Anatomic pattern of perforator arteries from proper digital arteries in human triphalangeal digits.

INTRODUCTION: The localization of the perforator artery for the performance of digital artery perforator (DAP) flaps poses a challenge. This study aims to describe the anatomical pattern of the perforator arteries originating from the proper digital artery in fresh cadaveric triphalangeal digits and to use this pattern as a point of reference for performing these flaps. MATERIAL AND METHOD: We performed a descriptive anatomical study on 28 fresh cadaveric hands (14 male, 14 female; 10 right hands, 18 left hands) after injecting the arterial system with latex. Digital photographs were taken of each specimen after dissection and the number of perforator arteries in each finger (second to fifth), phalanx (proximal, middle and distal) and finger side (radial or ulnar) were obtained by analysis in Adobe Photoshop CS6. RESULTS: We obtained statistically significant results when comparing the means of the number of perforator arteries between fingers, phalanx, finger side, gender and laterality. When analyzing the number of perforator arteries in each phalanx third in each finger, we found that more than 75% of specimens had at least one perforator artery in the two distal thirds of the proximal phalanx and the three-thirds of the middle phalanx and more than 50% had at least one in the proximal third of the distal phalanx. CONCLUSIONS: We present a homogeneous perforator artery anatomic pattern, by finger, phalanx, finger side, gender and laterality, consisting of a high density of perforator arteries in the distal proximal phalanx region, throughout the middle phalanx and in the proximal distal phalanx region, which would be the areas of greatest certainty to help predict the favorable evolution of a digital artery perforator flap in the fingers.

Transdiscal screw versus pedicle screw fixation for high-grade L5-S1 isthmic spondylolisthesis in patients younger than 60 years: a case-control study.

PURPOSE: To compare outcomes between transdiscal and conventional pedicle fixation for high-grade L5-S1 spondylolisthesis. METHODS: This was a retrospective case-control study with patients prospectively followed. Twenty-five consecutive patients with mean age of 36.7 years underwent transdiscal fixation, and 31 other with mean age of 42.0 years to pedicle fixation were clinically and radiographically compared. Clinical assessments were performed using Oswestry Disability Index (ODI), Core Outcomes Measures Index (COMI), Short-Form 12 (SF-12), and pain visual analog scale (VAS). Radiographic spinopelvic parameters were also evaluated. The mean follow-up was 2.7 years (range 2.0-5.3). RESULTS: Preoperative data were comparable between groups. Surgery time, blood loss, and hospital stay were similar between groups. At last follow-up, clinical and radiographic outcomes were significantly improved in both groups. Postoperatively, both lumbar and leg pain VAS were similar between groups, but ODI (20.2 vs. 31.6, p = 0.010), COMI (1.6 vs. 2.8, p = 0.012), and SF-12 physical (84.3 vs. 61.5, p = 0.004) and mental (81.5 vs. 69.4, p = 0.021) scores were significantly better in the transdiscal group. The neurologic complication rate was similar in both groups. There were 4 pseudoarthroses in the pedicle group, and none in the transdiscal group. CONCLUSION: L5-S1 transdiscal screw fixation provided better functional and radiographic outcomes at medium-term than conventional pedicle fixation for high-grade spondylolisthesis, although transdiscal sacral screws are difficult to place in correct position.