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Anatomy
Published in Peter Houpt, Hand Injuries in the Emergency Department, 2023
Clearly visible on the volar side of the wrist are the tendons of the m. flexor carpi radialis, the m. palmaris longus (which is not present in approximately 20% of the population) and the m.flexor carpi ulnaris (Figure 2.1).
Introduction
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The palmaris longus is a muscle of the superficial flexor compartment of the forearm. It inserts into the distal half of the flexor retinaculum and palmar aponeurosis. It is supplied by the median nerve. It acts as a tensor of the palmar aponeurosis and a weak wrist flexor. This muscle is phylogenetically degenerated and has been reported quite extensively for its anatomical variability and variation in the prevalence of absence in different ethnic groups. It is an expendable tendon used as a tendon graft in various reconstructive surgeries of the upper limb. Its absence has been reported in literature as 16% unilateral and 9% bilateral [20]. Considering its potential use and demand for tendon reconstruction, its presence has to be checked routinely in any clinical practice. There have been various methods described in literature to check the presence of palmaris longus (Figures 1.46–1.49).
Upper Limb Muscles
Published in Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo, Handbook of Muscle Variations and Anomalies in Humans, 2022
Eve K. Boyle, Vondel S. E. Mahon, Rui Diogo
Both its origin and insertion are variable. Palmaris longus can originate from the medial intermuscular septum, biceps, brachialis, the fascia of the forearm, the coronoid process, or the radius (Macalister 1875; Knott 1883a; Bergman et al. 1988; Akita and Nimura 2016b). It can insert onto the interosseous membrane, forearm fascia, the flexor carpi ulnaris tendon, abductor pollicis brevis, the hypothenar eminence, any one of the flexor tendons, the pisiform, scaphoid, or digit four (Macalister 1875; Knott 1883a; Bergman et al. 1988; Akita and Nimura 2016b). The proportion of fleshy muscle belly to tendon in palmaris longus is variable (Macalister 1875; Knott 1883a; Bergman et al. 1988; Akita and Nimura 2016b). The tendon and muscle can be inverted so that palmaris longus is fleshy distally and the tendon is proximal, in which the muscle would be termed palmaris longus inversus (Macalister 1875; Mori 1964; Bergman et al. 1988; Akita and Nimura 2016b; Georgiev et al. 2017b).
Comparing the outcomes of fingertip-to-palm and fingertip-to-forearm two-stage flexor tendon reconstruction for isolated flexor digitorum profundus tendon injuries
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Osman Orman, Ethem Ayhan Ünkar, Kahraman Öztürk
Second stage was planned to be performed after 12 weeks when the injured digit could be passively flexed to touch the palm. Bruner-type incision at the distal phalanx was used to reveal the distal stump of the FDP and the distal end of the tendon implant and the connecting sutures were divided. Cautious dissection was held not to harm the pseudosheath proximal to the DIP joint or to injure any of the pulleys. The proximal end of the implant was retrieved through the forearm or palm incision. Tendon stripper is employed to harvest the grafts. The tendon graft is sutured to the proximal end of the implant and pulled through the new tendon sheath. Palmaris longus tendon was used as tendon graft in 28 patients (80%) and plantaris tendon was used in seven patients (20%). Tenorrhaphy was applied to the FDP tendon of the involved digit in group I. In group II, common profundus tendon mass was used as a motor for 3rd, 4th and 5th digits, whereas the involved digit’s independent profundus tendon was used as a motor for the 2nd digit. Graft fixation was achieved distally using a grasping suture passed volar to dorsal through drill holes in the distal phalanx and secured on a button. Nonabsorbable sutures were used to suture the FDP tendon remnant on the distal phalanx to the tendon graft as reinforcement. The proximal tendon graft is secured in the palm or distal forearm with a Pulvertaft weave technique, secured with nonabsorbable suture. If palm-to-fingertip graft is used, the proximal juncture is made just distal to the lumbrical origin. Intraoperatively, restoration of the natural digital cascade has been confirmed.
Reconstruction of giant full-thickness lower eyelid defects using a combination of palmaris longus tendon with superiorly based nasolabial skin flap and palatal mucosal graft
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Wangshu Wang, Hao Meng, Shujian Yu, Tianyi Liu, Ying Shao
A free composite graft of hard palate mucosa was used to repair the posterior layer of the eyelid. Because the oral mucosa has a texture similar to the palpebral conjunctiva, and supportive features similar to the tarsal tissue, both the eyelid conjunctiva and tarsal plate could be reconstructed. The palatal mucosa grafts measuring 0.5 × 3 cm to 1.5 × 3 cm were harvested from the hard palate and then sutured to the residual bulbar conjunctiva in the fornical area of the lower eyelid using resorbable stitches (Figure 2). The palmaris longus tendon 3.5–4 cm in length and 0.3–0.5 cm in width was harvested according to the size of the palpebral fissure in individual patients. If the palmaris longus tendon was too wide, blood circulation within the inner layer of the free hard palatal mucosa composite tissue would be affected, thus leading to necrosis. If the palmaris longus tendon was too narrow, it would not generate sufficient tension to support the reconstructed eyelid. The two sides of the palmaris longus tendon were riveted on the periostea, corresponding to the inner and outer canthus, and the central part was sutured intermittently with the free hard palatal mucosa graft.
Reconstruction of a metacarpal head defect due to bite injury: two case reports
Published in Case Reports in Plastic Surgery and Hand Surgery, 2018
Akito Nakanishi, Kenji Kawamura, Shohei Omokawa, Takamasa Shimizu, Yasuhito Tanaka
An intraoperative Gram-stain wound culture did not reveal any bacteria due to treatment with the initial oral antibiotics. Surgical debridement was performed three times with intravenous systematic antibiotic therapy to resolve osteomyelitis completely. A large defect of the third extensor and third metacarpal head occurred due to the repeated debridements (articular defect size: 18 × 15 mm) (Figure 7(A)). The patient could not move his third finger due to pain. The motion arc was 0°, the pinch strength of the injured finger was 1.0 kg, and the DASH score was 52. Therefore, the patient was treated with an osteochondral vascularised medial femoral trochlea (MFT) flap for the third metacarpal head defect (Figure 7(B)). The flap was harvested using the method described by Bürger et al. [3,4]. The width, length, and depth of the osteocartilaginous segment were 18, 15, and 12 mm respectively. This segment was harvested on the transverse branch and common descending geniculate artery (DGA) (Figure 8(A)). The length of vascular pedicle available was 6.0 cm. No other procedure was performed at the donor site after harvesting the bone flap. DGA vessels were end-to-end anastomosed to the radial artery and accompanying vein at the snuff box (Figure 8(B)). Fixation was achieved with two K-wires (1.2 mm) through a dorsal approach at the MCP joint (Figure 9(A)). The cartilage-bearing segment of the MFT provided a good counter match with the MCP joint. Third extensor reconstruction was performed with a palmaris longus tendon graft.