ABSTRACT
We describe the case of an 82-year-old man who had recently undergone cardiac surgery (quadruple coronary bypass), who consulted due to the appearance of a necrotic eschar on the thumb of the right index finger, together with paraesthesia and hypoaesthesia in the first 3 fingers of the same hand. An ultrasound scan of the right elbow was performed to rule out involvement of the median nerve and an anechoic, thick-walled mass was found, dependent on the wall of the proximal ulnar artery, compatible with a pseudoaneurysm of the same, compressing the nerve. Electromyography showed an acute lesion of the proximal median nerve and angio-CT confirmed the diagnosis of pseudoaneurysm of the proximal ulnar artery. Pseudoaneurysm is a dilatation by rupture of the arterial wall, which does not involve all three layers of the arterial wall and communicates with the vascular lumen. Its development after vascular manipulation is very rare, and it is uncommon for it to act by compressing a nerve structure. In our case, together with vascular surgery, treatment with intralesional thrombin was decided, with good evolution.
Se describe el caso de un varón de 82 arios intervenido recientemente de cirugía cardíaca (cuádruple bypass coronario), que consulta por aparición de una escara necrótica en el pulpejo del dedo índice derecho, junto a parestesias e hipoestesias en los tres primeros dedos de dicha mano. Se realiza una ecografía del codo derecho para descartar afectación del nervio mediano y se objetiva una masa anecoica, de paredes engrosadas, dependientes de la pared de la arteria cubital proximal, compatible con pseudoaneurisma de esta, que comprime dicho nervio. En la electromiografía se evidencia una lesión aguda del nervio mediano a nivel proximal y en el angio-TC se confirma el diagnóstico de pseudoaneurisma de la arteria cubital proximal. El pseudoaneurisma es una dilatación por rotura de la pared arterial, que no implica a las tres capas de esta y se comunica con la luz vascular. Su desarrollo tras una manipulación vascular es muy infrecuente y que actúe comprimiendo una estructura nerviosa es poco común. En nuestro caso, conjuntamente con cirugía vascular se decidió tratamiento con trombina intralesional, con buena evolución.
Subject(s)
Humans , Male , Aged, 80 and over , Cardiovascular System , Arteries , Vascular Diseases , Blood Vessels , Cardiovascular Diseases , Ulnar Artery , Aneurysm, False , Peripheral Nervous System , Median Nerve , Nervous SystemABSTRACT
Objective@#To evaluate the design and clinical application of forearm proximal radial inferior cubital artery perforator flap.@*Methods@#The clinical data of 11 patients with defects of anterior elbow from June 2013 to June 2018 were analyzed retrospectively, in which including 8 male and 3 female, mean age is 51.5 years old, ranged from 48 to 76 years old. The sizes of soft tissue defects ranged from 7.5 cm×4.5 cm to 14 cm×7 cm. Forearm proximal inferior cubital artery perforator flaps were used to repair the defects according to flap their location, size and shape, in which the largest is 15 cm×10 cm and the smallest is 7 cm×5 cm. To evaluate the effect according to flap survival, infection control, elasticity and color, appearance, the scar of the donor site, cutaneous sense, and satisfaction of patients. The elbow efficacy and function were evaluated according to Mayo criteria and the swelling degree of flap was also evaluated.@*Results@#All the flaps survived in 11 cases, the incisions in donor and recipient site were primary healing. The survival of flaps is good and the appearance, color and elasticity are close to normal, on the other hand, the scar at the donor site is small after 6 to 36 months follow-up. The efficacy is satisfied in 8 cases, general in 3 cases and no dissatisfactory. The function of elbow is excellent in 4 cases, good in 6 cases and general in 1 case. Skin swelling rating in early stage is 1st degree in 6 cases, 2nd degree in 3 cases, 3rd degree in 2 cases; in later stage is 1st degree in 8 cases, 2nd degree in 2 cases, 3rd degree in 1 case.@*Conclusions@#The anatomic position of forearm proximal radial inferior cubital artery perforator flap is constant, the blood supply is good, and the operation method is simple and safe which could be a new supplementary method and be available for clinical selection to repair the soft tissue defects of elbow.
ABSTRACT
Objective To provide anatomical basis for lateral antebrachial neurocutaneous flap pedi-cled with inferior cubital artery perforator in repairing tissue defects around elbow joint. Methods Thirty embalmed upper limbs of adult cadavers perfused with red latex were used for this study, and followings were observed:①The course and distribution of lateral antebrachial cutaneous nerve; ②Anastomoses between inferior cubital artery and nutrient vessels of lateral antebrachial cutaneous nerve. Mimic operation was performed on other side of fresh specimen. Results ①The main trunk of lateral antebrachial cutaneous nerve (LACN) lined in the radial forearm and distributed in the 1/3 region of lateral forearm. ①The nutritional vessels of the flap were plurisegmental and polyphyletic. The inferior cubital artery which was relatively constant reached to skin through "V"-shaped peak formed by communicating branches of cephalic vein and deep venous system. They also gave off large number of small veins, which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. Conclusion The lateral antebrachial neurocutaneos flap pedicled with inferior cubital artery perforator can be formed to repaire tissue defects around elbow joint.