Conservative treatment for Carpal Tunnel Syndrome caused by persistent median artery: a case report

Knowledge of a persistent median artery, defined as an anatomical vascular variation, is of clinical importance because it can be an unusual etiology of carpal tunnel syndrome. This report describes the case of a 42-year-old female patient with acute pain and paresthesia involving the volar aspect of the first, second, and third fingers of the left hand. The clinical manifestations pointed to compressive neuropathy of the median nerve, and diagnostic imaging showed anatomical vascular variation. Details were collected through interviews with the patient, and photographic records of imaging exams were thoroughly analyzed. This case study shows the importance of the identification and knowledge about anatomical variations considering that under specific pathological conditions, they can be a cause of clinical syndromes. Such knowledge is also important in the field of surgery for the prevention of iatrogenic injuries.

Cephalic Vein Loop Transposition with Proximal Radial Artery Anastomoses for Haemodialysis

In Romania the prevalence of chronic kidney disease is estimated to be 7% and end-stage renal disease is an increasingly common diagnosis. A long-term, reliable, dependable, and safe method of repeatedly accessing patient’s blood is one of the most difficult challenges for haemodialysis therapy. The best method to date to accomplish vascular access the arterio-venous fistula (AVF). This segment can be accessed with dialysis needles, providing blood for dialysis. We present a case of a 57-year-old man was diagnosed with an end-stage renal disease and occluded distal radial artery. The cephalic vein was transposed and looped in a tunnel created in the volar aspect of the forearm’s subcutaneous tissue with the end to side anastomosis with the proximal radial artery in the antecubital fossa. The fistula matured in 40 days and the flow volume was 1100 mL/min. He continues his dialysis sessions and is included on the national kidney transplant list.

Accidental adrenaline auto-injector-induced digital ischaemia: a proposed treatment algorithm

Increased numbers of adrenaline auto-injectors (AAIs) are in circulation in the UK. The rate of accidental auto-injection injuries has increased during this time. Various treatment strategies are described in the literature. We present the case of a 32-year-old, right-hand-dominant man who sustained an unintentional AAI injury to the volar aspect of his right thumb. On presentation to the emergency department, the thumb was ischaemic. There was no improvement with simple conservative measures (warm soaks). The patient was referred to our tertiary hand surgery service and a digital block using 2% lidocaine promoted reversal of ischaemia within 2 hours with no long-term sequelae. Phentolamine rescue, on standby, was not necessary in this case. In this case report, we highlight the therapeutic challenges associated with managing AAI injury and propose an evidence-based treatment algorithm to prevent risk of severe adverse outcomes such as digital necrosis.

Carpal tunnel syndrome secondary to neoplastic space-occupying lesion

This article presents a previously reported case of a 66-year-old woman with a mass on the volar aspect of her right wrist and a one-month history of right wrist pain. The importance of considering a wide range of causes for carpal tunnel syndrome when assessing a patient with persistent wrist pain and an associated mass is highlighted. The differential diagnosis of space-occupying lesions should include benign and malignant neoplastic etiologies in addition to non-neoplastic etiologies. The clinical features, diagnostic methods, and management options for a patient with carpal tunnel syndrome are presented and key distinctions between conventional and secondary carpal tunnel syndrome are discussed. Lipomas, schwannomas, and synovial sarcomas are discussed to showcase different neoplastic causes that may present as secondary carpal tunnel syndrome with an associated wrist mass as seen in this case.

Omega Flap Technique: Revisiting Conventional Wisdom

Various surgical techniques have been described for the release of syndactylized fingers. In our experience, the omega flap technique, which includes a dorsal truncated flap and an anchor incision on the volar side, stands out as a good technique to release syndactyly. Incidentally, in symbrachydactyly also, the fused digits can be released using this technique. Despite this, we could find no reference in the recent years. We would like to stress the ease and importance of this technique, hoping many practicing hand surgeons will benefit from this. Our purpose was to revisit this technique and expose it to the younger generation of hand surgeons. We have operated on 20 cases of syndactyly of different types—simple, compound, and complex—and 5 cases of symbrachydactyly. In all cases, the omega flap on the dorsum and anchor incision on the volar aspect of the finger forming 2 lateral palmar flaps were used. The release of syndactyly was satisfactory in all patients. There was no flap necrosis. None of these cases have required secondary surgery because the primary releases were adequate. Release of syndactyly had been a problem for centuries. Awareness of the disability was insufficient in earlier days; currently, they seek early medical care. The release should be complete. These children must be able to achieve the form and function of the hand, and additionally precision to work. We believe that the use of omega flap and anchor flap is a good procedure for syndactyly release.

Reverse wedge osteotomy for Madelung’s deformity in a high school student: A case report

Madelung deformity is a congenital disorder with the malformation of anterior ulnar bowing of radius and a dorsally protruding ulnar head caused by premature growth disturbance at the medial volar aspect of the distal radius. This report describes a bilateral idiopathic Madelung deformity in a 17-year-old woman treated successfully using reverse wedge osteotomy of the distal radius in a symptomatic left wrist. Reverse wedge osteotomy can orient the radial joint surface while correcting the whole radius length by reversely putting the wedge bone removed from the distal metaphysis of radius, the base of which is cut from the surplus of the radial and dorsal cortical bone in the hypotrophic portion. We corrected the palmar subluxation of the carpus, restored her good function, and relieved her wrist pain.

Case of Treatment of Snakebite on Finger with Topical Oxygen Therapy

Snakebites, though uncommon, are a potentially serious cause of disability or death. Local symptoms may include pain, edema, or ecchymosis that may progress to skin necrosis or compartment syndrome. This study explores the case of a 4-year-old male patient bitten by a snake on the distal volar aspect of his left ring finger. On physical examination, there were moderate swelling, hemobullae formation, and the skin necrosis was progressing on middle phalanx of ring finger. Fasciotomy and topical oxygen therapy was performed. The topical oxygen therapy (TOT) was started once a day for 90 minutes with 4 L/minute of oxygen flow. TOT is a method of delivering humidified oxygen directly to the wound bed to support the healing of chronic and hypoxic wounds. There is no report on TOT for snakebite injury. In this report, we would like to report on the clinical experience of early surgery and adjuvant TOT with literary consideration.

Keratolysis Exfoliativa: Description of a Case Report

An 8 year-old boy, previously healthy, presented on the emergency department, during the summer, with air-filled blisters on the volar aspect of the extremities of fingers on the hands (Fig. 1). On follow-up as an outpatient, he showed resolution of the first lesions but with various relapses associated with contact with water for a long period of time, showing posterior peeling of the skin and posterior resolution. What is your diagnosis?

Glomus Tumor on the Volar Aspect of the Distal Phalanx, an Unusual Presentation for an Unusual Neoplasm‎: A Case Report

Background: In the fingertips, the glomus tumors usually involve the subungual areas with typical triad symptoms including pain, tenderness to palpation, and cold sensitivity. The glomus tumor of volar aspect of digits is rare. Case Presentation: A case of glomus tumor was presented at the volar side of the distal phalanx of the ring finger of a 52-year-old woman. The tumor was painful and tender to palpation, yet insensitive to cold. The atypical location and insensitivity to cold led to a 4-year delay in diagnosis. After the surgical excision of the lesion, the extracted mass was sent for histologic evaluation and the diagnosis of glomus tumor was confirmed. One-year follow-up of the patient was event-free. Conclusions: Atypical glomus tumor should be considered in the differential diagnosis of finger pain, even in the absence of characteristic diagnostic features.

How to Harvest The Radial Forearm Free Flap

Summary: Radial forearm flap is fasciocutaneous flap from the volar aspect of the forearm that based on the perforator of radial artery. Radial forearm free flap (RFFF) has several advantages and disadvantages. It has unique characteristic of thin and pliable tissue. It may be indicated when a defect requires a thin flap with little bulk of soft tissue or multiple skin islands are needed to be provided. Physical signs and symptoms of poor peripheral digit perfusion or healing contraindicate the harvest of the radial artery pedicle. Preparations for RFFF procedure include history taking, physical examinations and supporting examinations. Several steps of intraoperative preparations should also be conducted.