Occasional head of flexor pollicis longus muscle: a study of its morphology and clinical significance.

A cadaveric dissection study of 54 upper extremities to determine the incidence of occurrence, morphology and relations of the occasional head of the flexor pollicis longus muscle is presented. The occasional head of the flexor pollicis longus muscle was found to be present more frequently (66.66%) than absent. It mainly arose from the medical epicondyle of the humerus (55.55%) and the medial border of the coronoid process of the ulna (16.66%). It was found to be in close association with the median nerve (anteriorly) and the anterior interosseous nerve (posteriorly). The clinical implications of these findings are discussed viz. entrapment neuropathies of the median and anterior interosseous nerves, cicatricial contraction of the occasional head leading to flexion deformity of the thumb and the likely necessity to lengthen/release the occasional head in spastic paralysis of the flexor pollicis longus muscle.

A new approach to heel ulcers: dorsalis pedis neurovascular trans-interosseous island flap.

The most important requisite in the care of ulcers in the heel region is replacement skin cover with adequate sensation. The dorsalis pedis flap appears adequate, but the anterior subcutaneous approach gives a pedicle of inadequate length to enable the flap to reach the most important posterior weight-bearing area. It was therefore decided to short-circuit the course of the pedicle by passing the whole flap through the interosseous membrane between the tibia and the fibula to enable the flap to reach the weight-bearing area without tension. After 10 meticulous cadaver and two post-traumatic limb dissections with angiographic confirmation, it appeared that such a flap was feasible and would satisfy all basic requirements. Clinically this technique was tried in two patients who were provided with sensate, well padded skin cover for the whole of the heel region.