Late haemodynamic and functional consequences of radial artery removal on the forearm circulation

[Scapular flap, an alternative to the radial forearm flap in phalloplasty: Advantages and limitations]

INTRODUCTION

Antebrachial phalloplasty is considered as the standard technique in total penile reconstruction. This technique allows the creation of a phallus and a neourethra in one step at the cost of significant sequelae of the donor site. Thus, this technique has been replaced in some centers by other techniques such as the MSLD flap or the ALT flap. However, in Western populations, these techniques require the addition of a technique dedicated to the urethroplasty. The scapular flap is a technique that is not widely described in the literature and, like the antebrachial flap, allows the creation of a phallus and a urethra in one step according to the "tube within tube" technique.

AIM

The aim of the study was to detail this technique, to study its vascularization and to adapt the measurements of the flap to a western population.

PATIENTS AND METHODS

Six cadaveric dissections were performed in the laboratory. Intravascular injection of colored latex allowed easier identification of the vessels of interest and study of the subcutaneous vascular tree. Scapular flaps of variable size were raised to adapt the size to a Western population.

RESULTS

Six dissections were performed in Caucasian subjects. The scapular circumflex artery was constant and had a mean diameter of 3.5mm (3.3mm-3.8mm). The mean pedicle length was 7.3cm (6.8cm-8.1cm). The size of the flaps was adapted to the subcutaneous tissue and flaps of at least 14×16cm allowed the "tube within tube" technique to be performed.

CONCLUSION

The scapular flap has the advantage of allowing phalloplasty with urethroplasty to be performed at the same time. The pedicle is constant and of good diameter. In addition, the sequelae of the donor site are minimal. On the other hand, the pedicle used is short and the flap cannot be surgically reinnervated. Nevertheless, the restoration of a protective sensitivity allows the implantation of a penile prosthesis.

Brachioradialis Flap for Soft Tissue Coverage of Posterior Elbow Wounds: Case Report and Surgical Technique

The posterior aspect of the elbow is an area prone to chronic wound complications due to its prominence and the tensile forces resulting from elbow range of motion. In situations in which local wound care fails, various options for soft tissue coverage are available, including the anconeus, lateral arm, radial forearm, extensor carpi radialis longus, and flexor carpi ulnaris flaps. Each option offers unique considerations depending on the complexity and extent of the soft tissue defect. In situations in which coverage of a large defect is required, or when primary soft tissue coverage options fail, an alternative option is the brachioradialis rotational muscle flap. We present a review of the literature, case report, and surgical technique using the brachioradialis muscle for coverage of a large posterior elbow wound after failure of an anconeus flap.

Neurovascular Complications of the Upper Extremity Following Cardiovascular Procedures

BACKGROUND

Cardiovascular procedures are common and are trending toward endovascular interventions. With this increase in endovascular procedures, there is also increasing awareness of upper extremity morbidity resulting from treatment.

METHODS

Articles indexed within PubMed between the years 1975 and 2015 that discussed such complications were reviewed.

RESULTS

Percutaneous radial artery access can lead to nerve ischemia, especially in the setting of an incomplete arterial arch, whereas radial artery harvesting for bypass surgery more commonly causes frank tissue ischemia and radial neuropathy. Transulnar catheterization may cause ischemic hand injuries, while transbrachial angiography has resulted in compartment syndrome. Injuries to the nerves themselves often result from surgical equipment, such as sternal retractors, or from patient positioning leading to compression of the ulnar nerve. For percutaneous radial artery access, the incidence of ischemic injury is as high as 24%, whereas nerve injury is too rare to be estimated. In the setting of radial artery harvesting, ischemic injury is limited to case reports, and radial neuropathy is estimated to occur in as many as 25% of patients at discharge. Open heart surgery is the primary setting in which equipment or patient positioning plays a role, affecting 10% of patients with brachial plexus injuries and 15% with ulnar neuropathies.

CONCLUSION

Complications following cardiovascular interventions are varied and are typically associated with specific procedures. Careful preoperative and postoperative assessments of patients may aid in preventing, minimizing, and treating these often undiagnosed complications.

Complications related to radial artery occlusion, radial artery harvest, and arterial lines

Recent publications have suggested that there may be an important role for the radial artery regarding long-term perfusion of the hand. The increasing popularity of the radial artery as an access site for cardiac catheterization has also resulted in the recognition of acute and chronic radial artery occlusion, and cardiologists have placed renewed emphasis on preserving the patency of this artery for future interventional procedures. This article reviews the present literature on radial artery harvest and occlusion. Also discussed are the complications associated with radial artery occlusion and treatment options to prevent such complications.

Posterior elbow wounds: soft tissue coverage options and techniques

Many options exist for reconstruction of the posterior elbow/olecranon area following wound formation. Careful early wound management is crucial to ensure successful outcomes following reconstruction. Local and regional options are preferred methods for soft tissue coverage in this region. Common flap options include the reversed lateral arm flap, the radial forearm flap, posterior interosseous artery flap, brachioradialis muscle flap, flexor carpi ulnaris flap, and the latissimus flap. The advantages and disadvantages of these flap options are discussed in this review.