China
Africa
Explore chapters and articles related to this topic
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 most superficial muscle of the hand is the palmaris brevis (Plate 4.17a), which is accordingly innervated by the superficial branch of the ulnar nerve. No other hand muscle is innervated by this branch. The palmaris brevis is the single muscle remaining from a group of very superficial flexor muscles present in our early tetrapod ancestors. It is essentially vestigial in humans (Box 4.10), and is often inadvertently destroyed during dissection as it lies just deep to the skin of the palm of the hand. Deep to this muscle, and to the tendons of flexor digitorum superficialis, at the center of the carpal and metacarpal region, lie the lumbricals (Plate 4.17b). These muscles have a peculiar dual function: They flex the proximal phalanges and extend the distal phalanges of the fingers. These two actions are possible because the lumbricales have two insertions: They insert onto the radial side of the anterior (ventral) region of the base of the proximal phalanges of digits 2, 3, 4, and 5 to flex the proximal phalanges, and they also extend distally to insert onto the extensor expansion of these digits, thus reaching—and extending—their middle and distal phalanges. The innervation of the lumbricals is far easier to learn than their function; they share an innervation with their proximal attachments, the tendons of the flexor digitorum profundus. Therefore, the lumbricals to digits 2 and 3 are innervated by the median nerve, and the lumbricals to digits 4 and 5 are innervated by the ulnar nerve (see innervation of flexor digitorum profundus in Section 4.3.3).
The Hand
Published in Gene L. Colborn, David B. Lause, Musculoskeletal Anatomy, 2009
Gene L. Colborn, David B. Lause
Dissection of the Palm. At the medial aspect of the palm is the hypothenar eminence, which contains the muscles of the fifth digit. The most superficially placed muscle in the hypothenar eminence is the palmaris brevis. This thin muscle, frequently difficult to find, arises from the flexor retinaculum and palmar aponeurosis and inserts into the skin. Its contraction assists in deepening the cup of the palm. Identify the palmaris brevis and its nerve supply from the ulnar nerve.
Treatment of cold intolerance following finger pulp amputations: a case comparison between immediate finger replantation and delayed pulp and digital arterial arch reconstruction with flow-through free hypothenar flap
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Ryohei Ishiura, Makoto Shiraishi, Yoshimoto Okada, Kohei Mitsui, Chihena Hansini Banda, Kanako Danno, Mitsunaga Narushima
Preoperatively, locations of the hypothenar perforators were identified by color doppler ultrasound (APLIO 500 TUS − A500, Toshiba, Japan) and marked. Reconstruction was performed under general anesthesia and hemorrhage controlled with a pneumatic tourniquet. A 40 × 15 mm hypothenar perforator flap was designed in the ipsilateral hand and incised from the ulnar side. The flap was elevated above the palmaris brevis fascia with two artery perforators and two cutaneous veins included in the flap. The perforators were then dissected proximally and the pedicles prepared. The diameter of the artery pedicle was 1 mm on the proximal side and 1 mm on the distal side. A pedicle length of 15 mm was included in the flap for reconstruction of the digital arterial arch. The middle finger was prepared for the transfer with bilateral mid-lateral incisions and excision of the scar tissue. Bilateral proper palmar digital arteries and palmar digital veins were prepared for the anastomoses. The diameters of the recipient arteries were 1 mm on the ulnar side and 0.9 mm on the radial side. The diameters of the recipient’s veins were 1.2 mm on the ulnar side and 1 mm on the radial side. The harvested flap was placed on the prepared site with the distal side of the flap on the ulnar side of the fingertip. Both arteries were anastomosed in end-to-end fashion in flow-through style and both veins were also anastomosed end-to-end in antegrade fashion (Figure 2). The donor site was closed primarily. Intravenous Prostaglandin E1 analog (Apistandin, Fuji Pharma Co., Ltd, Tokyo, Japan) was administered at 40 micrograms a day for a week.