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Beyuma-Mora HE, Morales-Gonzalez JC, Zavala-Elizondo E, Villalobos-Salazar VI, Ruelas-Pérez JI. Neurovascular Grafting in Complex Upper Extremity Trauma: A Case Series Report. Cureus 2024; 16:e69467. [PMID: 39411609 PMCID: PMC11479592 DOI: 10.7759/cureus.69467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 10/19/2024] Open
Abstract
Upper extremity trauma is one of the most frequent surgical emergencies encountered in hospital trauma units. The complexity of injuries to the hand and forearm is due to the convergence of multiple anatomical structures within a relatively small and compact area, all of which are essential for the proper function of the extremity. Among these, neurovascular injuries are particularly significant. While these lesions are rarely associated with high mortality, inadequate or delayed management often results in severe dysfunction. In this paper, we present a series of cases involving complex forearm and upper extremity trauma, where autologous neurovascular grafts were utilized under microsurgical techniques for reconstruction.
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Affiliation(s)
- Hugo E Beyuma-Mora
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia No. 21, Monterrey, MEX
| | - Juan C Morales-Gonzalez
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia No. 21, Monterrey, MEX
| | - Eduardo Zavala-Elizondo
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia No. 21, Monterrey, MEX
| | | | - Jaime I Ruelas-Pérez
- Plastic and Reconstructive Surgery, Instituto Mexicano del Seguro Social, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia No. 21, Monterrey, MEX
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Mahajan RK, Srinivasan K, Jain A, Bhamre A, Narayan U, Sharma M. Management of Complex Upper Extremity Trauma with Associated Vascular Injury. Indian J Plast Surg 2022; 55:224-233. [DOI: 10.1055/s-0042-1744453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Introduction Combined soft tissue and vascular injuries of the upper extremity pose several challenges at once to the plastic surgeon. Many decisions have to be taken urgently that will influence the salvage or amputation of the affected extremity. The aim of this article was to provide an evidence-based outline for the management of such injuries. Learning objectives of this article are as follows: (1) approach to a patient with upper extremity composite tissue and vascular injury presenting to the emergency, (2) decision-making as to when to salvage and when to go for amputation of the traumatized upper extremity, (3) role of imaging in emergency situation, (4) role of fasciotomy, (5) intraoperative sequencing of steps, and (6) options for vascular reconstruction and the flaps used for coverage. After reading this article, the reader should have a clear understanding of the management of vascular injury in a patient with composite defects of upper extremity.
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Affiliation(s)
- Ravi K. Mahajan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Krishnan Srinivasan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Adish Jain
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Abhishek Bhamre
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Udit Narayan
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, Punjab, India
| | - Manish Sharma
- Department of Plastic and Reconstructive Surgery, Amandeep Hospital, Amritsar, Punjab, India
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Skarupa DJ, Feliciano DV. Beware the circular saw. Trauma Surg Acute Care Open 2021; 6:e000704. [PMID: 33748429 PMCID: PMC7934763 DOI: 10.1136/tsaco-2021-000704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- David J Skarupa
- Department of Surgery, University of Florida College of Medicine, Jacksonville, Florida, USA
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Diaz-Abele J, Saganski E, Islur A. Use of Arterial Grafts in Hypothenar Hammer Syndrome: Application of Perforator Flap Anatomy. Plast Surg (Oakv) 2020; 28:204-209. [PMID: 33215034 DOI: 10.1177/2292550320933684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Hypothenar hammer syndrome (HHS) is traditionally treated with venous bypass grafting, but controversy has arisen as arterial grafts have become more available. Methods A retrospective review of all patients undergoing ulnar artery bypass grafting for HHS with an arterial graft from 2008 to 2017 was performed. We also review the literature for patency rates and discuss the scenarios that favor different graft choices. Results Six patients were included in our series. Five had primary surgery and 1 had revision surgery for HHS. Five arterial grafts were from the deep inferior epigastric artery and 1 was from the lateral circumflex femoral artery. The proximal anastomotic site was the ulnar artery for all: n = 6. The distal anastomosis site was the palmar arch and common digital artery (CDA) of the ring/small finger and CDA of the middle/ring finger: n = 3; the palmar arch and the CDA of the ring/small finger: n = 3. All patients were symptom-free at follow-up and had a patent ulnar artery on Allen's testing or angiogram. Conclusion Patency rates of arterial grafts for HHS appear to be excellent and this small series and may offer an alternative to traditional venous grafts and end-to-end arterial anastomoses. We suggest using arterial perforator grafts from free flap donor sites. These have well-described anatomy, are easily harvested, and carry minimal donor site morbidity. Lateral circumflex femoral artery graft is favored in patients requiring a single distal anastomosis, who have a ventral hernia, or who are obese. Deep inferior epigastric artery graft is preferred when multiple distal targets or versatile configurations are needed, in thin patients, or in female patients.
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Affiliation(s)
- Julian Diaz-Abele
- Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Emily Saganski
- Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Avinash Islur
- Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
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Remy H, Locatelli F, Maertens A, Balaguer T, Baqué P, Bronsard N, Camuzard O. Arterial grafts for proper palmar digital artery reconstruction: An anatomical study. HAND SURGERY & REHABILITATION 2020; 40:69-74. [PMID: 33137466 DOI: 10.1016/j.hansur.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 10/23/2022]
Abstract
Digital ischemia due to arterial defects need urgent surgical management. The traditional treatment consists of vascular reconstruction using a reversed autologous venous graft as a bypass. Very few studies have described the use of arterial grafts for digital artery reconstruction. This cadaver study characterized the forearm perforator arteries to assess the potential feasibility of using them as donor grafts for digital artery reconstruction. Eleven forearms and twenty hands were dissected from freshly injected cadavers. All clinically significant perforators (>0.5 mm) derived from radial or ulnar arteries and digital arteries were evaluated. The digital palmar arteries were measured at three points: metacarpophalangeal (MCP) joint, proximal interphalangeal (PIP) joint, and distal interphalangeal (PIP) joint. In the 11 forearms analyzed, 5.5 ± 1.3 perforators from radial or ulnar arteries with a diameter of at least 0.5 mm were found per dissection. The mean diameters were 0.9 ± 0.18 mm proximally and 0.8 ± 0.15 mm distally; the mean length was 35.6 ± 11.35 mm. The mean diameters for the dominant and non-dominant arteries were 1.5 and 1.3 mm at the MCP, 1.3 and 1.0 mm at the PIP, 0.8 and 0.7 mm at the DIP, respectively. The forearms are good donor sites as they have large-diameter arteries of suitable length for arterial grafting. These new arterial grafts may be suitable for vascular reconstruction of digital arteries starting from the PIP joint.
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Affiliation(s)
- H Remy
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - F Locatelli
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Microchirurgia e Chirurgia della mano, ASST Gaetano Pini-CTO, Università di Milano, Milano, Italia
| | - A Maertens
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - T Balaguer
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France
| | - P Baqué
- Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France; Service de Chirurgie viscérale d'urgence, Hôpital Pasteur 2, University of Côte d'Azur, Nice, France
| | - N Bronsard
- IULS, Service de Traumatologie et d'Orthopédie, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France
| | - O Camuzard
- Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France.
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Abstract
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.
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Del Piñal F, Urrutia E, Klich M. Severe Crush Injury to the Forearm and Hand: The Role of Microsurgery. Clin Plast Surg 2017; 44:233-255. [PMID: 28340660 DOI: 10.1016/j.cps.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain.
| | - Esteban Urrutia
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain; Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Maciej Klich
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain; Department of Traumatology and Orthopedics, Clinical Hospital, Warsaw, Otwock, Poland
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