Alterations in the Structure, Composition, and Organization of Galactosaminoglycan-Containing Proteoglycans and Collagen Correspond to the Progressive Stages of Dupuytren's Disease.

Dupuytren's disease (DD) is a prevalent fibroproliferative disorder of the hand, shaped by genetic, epigenetic, and environmental influences. The extracellular matrix (ECM) is a complex assembly of diverse macromolecules. Alterations in the ECM's content, structure and organization can impact both normal physiological functions and pathological conditions. This study explored the content and organization of glycosaminoglycans, proteoglycans, and collagen in the ECM of patients at various stages of DD, assessing their potential as prognostic indicators. This research reveals, for the first time, relevant changes in the complexity of chondroitin/dermatan sulfate structures, specifically an increase of disaccharides containing iduronic acid residues covalently linked to either N-acetylgalactosamine 6-O-sulfated or N-acetylgalactosamine 4-O-sulfated, correlating with the disease's severity. Additionally, we noted an increase in versican expression, a high molecular weight proteoglycan, across stages I to IV, while decorin, a small leucine-rich proteoglycan, significantly diminishes as DD progresses, both confirmed by mRNA analysis and protein detection via confocal microscopy. Coherent anti-Stokes Raman scattering (CARS) microscopy further demonstrated that collagen fibril architecture in DD varies importantly with disease stages. Moreover, the urinary excretion of both hyaluronic and sulfated glycosaminoglycans markedly decreased among DD patients.Our findings indicate that specific proteoglycans with galactosaminoglycan chains and collagen arrangements could serve as biomarkers for DD progression. The reduction in glycosaminoglycan excretion suggests a systemic manifestation of the disease.

Reparación del músculo pronador cuadrado en fracturas de radio distal tratadas con fijación interna por abordaje palmar: una revisión sistemática y metaanálisis / Repair of the pronator quadratus muscle in distal radius fractures treated with internal fixation through a palmar approach: a systematic review and meta-analysis

Introducción: el músculo pronador cuadrado funciona como un estabilizador dinámico de la articulación radiocubital distal. Su reparación posterior a la fijación interna con placa de bloqueo volar en fracturas distales del radio es controvertida. Objetivo: determinar si la reparación del músculo pronador cuadrado influye en los resultados clínicos y funcionales de pacientes con fractura de radio distal que se sometieron a reducción abierta y fijación interna con placa de bloqueo volar. Materiales y métodos: se realizó una revisión sistemática y metanálisis. Las bases de datos analizadas fueron PubMed/Medline, Embase y Bireme/Lilacs (búsqueda realizada hasta el 20 de febrero del año 2023). Los términos de búsqueda fueron: distal radius fracture AND volar plate AND pronator quadratus. Se determinó la calidad metodológica según el manual de revisiones Cochrane. Resultados: en total se incluyeron 4 ensayos clínicos aleatorizados de adecuada calidad metodológica, lo cual corresponde al análisis de 213 participantes. Existen mejores resultados en la puntuación DASH a los 12 meses de seguimiento en el grupo de no reparación del músculo pronador cuadrado DM 2,8 [IC 95%: 0,51;5,10]. No hubo diferencias significativas al año de seguimiento en las puntuaciones de dolor, rangos de movilidad de la muñeca, fuerza de agarre e incidencia de complicaciones. Conclusión: no existe evidencia que sustente la reparación rutinaria del músculo pronador cuadrado posterior a la fijación interna con placa de bloqueo volar en las fracturas de radio distal. (AU)

Introduction: the pronator quadratus muscle functions as a dynamic stabilizer of the distal radioulnar joint, and its repair after internal fixation with volar locking plate in distal radius fractures is controversial. Objective: to determine whether the repair of the pronator quadratus muscle influences the clinical and functional outcomes of patients with distal radius fracture who underwent open reduction and internal fixation with volar locking plate. Materials and methods: a systematic review and meta-analysis were conducted. The analyzed databases were Pubmed/Medline, Embase, and Bireme/Lilacs (search performed until February 20th, 2023). The search terms were distal radius fracture AND volar plate AND pronator quadratus. Methodological quality was determined according to the Cochrane Reviewer's Handbook. Results: a total of 4 randomized clinical trials of adequate methodological quality, corresponding to the analysis of 213 participants, were included. Better DASH scores were observed at 12 months of follow-up in the non-repair group of the pronator quadratus muscle, with a mean difference of 2.8 [95% CI 0.51; 5.10]. There were no significant differences at one-year follow-up in pain scores, wrist mobility ranges, grip strength, and incidence of complications. Conclusion: there is no evidence to support routine repair of the pronator quadratus muscle after internal fixation with volar locking plate in distal radius fractures. (AU)

An overview of the osseous palmar sesamoid in Anura, with the particular case of some Rhinella species.

Background: Sesamoids are generally regarded as structures that are not part of the tetrapod body plan. The presence of a palmar sesamoid is assumed to serve as a distribution point for the forces of the flexor digitorum communis muscle to the flexor tendons of the digits, which are embedded in the flexor plate. It has been considered that the palmar sesamoid is present in most anuran groups, and it has been suggested that it acts by inhibiting the closing of the palm, preventing grasping. Typical arboreal anuran groups lack a palmar sesamoid and flexor plate, a pattern shared with other tetrapod groups, which can retain a reduced sesamoid and flexor plate. We focus on the anatomical structure of the Rhinella group, which includes species that present an osseous palmar sesamoid and climb bushes or trees to avoid depredation or escape dangerous situations, and can exhibit scansorial and arboreal behaviors. We also add data on the bony sesamoids of 170 anuran species to study the anatomy and evolution of the osseous palmar sesamoid within this amphibian group. Our objective is to bring an overview of the osseous palmar sesamoid in anurans, unveiling the relationship between this element of the manus, its phylogeny, and the anuran habitat use. Methods: Skeletal whole-mount specimens of Rhinella were cleared and double-dyed to describe the sesamoid anatomy and related tissues. We review and describe the palmar sesamoid of 170 anuran species from CT images downloaded from Morphosource.org, representing almost all Anuran families. We performed an standard ancestral state reconstruction by optimizing two selected characters (osseous palmar sesamoid presence, distal carpal palmar surface) along with the habitat use of the sampled taxa, using parsimony with Mesquite 3.7. Results: Our primary finding is that sesamoid optimization in the anuran phylogeny revealed that its presence is associated with certain clades and not as widespread as previously anticipated. Additionally, we will also be delving into other important outcomes of our study that are relevant to those working in the field of anuran sesamoids. The osseous palmar sesamoid is present in the clade Bufonidae-Dendrobatidae-Leptodactylidae-Brachicephalidae that we named as PS clade, and also in the archeobatrachian pelobatoid Leptobranchium, all strongly terrestrial and burrowing species, though with exceptions. The osseous palmar sesamoid is always present in Bufonidae, but varies in form and size, depending on the mode that they use their manus, such as in the Rhinella margaritifera which has a cylindrical one and also grasping abilities that involve closing the manus. The scattered presence of the bony palmar sesamoid among anuran clades raises the question whether this sesamoid can be present with a different tissular composition in other groups.

CLINICAL RESULTS OF COLLAGENASE TREATMENT FOR DUPUYTREN'S DISEASE: A CASE SERIES STUDY WITH 2-YEARS FOLLOW-UP.

Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series .

Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos .

Clinical results of collagenase treatment for dupuytren's disease: a case series study with 2-years follow-up / Resultados clínicos do tratamento com colagenase para a doença de dupuytren: um estudo de série de casos com 2 anos de acompanhamento

ABSTRACT Objectives: This study aims to report our experience with Clostridium Histolyticum collagenase (CCH) to support the importance of its clinical use and assess its clinical efficacy, complications, and recurrences. Methods: This prospective observational study of 66 patients with a 2-year follow-up. Patients with an extension lag major of 20° at the metacarpophalangeal joint (MPJ) and/or proximal interphalangeal joint (PIPJ) were included. We collected data on demographic and anamnestic details, MPJ and PIPJ contracture degrees, DASH score, complications, and recurrences. Results: The mean pre-injection contracture was 34° for MPJ and 31° for PIPJ. At the 2-year follow-up, the mean contracture for the MPJ and PIPJ were respectively 3° and 14.5°. The mean DASH score decreased from 21.8 before injection to 10,4 after 2 years. The disease recurrence occurred in 34.8% of the patients, all with PIPJ contracture. The main complication was skin breakage (25.7%). Conclusion: The CCH injections remain a consistent option in treating DD; withdrawal from the European market deprives surgeons and patients of low invasiveness and safe tool for treating DD. Level of evidence IV, Therapeutic study investigating treatment results, Case series.

RESUMO Objetivos: O objetivo deste estudo é relatar nossa experiência com Clostridium Histolyticum colagenase (CCH) para apoiar a importância de seu uso clínico e para avaliar sua eficácia clínica, complicações e recidivas. Métodos: Estudo observacional prospectivo de acompanhamento por 2 anos em 66 pacientes com um atraso de extensão maior de 20° na articulação metacarpofalângica (MPJ) e/ou articulação interfalângica proximal (PIPJ). Foram coletados dados sobre detalhes demográficos e anamnésicos, graus de contração da MPJ e PIPJ, escore de DASH, complicações e recidivas. Resultados: A média da contração pré-injeção foi de 34° para a MPJ e 31° para a PIPJ. Com 2 anos de acompanhamento, a contração média para a MPJ e PIPJ foi de 3° e 14,5° respectivamente. A pontuação média do DASH diminuiu de 21,8 antes da injeção para 10,4 após 2 anos. A recorrência da doença ocorreu em 34,8% dos pacientes, todos com contração de PIPJ. A principal complicação foi a quebra da pele (25,7%). Conclusão: As injeções de CCH continuam sendo uma opção consistente no tratamento do DD; a retirada do medicamento do mercado europeu priva os cirurgiões e pacientes de uma ferramenta pouco invasiva e segura para o tratamento do DD. Nível de evidência IV, Estudo terapêutico que investiga os resultados do tratamento, série de casos.

Luxação dorsal complexa da articulação metacarpofalangeana dos dedos longos: relato de caso e revisão da literatura / Complex dorsal dislocation of the metacarpophalangeal joint of the long fingers: case report and literature review

As luxações dorsais da articulação metacarpofalangeana dos dedos são lesões raras, vistas com mais frequência em pacientes jovens, secundárias a trauma por hiperextensão forçada do dedo na mão que estende. São classificadas como simples, quando a redução fechada é possível; ou complexas, quando a redução por métodos fechados não é possível devido à interposição de estruturas periarticulares. É importante distinguir entre uma luxação simples e uma complexa porque sua abordagem e tratamento são diferentes. O objetivo deste estudo é atualizar a abordagem clínica e as diferentes técnicas cirúrgicas utilizadas no tratamento das luxações complexas. Foi realizada uma revisão bibliográfica sobre a luxação dorsal metacarpofalangeana dos dedos longos, excluindo os do polegar, incluindo o Medline (interface PubMed), SciELO e bancos de dados acadêmicos do Google. Todos os artigos revisados concluem que as tentativas de redução incruenta nesses tipos de lesões costumam ser malsucedidas e levar a complicações adicionais. A redução cirúrgica aberta é o método de escolha, permitindo a recuperação anatômica articular com o menor risco de complicações. A imobilização pós-operatória com uma tala de travamento dorsal é recomendada por duas semanas, seguida por reabilitação por terapia ocupacional, esperando-se uma amplitude de movimento normal em seis semanas. A baixa frequência somada ao desconhecimento do médico emergencista ao realizar a manobra de redução pode, muitas vezes, levar à transformação de um simples deslocamento em complexo, tornando-o irredutível e lesionando estruturas adjacentes, por isso, acreditamos ser fundamental conhecer o manejo desta lesão.

Dorsal dislocations of the metacarpophalangeal joint of the fingers are rare injuries that are seen more frequently in young patients secondary to trauma due to forced hyperextension of the finger on the extending hand. They are classified as simple when closed reduction is possible, or complex when reduction by closed methods is not possible given the interposition of peri-articular structures. It is important to distinguish between a simple and complex dislocation because their approach and treatment differ. The objective of this study is to update the clinical approach and the different surgical techniques used in the treatment of complex dislocations. We conducted a bibliographic review on metacarpophalangeal dorsal dislocation of the long fingers, excluding those of the thumb, including the Medline (PubMed interface), SciELO and academic google databases. All the articles reviewed conclude that attempts at closed reduction in these types of injuries are often unsuccessful and often lead to additional complications. Open surgical reduction is the method of choice, allowing joint anatomical recovery with the lowest risk of complications. Postoperative immobilization using a dorsal locking splint is recommended for two weeks followed by rehabilitation by occupational therapy, expecting a normal range of motion at six weeks. The low frequency added to the ignorance of the emergency physician when performing the reduction maneuver can often lead to transform a simple dislocation into a complex one, making it irreducible and injuring adjacent structures, which is why we believe it is essential to know the management of this injury.

Reverse Neurocutaneous Flap Based on the Dorsal Branch of the Ulnar Artery for Palm Coverage in Children: Long-Term Results.

PURPOSE: Although the palm is spared mostly in severe burn injuries, it often is affected in children and requires radical excision of contracting scar tissue to allow normal hand development. Since alternatives are limited for palmar coverage, we primarily use a reverse-perfused, neurocutaneous dorsal ulnar artery flap. We report here our long-term follow-up results. METHODS: We reviewed the long-term results of 10 postburn palmar contracture release and flap coverage procedures in 10 children. The applied flap was based distally on the dorsal branch of the ulnar artery and harvested along the ulnar aspect of the hand and wrist. The pivot point of the flap was located dorsally, close to the 4th and 5th metacarpal base. Patients were followed for a median period of 6 years (range, 4-20 years). RESULTS: Flap size ranged from 60-130 mm in length and 20-35 mm in width. This variation in flap dimensions resulted from different hand sizes, because of the various patient ages at surgery. All flaps survived, donor site healing was uneventful, and marginal flap necrosis occurred only once. Satisfactory restoration of range of motion without secondary contractures was observed. Moreover, we detected adequate progressive growth, adaptability and sensory recovery in all flaps. Over time, the flaps mostly become hairless and progressively flattened without debulking. CONCLUSIONS: The importance of this flap lies in the potential for considerable tissue mobilization to cover palmar defects without sacrificing any major vascular axis. The adequate progressive growth of the flap facilitates functional hand development in children. The predictable vascular anatomy, wide range, and durable, thin, and pliable skin make the reverse neurocutaneous dorsal ulnar artery flap an appealing option for soft tissue reconstruction of the palm in children. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.

Evaluación de las relaciones entre la rama palmar profunda de la arteria ulnar y el ramo profundo del nervio ulnar en la región palmar / Evaluation of the relationship between the deep palmar branch of ulnar artery and the deep branch of the ulnar nerve in the palmar region

RESUMEN: Nos motivó esta presentación los hallazgos observados en la sala de disección sobre las relaciones de la rama palmar profunda de la arteria ulnar y el ramo profundo del nervio ulnar, las diferentes disposiciones de esta rama, el cruzamiento, cuando existe, entre ambos elementos y las pocas referencias sobre el tema, todo con miras a favorecer el abordaje profundo de la palma de la mano y contribuir al conocimiento del área en donde se practican las neurotomías del ramo profundo del nervio ulnar y/ o sus ramas.

SUMMARY: We are motivated by the findings observed in the dissection room on the relationship between the deep palmar branch of ulnar artery and the deep branch of ulnar nerve, the different dispositions of this branch, the crossing, when it exists, between both elements and the few references on the subject, all with a view to favoring the deep approach to the palm and contributing to the knowledge of the area where neurotomies of the deep branch of ulnar nerve and/or its branches are performed.

A very rare localization of a rare disease: palmar lichen nitidus

Abstract Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple, separated, shiny, pinpoint, pale to skin-colored papules. Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus. It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body. There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination. Herein, we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation.

A very rare localization of a rare disease: palmar lichen nitidus.

Lichen nitidus is an uncommon lichenoid dermatosis that could be defined as multiple, separated, shiny, pinpoint, pale to skin-colored papules. Palmoplantar lichen nitidus is a quite rare variant of lichen nitidus. It is hard to make a diagnosis of palmar lichen nitidus when there are no lesions elsewhere on the body. There are some dermoscopic features defined for both palmoplantar and non-palmoplantar lichen nitidus that might be useful to facilitate the diagnosis before histopathological examination. Herein, we report a case of a 24-year-old man diagnosed with isolated palmar lichen nitidus with dermoscopic features and histopathological confirmation.

Treating complex palmar-plantar wounds using a bilaminar 'trapdoor' technique: a case series.

OBJECTIVE: Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar-plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. METHOD: This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar 'trapdoor' technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. RESULTS: At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar-plantar region. CONCLUSION: This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar-plantar recipient region. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.

Disposición infrecuente de la arteria digital palmar propia radial del índice / Uncommon disposition of the index radial properpalmar digital artery

RESUMEN: Se presentan 3 casos de variación de origen de la arteria digital palmar propia radial del índice, dos de los cuales tienen su origen en la rama palmar superficial de la arteria radial, no detalladas previamente en la literatura, junto a variaciones vasculares en uno de ellos, mientras que en el tercero, su origen en la arteria digital palmar propia ulnar del pulgar, es fuente de controversia. Esto es discutida en la presente comunicación. Se describen anastomosis vasculares entre la arteria ulnar superficial, la rama palmar superficial de la arteria radial, la primera arteria interósea dorsal y la arteria digital palmar propia radial del índice, como circuitos anastomóticos alternativos.

SUMMARY: We present 3 cases of variation of origin of the index radial proper palmar digital artery, two of which have their origin in the superficial palmar branch of the radial artery, not previously detailed in the literature, together with vascular variations in one of them, while in the third, its origin in the palmar proper ulnar digital artery of thumb, is a source of controversy. This is discussed in this communication. Vascular anastomoses between the superficial ulnar artery, the superficial palmar branch of the radial artery, the first dorsal interosseous artery, and the radial index palmar digital artery are described as alternative anastomotic circuits.

Aspectos morfológicos del arco palmar superficial en individuos adultos mayores / Morphological aspects of the surface palmar arch in old adult individuals

RESUMEN: El objetivo de este trabajo consiste en el análisis de la posición del arco palmar superficial en la palma de la mano, con identificación del origen, forma de disposición, anastomosis presentes y terminación del mismo, proporcionando la experiencia propia y comparándola con los referentes del área, sin llevar adelante una comparación de clasificaciones, sino por el contrario, buscando analizar la información desde un punto de vista clínico-quirúrgico, demostrando la importancia del conocimiento de la anatomía real del arco palmar superficial al momento de abordar la anatomía vascular de la mano en todo tipo de situaciones patológicas.

SUMMARY: The objective of this work consists in the analysis of the position of the superficial palmar arch in the palm of the hand, with identification of the origin, form of disposition, present anastomosis and termination of the same, providing the own experience and comparing it with the referents of the area, without carrying out a comparison of classifications, but on the contrary, seeking to analyze the information from a clinical-surgical point of view, demonstrating the importance of knowledge of the real anatomy of the superficial palmar arch when addressing the vascular anatomy of the hand in all kinds of pathological situations.

Predicting the risk of postinflammatory hyperpigmentation: The palmar creases pigmentation scale.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) may affect any skin type but has been linked more often to darker skin. While propensity to hyperpigmentation has not been fully elucidated, there may be a direct correlation to one's palmar crease pigmentation. OBJECTIVE: The aim of this study is to validate the reliable use of a palmar creases pigmentation (PCP) scale, and its accuracy in predicting the risk of PIH. METHODS: A prospective, comparative, and blinded study was conducted through photo-numeric analysis of 126 photographs of pairs of palms. We utilized a 4-point visual scale based on the level of contrast between palmar crease pigment and that of the surrounding skin. Score 0 indicated no difference, score 1 referred to a low difference, score 2 meant a moderate difference, and score 3 related to a high difference. Scores were subdivided based on the risk of PIH. Scores 0-1 are low risk and scores 2-3 are high risk. A panel of 8 medical experts independently evaluated and re-evaluated the photographs that were shown in a random order. RESULTS: A significant degree of inter-rater reliability was found at both evaluation visits, with an intra-class correlation coefficient (ICC) = 0.908, P <.001, at the first evaluation and an ICC = 0.924, P <.001, at the second evaluation, demonstrating a validity of the scale. Global Fleiss kappa for intra-rater reliability for all physicians was 0.514. CONCLUSION: The PCP scale can be effectively used by any physician to predict hyperpigmentation risk.

Infrequent disposition of the first metacarpal artery related to anastomoses of the superficial and deep systems of the hand.

There is an infrequent disposition of the first metacarpal artery which results in an anastomosis with the common palmar digital artery of the second space, forming an anastomotic system between the deep radial system and the superficial ulnar system. The radial system in turn, through the first dorsal interosseous artery, anastomoses with a collateral of the common palmar digital artery of the second space, ending as the ulnar palmar digital artery of the thumb and establishing a second anastomotic system. A third anastomosis is established in one case, between the common palmar digital artery of the fourth space and the fourth metacarpal artery. To this may be added the classic anastomosis between the superficial branch of the ulnar artery and the deep branch of the radial artery, i.e. the deep palmar arch.

The Proximal Fasciocutaneous Hypothenar Flap Based on the Cutaneous Branch of the Deep Palmar Artery: A Case Report.

The abductor digiti quinti flap for thumb hypoplasia has been used in its muscular variant as musculocutaneous flap. Several authors have reported myocutaneous branches in the proximal hypothenar region which would vascularize the skin segment covering the hypothenar muscles. Nevertheless, the presence of a cutaneous branch deep palmar artery (CBDPA) vascularizing the proximal hypothenar territory and possibly responsible for the proximal hypothenar cutaneous vascularization was reported. In this paper, a fasciocutaneous hypothenar flap was designed, based on the CBDPA, transposed to the wrist anterior region for the treatment of a post burn contracture which was limiting the wrist extension. Its viability was assessed. The flap had a lozenge-shaped design from the cutaneous fold of the wrist to the fifth metacarpophalangeal joint over the abductor digiti quinti muscle. It was dissected in the fasciocutaneous plane to a width of 20 mm. The adipose tissue zone 10 mm distal to the pisiform was preserved, as well as the ulnar nerve sensory branch crossing the flap longitudinally. The flap was transposed to the anterior fold of the wrist. Neither the flap nor the donor site underwent complications. The patient improved wrist extension without referring any discomfort. Sensitivity was 8 mm 2 months after surgery compared to 6 mm within the preoperative period. In conclusion, it is possible to develop a proximal fasciocutaneous hypothenar flap based on CBDPA involving the proximal and distal hypothenar territory.

Bird visits and resource use in Butia odorata (Arecaceae) palm groves in southern Brazil / Visitas de pássaros e uso de recursos em palmares de Butia odorata (Arecaceae) no sul do Brasil

We evaluated avian use of a palm grove of Butia odorata (Barb. Rodr.) Noblick in the Brazilian Pampa. We recorded bird species richness, frequency of visits, and feeding behavior in palms trees with different flower and fruit availability. From January 2018 to February 2019, we observed 1,094 bird visits in 347 palm trees and identified 53 species. The most frequent visitors were Sicalis flaveola (Linnaeus, 1766), Myiopsitta monachus (Boddaert, 1783) and Zonotrichia capensis (Statius Muller, 1776). Perching was the most frequent use of palm trees by the birds (79%). Our hypothesis that an increase in the availability of flowers and fruits will be followed by a larger number of visits by insectivorous and frugivorous birds was not corroborated. In addition, there was a higher number of species visiting palm trees with no resources. The species composition and the number of guilds of visiting birds varied seasonally, but independently from resources availability. Bird richness, number of visits, and time length of visits did not vary between flowering/fruiting and resourceless palm trees. Based on this we argue that the main contribution of Butia odorata to the establishment of bird assemblages in palm groves is their role in offering perching, sheltering, and nesting sites.

Avaliamos as visitas das aves nas palmeiras Butia odorata (Barb. Rodr.) Noblick. em um palmar localizado no Pampa brasileiro. Registramos as espécies de aves, a frequência de visitas, e seu comportamento alimentar em palmeiras com diferentes disponibilidades de flores e frutos. Entre janeiro de 2018 e fevereiro de 2019 observamos 1.094 visitas em 347 palmeiras e registramos 53 espécies de aves. As visitas mais frequentes foram feitas por Sicalis flaveola (Linnaeus, 1766), Myiopsitta monachus (Boddaert, 1783) e Zonotrichia capensis (Statius Muller, 1776). O principal uso das palmeiras foi o uso como poleiro (79%). Nossa hipótese de que o aumento de oferta de flores e frutos seria acompanhado por um maior número de visitas de aves insetívoras e frugívoras não foi corroborada. Além disso, houve um maior número de espécies visitando as palmeiras sem recursos do que as com recursos. A riqueza de espécies, o número de visitas, bem como a duração das visitas não variaram entre as palmeiras com e sem flores ou frutos. Com isso nós acreditamos que a principal contribuição da Butia odorata no palmar para o estabelecimento da avifauna está relaciona com a oferta de poleiros, abrigos e sítios para nidificação.

Bird visits and resource use in Butia odorata (Arecaceae) palm groves in southern Brazil

ABSTRACT We evaluated avian use of a palm grove of Butia odorata (Barb. Rodr.) Noblick in the Brazilian Pampa. We recorded bird species richness, frequency of visits, and feeding behavior in palms trees with different flower and fruit availability. From January 2018 to February 2019, we observed 1,094 bird visits in 347 palm trees and identified 53 species. The most frequent visitors were Sicalis flaveola (Linnaeus, 1766), Myiopsitta monachus (Boddaert, 1783) and Zonotrichia capensis (Statius Muller, 1776). Perching was the most frequent use of palm trees by the birds (79%). Our hypothesis that an increase in the availability of flowers and fruits will be followed by a larger number of visits by insectivorous and frugivorous birds was not corroborated. In addition, there was a higher number of species visiting palm trees with no resources. The species composition and the number of guilds of visiting birds varied seasonally, but independently from resources availability. Bird richness, number of visits, and time length of visits did not vary between flowering/fruiting and resourceless palm trees. Based on this we argue that the main contribution of Butia odorata to the establishment of bird assemblages in palm groves is their role in offering perching, sheltering, and nesting sites.

RESUMO Visitas de pássaros e uso de recursos em palmares de Butia odorata (Arecaceae) no sul do Brasil. Avaliamos as visitas das aves nas palmeiras Butia odorata (Barb. Rodr.) Noblick. em um palmar localizado no Pampa brasileiro. Registramos as espécies de aves, a frequênc ia de visitas, e seu comportamento alimentar em palmeiras com diferentes disponibilidades de flores e frutos. Entre janeiro de 2018 e fevereiro de 2019 observamos 1.094 visitas em 347 palmeiras e registramos 53 espécies de aves. As visitas mais frequentes foram feitas por Sicalis flaveola (Linnaeus, 1766), Myiopsitta monachus (Boddaert, 1783) e Zonotrichia capensis (Statius Muller, 1776). O principal uso das palmeiras foi o uso como poleiro (79%). Nossa hipótese de que o aumento de oferta de flores e frutos seria acompanhado por um maior número de visitas de aves insetívoras e frugívoras não foi corroborada. Além disso, houve um maior número de espécies visitando as palmeiras sem recursos do que as com recursos. A riqueza de espécies, o número de visitas, bem como a duração das visitas não variaram entre as palmeiras com e sem flores ou frutos. Com isso nós acreditamos que a principal contribuição da Butia odorata no palmar para o estabelecimento da avifauna está relaciona com a oferta de poleiros, abrigos e sítios para nidificação.

Bird visits and resource use in Butia odorata (Arecaceae) palm groves in southern Brazil / Visitas de pássaros e uso de recursos em palmares de Butia odorata (Arecaceae) no sul do Brasil

We evaluated avian use of a palm grove of Butia odorata (Barb. Rodr.) Noblick in the Brazilian Pampa. We recorded bird species richness, frequency of visits, and feeding behavior in palms trees with different flower and fruit availability. From January 2018 to February 2019, we observed 1,094 bird visits in 347 palm trees and identified 53 species. The most frequent visitors were Sicalis flaveola (Linnaeus, 1766), Myiopsitta monachus (Boddaert, 1783) and Zonotrichia capensis (Statius Muller, 1776). Perching was the most frequent use of palm trees by the birds (79%). Our hypothesis that an increase in the availability of flowers and fruits will be followed by a larger number of visits by insectivorous and frugivorous birds was not corroborated. In addition, there was a higher number of species visiting palm trees with no resources. The species composition and the number of guilds of visiting birds varied seasonally, but independently from resources availability. Bird richness, number of visits, and time length of visits did not vary between flowering/fruiting and resourceless palm trees. Based on this we argue that the main contribution of Butia odorata to the establishment of bird assemblages in palm groves is their role in offering perching, sheltering, and nesting sites.(AU)

Avaliamos as visitas das aves nas palmeiras Butia odorata (Barb. Rodr.) Noblick. em um palmar localizado no Pampa brasileiro. Registramos as espécies de aves, a frequência de visitas, e seu comportamento alimentar em palmeiras com diferentes disponibilidades de flores e frutos. Entre janeiro de 2018 e fevereiro de 2019 observamos 1.094 visitas em 347 palmeiras e registramos 53 espécies de aves. As visitas mais frequentes foram feitas por Sicalis flaveola (Linnaeus, 1766), Myiopsitta monachus (Boddaert, 1783) e Zonotrichia capensis (Statius Muller, 1776). O principal uso das palmeiras foi o uso como poleiro (79%). Nossa hipótese de que o aumento de oferta de flores e frutos seria acompanhado por um maior número de visitas de aves insetívoras e frugívoras não foi corroborada. Além disso, houve um maior número de espécies visitando as palmeiras sem recursos do que as com recursos. A riqueza de espécies, o número de visitas, bem como a duração das visitas não variaram entre as palmeiras com e sem flores ou frutos. Com isso nós acreditamos que a principal contribuição da Butia odorata no palmar para o estabelecimento da avifauna está relaciona com a oferta de poleiros, abrigos e sítios para nidificação.(AU)

Caracterización de la comunicación ulnar-mediano palmar profunda en una muestra con material cadavérico / Characterization of ulnar-median deep palmar communication in a sample with cadaveric material

RESUMEN: La comunicación Ulnar-Mediano Palmar Profunda (CUMPP) es la conexión entre la rama profunda del nervio ulnar (NU) y la rama del nervio mediano (NM) que inerva a los músculos tenares como la cabeza superficial del flexor corto del pulgar. Son escasos los trabajos que se ocupan de esta rama comunicante, y su prevalencia es reportada con una amplia variabilidad, en un rango del 16-77 %. Este estudio no probabilístico, descriptivo, transversal, evaluó la frecuencia y características morfológicas de la CUMPP en 106 manos de especímenes cadavéricos frescos no reclamados, a quienes se les practicó necropsia en el Instituto de Medicina Legal de Bucaramanga (Colombia). Se observó rama comunicante CUMPP en 39 especímenes (50,2 %), de los cuales 12 (44,5 %) fueron bilate- rales, 15 (55,6 %) unilaterales, con predominio unilateral derecho para 9 casos (60 %), sobre el izquierdo de tan solo 6 casos (40 %). No se evidenciaron diferencias estadísticamente significativas con relación al lado de presentación (P=0,223). En 21 especímenes (54 %) se observó el tipo IV; mientras que el tipo I fue encontrado en 4 casos (10 %). El promedio de la longitud de la rama comunicante fue de 24,67 DE 6,46 mm; mientras que la distancia del punto proximal de la CUMPP al surco distal del carpo fue de 41,4 DE 2,6 mm. Nuestros hallazgos no son concordantes con lo reportado en la mayoría de estudios previos. Diversos factores como el tamaño de las muestras, las diferentes metodologías de medición y las expresiones fenotípicas de cada grupo de población evaluado, pueden explicar la variabilidad de la CUMPP.

SUMMARY: Deep Palmar Ulnar-Medium Communication (DPUMC) is the connection between the deep branch of the ulnar nerve (UN) and the median nerve (MN) branch, that innervates the thenar muscles as the superficial head of the short flexor of the thumb. Few studies dealing with this communicating branch, and its prevalence is reported with a wide variability in the range of 16-77 %. This non-probabilistic, descriptive, cross-sectional study; evaluated the frequency and morphological characteristics of DPUMC in 106 hands of fresh unclaimed cadaveric specimens, that underwent necropsy at the Institute of Legal Medicine of Bucaramanga (Colombia). DPUMC communicating branch was observed in 39 specimens (50.2 %), of which 12 (44.5 %) were bilateral, 15 (55.6 %) unilateral, with right unilateral predominance for 9 cases (60 %), on the left of only 6 cases (40 %). There were no statistically significant differences in relation to the presentation side (P = 0.223). In 21 specimens (54%), type IV was observed; while type I was found in 4 cases (10%). The average length of the communicating branch was 24.67 SD 6.46 mm; while the distance from the proximal point of the DPUMC to the distal carpal groove was 41.4 SD 2.6 mm. Our findings are not consistent with those reported in most previous studies. Various factors such as sample size, different measurement methodologies and phenotypic expressions of each population group evaluated can explain the variability of the DPUMC.