。

A cadaveric study on anatomical variations of the superficial palmar arch

Background: The Superficial Palmar arch (SPA) is an anastomosis between the ulnar and radial artery in the palm. Maximum contribution in the arch is by an ulnar artery and it is completed by superficial palmar branch of radial artery or arteria princeps pollicis or arteria radialis indicis or median artery. The SPA develops as a terminal plexus of axis artery which is later joined by median, ulnar and radial arteries as these arteries develop. Materials & Methods: Present study conducted in the Department of Anatomy, Chettinad Hospital and Research Institute on 50 (28 right and 22 left) formalin fixed hands were used. The variations observed were classified as per Coleman and Anson, 1961, classification of the superficial palmar arch. Results: As per Coleman and Anson classification, complete arch of type A was seen in 43 hands (86%) and of type B in 3 hands (6%). In this study incomplete arch was seen in 4 hands (8%, 1 right and 3 left), persistent median artery type H supplying the radial side of the palm and digits was seen in only one hand (2%). Conclusion: The data regarding the study on variations of SPA is helpful in crushing injury of hand, arterial grafting, and vascular trauma of the upper extremity.

Pattern of variations in superficial palmar arch in 134 Negro cadaveric hands.

To investigate the incidence of anatomical variations of superficial palmar arch in Negro population. A total of 134 upper limbs comprising 74 right and 60 left specimens embalmed with formaldehyde were used for the investigation. The hand was dissected with palmar aponeurosis identified and removed to expose the ulnar and radial arteries. A complete superficial arch was observed in 73.9% specimens. In 70.1% cases the superficial branch of the ulnar artery communicated with its radial arterial counterpart. In 3.0% cases the arch was formed entirely by the ulnar artery while in a single case (0.8%), a rare pattern was observed in which the superficial palmar branch of the ulnar artery gave rise to the princeps pollicis artery as its terminal branch with the exclusion of radialis indicis that had its origin from deep palmar branch of radial artery. The incomplete arch constituted 26.1% of the entire palmar arch formation. In our Negro population study, deviation from normal anatomical pattern was common. Therefore, a review of vascular pattern prior to invasive or intervention surgery is strongly recommended to be able to detect anomalies likely to necessitate modification of surgical procedures.

A Study of Complete Superficial Palmar Arches Formed Entirely by Ulnar Artery

Superficial Palmar Arch is an arterial arcade and a dominant vascular structure in the palm. It is defined as the anastomosis between the superficial branch of the ulnar artery and supericial palmar branch of the radial artery. In ulnar dominant complete superficial palmar arch, the ulnar artery does not anastomose with radial artery and it terminates by supplying thumb and index finger. In the present study, this type of variation was found in 50% of the hands. This is in contrast to the classical superficial palmar arch normally described where the arch is completed on the radial side by superficial palmar branch of radial artery. In accordance with the present study, a feature that is present in 50% of the specimens cannot be called as a variation. In these cases, without an efficient collateral circulation, ulnar artery occlusion may cause claudication and gangrene in the digits and has clinical significance.

Variation on the Formation of Superficial Palmar Arch. A cadaveric Study

The anatomy of the palmar vascular arches is a complex and challenging area. Understanding the vascular patterns of the hand and their variations is very important for surgeons, radiologists and anatomists because of innovative microsurgical techniques in reconstruction of a traumatized hand, and may be useful for graft surgeries, when the arteries of the upper limb are used for coronary artery bypass. The description of a complete arch refers to the existance of an anastomosis between the superficial palmar branches of ulnar and radial arteries, or in cases in which the ulnar artery alone supplies all the fingers an the ulnar side of the thumb. An incomplete arch was defined when it only supplies the 5th, 4th, and 3rd digits. We evaluated 36 hands belonging to 19 formalin preserved cadavers to determined the pattern of the superficial palmar arch, its branches, and contributing vessels. We discard two specimen. The ulnar artery was injected with red colored latex. In addition to the frequently encountered types of superficial palmar arch, a myriad of very rare cases in which the princeps pollicis and radialis indicis arteries arising from the first and second dorsal metacarpal arteries, and from a voluminous superficial palmar branch of radial artery. In other cases the palmar metacarpal arteries gave origin to the common palmar digital arteries.

Fascicular turnover flap for nerve gaps

It is well known that free vascularised nerve grafts have a potential for rapid axonal sprouting. However, they are not very popular as the surgical techniques are complicated. With the recent development of supramicrosurgical techniques and microanatomy of nerve trunks, a new method, 'fascicular turnover method', using vascularised fascicular flap was used for repairing nerve gaps. METHODSAND RESULTS: Arterial embalming method, using rat sciatic nerves, was employed to observe fascicular micro-vascularisation. Rich vascular network systems were observed within and outside the rat island nerve flaps. Four cases with digital and facial nerves gaps were repaired with fascicular turnover flap without a nerve graft. Three patients had digital nerve gaps (10-20mm in length) and one had a 3-cm facial nerve gap. The results of sensory recovery of digital nerve gap were 3.22-3.66 (Semmes-Weinstein values) and 6-12mm (moving two-point discriminations) at 6 and -16 months after surgery, respectively. The advantages of this method are: retention of the normal donor nerve, a shorter operation time and repair of the digital nerve gaps under local anaesthesia. Fascicular flap is a vascularised nerve flap with fast and accurate nerve sprouting in comparison to a non-vascularised graft. Excellent nerve regeneration can be expected even in cases with longer nerve gap and scarred recipient bed. It is a simple and quick surgery compared to free vascularised nerve flaps. In addition, there is no functional loss because of the sacrificed fascicle in the operated area. The only disadvantage is the need to employ superficial palmar branch of radial artery (SPRA)-microsurgical techniques using a 50-micron needle.

Ipsilateral incomplete (rare type) superficial palmar arch

This article describes a complex variation in the pattern of blood supply to palm of hand encountered during routine dissection. in the present case : there was no communication between superficial palmar branches of the radial and ulnar arteries (incomplete superficial palmar arch [SPA]; the superficial palmar branch of radial artery coursed superficial to the thenar muscles supplying two common palmar digital arteries for adjacent sides of thumb and index finger ( thereby replacing the conventional arteria radialis indices; the branch supplying the lateral side of thumb was seen arising from the deep branch of radial artery; the superficial palmar branch of ulnar artery supplied a branch to medial side of little finger and two common palmar digital arteries for the adjacent sides for the adjacent sides of little and ring finger and ring and middle finger respectively. SPA has received substantial attention in the recent times as it is the major source of vascular supply of the hand, one of the most important tools of evolutionary advancements in humans. Familiarity regarding the variations in the vascular patterns resulting from a number of developmental errors remains the crucial issue for personnel engaged in reconstructive hand surgeries where these varied patterns act as pivotal points around which successful accomplishment of various advanced surgical procedures revolve. With the type of incomplete SPA encountered in the present study, the arterial supply shows increased vulnerability following trauma thereby raising the chances of development of ischemic changes in the distal hand, hence, prior examination of the vascular anatomy of hand in advance of a planned hand surgery is highly recommended.

Non-invasive quantification of the three-dimensional movements of the human jaw and its application to the study of clicking temporomandibular joints (TMJ)

It is well known that free vascularised nerve grafts have a potential for rapid axonal sprouting. However, they are not very popular as the surgical techniques are complicated. With the recent development of supramicrosurgical techniques and microanatomy of nerve trunks, a new method, ‘fascicular turnover method’, using vascularised fascicular flap was used for repairing nerve gaps.Arterial embalming method, using rat sciatic nerves, was employed to observe fascicular micro-vascularisation. Rich vascular network systems were observed within and outside the rat island nerve flaps. Four cases with digital and facial nerves gaps were repaired with fascicular turnover flap without a nerve graft. Three patients had digital nerve gaps (10–20 mm in length) and one had a 3-cm facial nerve gap. The results of sensory recovery of digital nerve gap were 3.22–3.66 (Semmes–Weinstein values) and 6–12 mm (moving two-point discriminations) at 6 and –16 months after surgery, respectively.The advantages of this method are: retention of the normal donor nerve, a shorter operation time and repair of the digital nerve gaps under local anaesthesia. Fascicular flap is a vascularised nerve flap with fast and accurate nerve sprouting in comparison to a non-vascularised graft. Excellent nerve regeneration can be expected even in cases with longer nerve gap and scarred recipient bed. It is a simple and quick surgery compared to free vascularised nerve flaps. In addition, there is no functional loss because of the sacrificed fascicle in the operated area. The only disadvantage is the need to employ superficial palmar branch of radial artery (SPRA)-microsurgical techniques using a 50-micron needle.