Real Color Sectioned Images and Correspondence with Ultrasound Images of the Palmar Wrist

The aim of this study was to identify sequential changes in the actual sites and shapes of wrist structures on the high-resolution sectioned images and to compare these with those on ultrasound (US) images. These images of the wrist may yield guidelines for diagnosing various pathological lesions in the wrist. In the sectioned images of a whole cadaver body, and the images including the wrist were selected, and part of the hand was cropped. A wrist of one healthy Korean subject was scanned by ultrasonography to obtain US images of the wrist. Wrist structures were identified and labeled in detail on the sectioned images and the corresponding US images. Serial changes of the sites and shapes of the wrist structures mainly occurred in the bones, median nerve, ulnar artery, ulnar nerve, and the flexor pollicis longus tendon, along with thickening of the thenar and hypothenar muscles. The present results could provide a new guide for anatomy mapping, diagnosing, and detecting various lesions of the wrist. They can also be useful and effective for educational purposes related to interpreting US images.

Dialysis Access-Associated Steal Syndrome with Percutaneous Endovascular Arteriovenous Fistula Creation.

Background: Dialysis access-associated steal syndrome is an infrequent complication after hemodialysis access creation. Clinical symptoms depend on the degree of steal. Mild symptoms include coldness, numbness and pain during dialysis. Severe steal can present with rest pain, cyanosis and ulcerations, and may require surgical ligation of the fistula. With recent advances in arteriovenous fistula creation, percutaneous endovascular arteriovenous fistula creation has demonstrated better maturation and patency rates with lower risk of wound healing and infection rates as compared to surgically created hemodialysis access. Percutaneous creation offers a minimally invasive alternative, though complications have been reported. The following presents the first described case of DASS following the use of percutaneous endovascular arteriovenous fistula creation, and discusses risk factors and management. Case Presentation: Our case is that of a 27-year-old male with end stage renal disease due to congenital renal dysplasia, who underwent left percutaneous arteriovenous fistula creation for initiation of dialysis. Two months after the procedure the patient complained of coldness, pain, tingling, and numbness in the left arm during dialysis, concerning for steal syndrome. The patient subsequently underwent brachial artery angiogram, which showed predominant flow through the fistula and minimal antegrade flow through the ulnar and interosseous arteries towards the hand, with a focal, severe stenosis in the distal ulnar artery. Angioplasty of the stenosis was performed, though steal symptoms continued. Conclusions: DASS, though rare, can be seen with percutaneous arteriovenous fistula creation. Identification of the risk factors prior to creation, especially in patients who are at higher risk of peripheral vascular disease, can help avoid this complication. Management is largely guided by clinical presentation. As long as there is adequate collateral supply to the extremity, single vessel occlusion is not a contraindication to percutaneous arteriovenous fistula creation with the use of WavelinQ technology. Careful patient selection with pre-creation angiogram may reduce the risk of symptomatic steal.

Study of contributing arteries to superficial palmar arch formation

The superficial palmar arch (SPA) is formed predominantly by the ulnar artery with a contribution from the superficial palmar branch of the radial artery.: To study contributing arteries in superficial palmar arch formation and variations in its formation.: Study comprised of 30 upper limbs from 15 cadavers. Palmar arches in them were dissected following classical incisions and dissection procedures of Cunninghams’ manual.: SPA was formed by superficial branch of ulnar artery only in 13.33% specimens, by superficial branch of both ulnar and radial artery in 70% specimens, by superficial branch of ulnar and persistent median artery in 13.33% specimens and was formed by superficial branches of ulnar and radial arteries with persistent median artery in 3.33% specimens. SPA was complete in 80% and was incomplete in 20% specimens.: The arch formation is highly variable. Knowledge of contribution to the SPA will be helpful to the reconstructive hand surgical procedures such as arterial repairs, vascular graft applications and re-implantations.

Chimerization of Monitor Flap in a Vascularized Ulnar Nerve Flap Is an Efficient Way for Vascularity Monitoring and the Reinnervation Checkup after Its Transplantation

Background Free vascularized ulnar nerve flaps (VUNF) are effective method for long nerve defects reconstruction. However, the monitorization of its microvascular circulation and the nerve regrowth can be challenging since it is usually designed as a buried flap. We designed a skin paddle based on a septocutaneous perforator from the ulnar artery that can be dissected and raised in conjunction with the vascularized ulnar nerve flap, which aims to improve postoperative monitorization to optimizing the clinical results. Methods We retrospectively reviewed 10 cases with long nerve defects who underwent reconstruction using VUNF between June 2018 and June 2019, including eight acute brachial plexus injuries, 1 multiple nerve injury due to a rolling machine accident, and 1 sequalae of nerve injury after arm replantation. All the demographic data, surgical details, outcomes, and perioperative complications were recorded. Results We evaluated 10 male patients, with a mean age of 34 ± 16 years. Cases included 5 antegrade, 4 retrograde, and 1 U-shaped VUNF. All chimeric skin paddles survived, and all of the underlying nerves presented with adequate circulation and functional improvement. There were no intraoperative or microvascular complications. One skin paddle had a transitory postoperative circulation compromise due to external compression (bandage) which resolved spontaneously after pressure release. Conclusion VUNF chimerization of a septocutaneous perforator skin flap is a relatively easy and efficient method for postoperative monitorization of the nerve’s microvascular circulation as well as beneficial for postoperative Tinel’s sign checkup to confirm the success of the nerve coaptation. The outcome is potentially improved.

Evaluation of radial and ulnar artery blood flow after radial artery decannulation using colour Doppler ultrasound

Background There is a lack of reports in the literature regarding changes in radial artery blood flow after decannulation. The objective of this study was to investigate changes in radial and ulnar artery blood flow after radial artery decannulation using Doppler ultrasound and to explore the factors that influence radial artery blood flow recovery. Methods In current observational study, we used colour Doppler ultrasound to measure the cross-sectional area of the radial (SR) and ulnar artery (SU) and peak systolic velocity of the radial (PSVR) and ulnar artery (PSVU) for both hands at four time points in patients with radial artery cannulation: pre-cannulation (T0), 30 min after decannulation (T1), 24 h after decannulation (T2), and 7 days after decannulation (T3). Repeated measures analysis of variance and logistic regression analysis were performed to analyse the data. Results Overall, 120 patients were included in the present study. We obtained the following results on the side ipsilateral to the cannulation: compared with T0, the ratio of PSVU/PSVR increased significantly at T1 and T2 (p < 0.01); compared with T1, the ratio of PSVU/PSVR decreased significantly at T2 and T3 (p < 0.01); compared with T2, the ratio of PSVU/PSVR decreased significantly at T3 (p < 0.01). Female sex (OR, 2.76; 95% CI, 1.01–7.57; p = 0.048) and local hematoma (OR 3.04 [1.12–8.25]; p = 0.029) were factors that were significantly associated with the recovery of radial artery blood flow 7 days after decannulation. Conclusions There was a compensatory increase in blood flow in the ulnar artery after ipsilateral radial artery decannulation. Female sex and local hematoma formation are factors that may affect the recovery of radial artery blood flow 7 days after catheter removal.

Dual Aneurysm Formation in an Occupationally Predisposed Male: Atypical Hypothenar Hammer Syndrome

Hypothenar hammer syndrome is typically described as a chronic repetitive injury to the ulnar artery at the level of hamulus of hamate and shows certain occupational predilection. Our case is an occupationally predisposed patient who had two aneurysm formations from the superficial palmar branch of ulnar artery and the digital branch, respectively, diagnosed and treated surgically. We call it an atypical hypothenar hammer syndrome as the arterial involvement was not typically at the level of hamate bone and only corresponded to the site of recurrent friction. This article also discusses the role of imaging and treatment options.

Laser Watch—New Generation 2021: Modern Integrative Photomedicine Equipment for Photobiomodulation

In the recent past, laser therapy has made immense progress as it is known to change microcirculation, modulate vegetative parameters, and stimulate mitochondrial activity in the human body. This editorial briefly describes a new laser watch prototype (generation 2021), which can be used to perform continuous and simultaneous blood irradiation at the radial and/or ulnar artery of the wrist with different wavelengths of laser light. In a preliminary measurement, the increase in regional oxygen saturation at the crook of the elbow during laser light stimulation with the watch was observed using near-infrared spectroscopy. Apart from this, laser stimulation applied via a newly designed laser watch can modulate biological parameters (photobiomodulation). However, presently, the possible long-term effects are not known, as there are no studies on this topic available to date.