Reconstrucción de antebrazo con colgajo DIEP. Caso clínico / DIEP flap for forearm reconstruction. Case report

Las heridas complejas del antebrazo con fracturas asociadas y pérdida circunferencial de piel, suponen un doble reto reconstructivo. Mostramos el tratamiento de una paciente con lesiones combinadas en el miembro superior tras atrapamiento por rodillos fríos industriales mediante el uso de un colgajo libre de perforante del eje epigástrico inferior profundo (DIEP), tras tratamiento de la fractura articular de la extremidad distal de radio guiado por artroscopia. Conseguimos la estabilización de las fracturas y la cobertura completa del defecto. El colgajo DIEP permite la cobertura de áreas extensas con escasa morbilidad en la zona donante y con un correcto resultado estético (AU)

Complex injuries in upper limb like fractures and forearm circumferential skin loss involving are a double reconstructive challenge. We show a case management in a patient with combined injuries in the upper limb because of entrapment by industrial rollers, using deep inferior epigastric perforator free flap (DIEP) after treatment of an articular fracture of distal radius guided by arthroscopy. Was achieved stabilization of fractures and complete coverage of the defect, with good acceptance of the donor site by the patient. DIEP flap provides coverage for large areas with low morbidity and good aesthetic result (AU)

The role of prostaglandin and antioxidant availability in recovery from forearm ischemia-reperfusion injury in humans.

BACKGROUND: Endothelial dysfunction, manifesting as attenuated flow-mediated dilation (FMD), is clinically important. Antioxidants may prevent this dysfunction; however, the acute effects of oral administration in humans are unknown. Low flow-mediated constriction (L-FMC), a further parameter of endothelial health, is largely unstudied and the mechanisms for this response unclear. METHODS: Twelve healthy participants (five women and seven men) completed three test conditions: control; antioxidant cocktail (α-lipoic acid, vitamins C and E); and prostaglandin inhibitor ingestion (ibuprofen). Ultrasound measurements of brachial artery responses were assessed throughout 5 min of forearm ischemia and 3 min after. Subsequently, an ischemia-reperfusion injury was induced by a 20-min upper arm occlusion. Further, vascular function protocols were completed at 15, 30, and 45 min of recovery. RESULTS: Endothelial dysfunction was evident in all conditions. FMD was attenuated at 15 min after ischemia-reperfusion injury (Pre: 6.24 ± 0.58%; Post15: 0.24 ± 0.75%; mean ± SD, P < 0.05), but recovered by 45 min. Antioxidant administration did not preserve FMD compared with control (P > 0.05). The magnitude of L-FMC was augmented at 15 min (Pre: 1.44 ± 0.27%; Post15: 3.75 ± 1.73%; P < 0.05) and recovered by 45 min. Ibuprofen administration produced the largest constrictive response (Pre: -1.13 ± 1.71%; Post15: -5.57 ± 3.82%; time × condition interaction: P < 0.05). CONCLUSION: Results demonstrate ischemia-reperfusion injury causes endothelial dysfunction and acute oral antioxidant supplementation fails to reduce its magnitude. Our results also suggest that a lack of shear stress during occlusion combined with suppression of prostaglandin synthesis magnifies L-FMC, possibly due to augmented endothelin-1 expression.

A case of coexistence of three anatomical variations in the forearm: Gantzer's muscles, Martin-Gruber anastomosis, and nerve of Henle

During routine dissection of a left forearm, a simultaneous occurrence of Gantzers' muscles, Martin-Gruber anastomosis and nerve of Henle was observed in a 72 year old male. Both accessory muscle heads (Gantzers' muscles) originated from the medial epicondyle and coursed distally. The lateral accessory head crossed the ulnar artery, the Martin-Gruber anastomosis, and the branches of the median nerve to the flexors, the interosseous neurovascular bundle and the median nerve itself. The medial accessory head (Flexor Digitorum Profundus Accessorius) crossed the above structures except the last two. The Martin-Gruber anastomosis was a connection between the nerve to the Flexor Digitorum Profundus (a branch of the median nerve) and the ulnar nerve, which traversed posterior to the ulnar artery and two accessory muscle heads. The nerve of Henle originated from the ulnar nerve just proximal to joining the Martin-Gruber anastomosis, coursed distally with the ulnar artery, and supplied the skin of the distal forearm. These muscular and nervous anomalies are clinically significant since they are mutually related to one another and could compress the nerves or may be compromised during surgical procedures (AU)

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Local bone mineral response to brief exercise that stresses the skeleton.

OBJECTIVE: To compare grip strength and bone mineral content in the forearm in women and to test the effects on bone mineral content of short periods of exercise that stresses the skeleton. DESIGN: Assessment of both wrists in 69 volunteers and of the non-fractured wrist in 30 patients followed by an exercise regimen entailing squeezing a tennis ball as hard as possible for 30 seconds each day for six weeks. SETTING: Old people's homes and outpatient departments of Hammersmith and Northampton general hospitals. PATIENTS: 99 Women, of whom 69 were volunteers and 30 had a fractured forearm. MAIN OUTCOME MEASURE: Grip strength and bone mineral content after six weeks and at six months after the exercises had stopped. RESULTS: The bone mineral content of the women's forearms was measured with a densitometer and the grip strength with a semi-inflated bag connected to an anaeroid barometer. Measurements before exercise showed that the two variables correlated closely, irrespective of age, and that there were significant differences in both between the dominant and non-dominant arms of the volunteers. After six weeks of exercise there was a mean increase in grip strength of 14.5% (95% confidence interval 9.9 to 19.2%) and in bone mineral content of 3.4% (1.4 to 5.3%) in the stressed forearms of the 77 women who attended for examination. After six months without exercise the improvements in the 33 women who attended for follow up had reversed. Women who had had a fractured forearm (n = 13), however, had continued to gain grip strength and bone mineral content in the arm that had not been injured. CONCLUSIONS: Grip strength in the forearm is a good indicator of bone mineral content. Both variables may be increased by brief periods of stressful exercise. If this principle can be applied to the whole skeleton it may provide a means of reversing osteoporosis.

Delayed fracture healing following jejunoileal bypass surgery for obesity.

A 38-year-old woman, who 5 years earlier had undergone a jejunoileal bypass for gross obesity, fractured the distal forearm by a minor trauma. Circulating 25-hydroxycholecalciferol was undetectable without vitamin D3 supplement but increased to the lower normal range on a daily dose of 1200 units of vitamin D3. Serum 1,25-dihydroxycholecalciferol was, however, in the upper normal range, both without and with vitamin D supplement. After intestinal reanastomosis the fracture healed and the biochemical changes normalized. Malabsorption due to reduced amount of functioning intestine may cause severe metabolic bone disease, which may not always be reverted by a high-calcium diet and vitamin D supplementation.