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Complications of upper extremity bypass grafting for occlusive and aneurysmal disease
Published in Sachinder Singh Hans, Mark F. Conrad, Vascular and Endovascular Complications, 2021
The radial artery can be exposed at the mid-forearm or at the wrist. For both exposures, the arm is prepped circumferentially for intraoperative manipulation and is positioned with shoulder abducted to 90 degrees and the hand in the supinated position. The radial artery in the forearm follows a path along the medial edge of the brachioradialis muscle, and the incision should be made along this line. It can be useful to first identify the artery with ultrasound and mark the incision on the skin, especially when an abundance of adipose tissue obscures the surface anatomy of the arm. The antebrachial fascia is thick, and division will expose the radial artery in the proximal two-thirds of the forearm between the brachioradialis and pronator teres muscles. The radial artery is again flanked by paired veins and crossing veins must be ligated to fully expose the artery. In the middle third of the forearm, the superficial radial nerve runs in close proximity to the radial artery and should be identified and avoided.
Surgery of the Elbow
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Alan Salih, David Butt, Deborah Higgs
The antebrachial fascia is incised parallel to and about 1 cm lateral to the crest of the ulna over anconeus. The dissection is taken under the fascia but outside anconeus to the crest and then, on bone, down to the supinator crest, the annular ligament and capsule of the proximal radioulnar joint, lifting anconeus away from the capsule and radial head, but preserving the posterior band of the lateral collateral ligament (to maintain stability in varus strain).
Upper Limb
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
The brachial fascia or deep fascia of the arm is formed by connective tissue that is continuous proximally with the pectoral fascia and the axillary fascia and distally with the antebrachial fascia or deep fascia of the forearm. Importantly, it is also connected to the medial and lateral sides of the humerus by intermuscular septa, forming the posterior (extensor) compartment of the arm and the anterior (flexor) compartment of the arm. The anterior compartment includes the muscles biceps brachii, brachialis, and coracobrachialis (Plate 4.10), which are innervated by the musculocutaneous nerve and form a developmental and evolutionary unit (Table 4.3). Students often confuse the long and short heads of the biceps; however, it is easy to remember once you realize that the long head is actually longer because it originates from the supraglenoid tubercle of the scapula, while the short head originates from the inferior tip of the coracoid process of the scapula. The posterior compartment includes the triceps brachii (Plate 4.11), which has a long head, a lateral head, and a medial head, and is innervated mainly by the radial nerve (Table 4.4). Most atlases and textbooks state that the anconeus is a posterior arm muscle developmentally related to the triceps brachii, but it is actually a posterior forearm muscle that is developmentally and evolutionary closely related to the extensor carpi ulnaris (see Section 4.3.3).
A Unique Method for Total Nasal Defect Reconstruction - Prefabricated Innervated Osteocutaneous Radial Forearm Free Flap
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Uros Ahcan, Vojko Didanovic, Ales Porcnik
In the 1st stage, an innervated osteocutaneous radial forearm free flap was designed based on a sterilised rubber 3D nose mold, which served as a template for skin incisions (Figure 1A). With meticulous dissecti on we preserved the osseous perforators to the radial bone, ensuring its vascular supply (Figure 1B, C). After radial osteotomy, an “L” shaped bone framework was reconstructed, using titanium micro plate and screws according to the preoperative measurements and 3D print (Figure 1D). Refined bone shaping enabled shaping of the columella and vertical bone thin. Well-vascularised bony framework was additionally covered with antebrachial fascia, further increasing vascularity. Prefabricated titanium coated cage was used to form soft tissues from the newly raised flap (“neo-nose”) (Figure 2A, B). Tissues were held in a rigid and anatomically correct position - representing nose inner lining. Titanium coated cage gave a desired support to the nasal vestibulum, tip, alae and the columella. A lateral antebrachial cutaneous nerve (LABCN) was dissected and preserved. When the “neo nose” was completed, it was reconnected back to the forearm (Figure 2C, D). In this stage, a tissue expander was placed in the subgaleal plane on the forehead, which was later regularly filled with saline solution until its maximum. Patient was discharged without any substantial facial disfigurement, except of placed tissue expander on the forehead (Figure 3). She wore temporary nasal prosthesis until next stage. Figure 4 shows x-ray of newly reconstructed “neo nose” with its bony framework and titanum coated cage.