Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources.

Abstract PURPOSE: The reverse posterior interosseous artery flap has several advantages, not sacrificing any major blood vessel, but its relatively short pedicle limits the use to cover defects up to the metacarpophalangeal joint. Our purpose is to demonstrate that the ligature of the anterior interosseous artery (AIA), proximal to the communicating branch with the posterior interosseous artery, leads to an improved flap rotation arch, preserving both vascular sources. METHODS: Sixteen fresh cadavers with latex perfusion were analyzed before and after our technique of elongation, and the so-obtained measures were standardized in "percentage of elongation of the pedicle." Eight patient with the loss of substance at the dorsal aspect of the hand have been treated with this technique, and results were evaluated in terms of flap survival and complication rates. RESULTS: The medium length of the pedicle in the normal flap was 10.8\u2009cm, and after the section of the AIA, the medium length of the pedicle was 13.6\u2009cm with a medium increase of 2.8\u2009cm. It means a medium increase of 24% of the length of the pedicle. In all patients treated, full coverage of the defect was obtained, and we did not experience major complications. CONCLUSIONS: This anatomical study supported by our clinical experience demonstrates that the use of the variant described above permits to reach more distal part of the hand without being afraid to stretch the pedicle because of the connection with the anastomotic arcades of the AIA at the wrist reducing the risk of ischemia of the flap

Critical Upper Limb Ischemia Due to Brachial Tourniquet in Misdiagnosed Thoracic Outlet Syndrome after Carpal Tunnel Decompression: A Case Report

We present the case of a 68-year-old woman, referred to our department for critical upper limb ischemia, which had occurred a few days after homolateral surgical ligamentotomy for carpal tunnel syndrome, diagnosed and confirmed by electromyography, and performed with a brachial tourniquet. The patient was later admitted for subsequent progressive necrosis of the first three fingers of the left hand, accompanied by signs of upper limb ischemia. An accessory cervical rib was identified, completely obliterating the subclavian artery distally at the origin of the suprascapular artery. A complete humeral artery occlusion was also found at the middle third of the humerus. The accessory rib was resected and the subclavian artery recanalized. A few days later, necrosis of the distal third of the first two fingers appeared and surgical resection was performed. Despite this chronic condition, the acute occlusion of collateral circles was probably induced by the brachial tourniquet. This represents a rare event, never previously reported in the literature: a case of critical upper limb ischemia due to a brachial tourniquet in a patient with misdiagnosed thoracic outlet syndrome. Until specific electrophysiological criteria for this syndrome can be found, attention should focus on history and clinical examination in patients with suspected carpal tunnel syndrome

Gender-specific Anatomical Distribution of Internal Pudendal Artery Perforator: A Radiographic Study for Perineal Reconstruction

Background: Cancer, trauma, infection, or radiation can cause perineal defects. Fasciocutaneous flaps based on perforator vessels (PV) from the internal pudendal artery (IPA) provide an ideal reconstructive option for moderate defects. We hypothesized that, due to gender differences in the pelvic-perineal region, the anatomical distribution of PV differs between genders. Methods: Computed tomography angiographies from male and female patients without pelvic-perineal pathologies were retrospectively analyzed to study the vascular anatomy of the IPA. The number, size, type, and distribution of PV were recorded and compared between genders. Four anatomical regions were defined to describe the distribution of PV on each perineal side: anterior (A), anterior-central (AC), central-posterior (CP), and posterior (P). Results: A total of 63 computed tomography angiographies were analyzed (men, 31; women, 32). Each IPA provides 2 +/- 1 PV and 5 +/- 2 terminal (cutaneous) branches: in both genders, 85% of PV are septocutaneous (15% musculocutaneous). In women, 70.5% of PV are located in AC, 28.2% in CP, 1.2% in A, and 0% in P: average diameter of the PV is 2.4 +/- 0.3 mm. In men, 53.7% of PV are located in CP, 43.1% in AC, 3.3% in A, and 0% in P: average diameter of the PV is 2.8 +/- 0.5 mm. Gender-specific differences in anatomical distribution of PV are significant (P \u3c 0.001). Conclusions: Number, size, and type of terminal branches of PV of the IPA are consistent between genders, but their distribution is different, with women having an anterior predominance. Knowledge of gender-specific anatomy can guide preoperative planning and intraoperative dissection in flap-based perineal reconstruction

Gaze, behavioral, and clinical data for phantom limbs after hand amputation from 15 amputees and 29 controls

Despite recent advances in prosthetics, many upper limb amputees still use prostheses with some reluctance. They often do not feel able to incorporate the artificial hand into their bodily self. Furthermore, prosthesis fitting is not usually tailored to accommodate the characteristics of an individual's phantom limb sensations. These are experienced by almost all persons with an acquired amputation and comprise the motor and postural properties of the lost limb. This article presents and validates a multimodal dataset including an extensive qualitative and quantitative assessment of phantom limb sensations in 15 transradial amputees, surface electromyography and accelerometry data of the forearm, and measurements of gaze behavior during exercises requiring pointing or repositioning of the forearm and the phantom hand. The data also include acquisitions from 29 able-bodied participants, matched for gender and age. Special emphasis was given to tracking the visuo-motor coupling between eye-hand/eye-phantom during these exercises

Anatomo-radiological study of the internal pudendal perforator vessels : clinical relevance in reconstructive surgery of the perineal region

Introduction. The mobilization of muscular and fasciocutaneous flaps represents a mandatory reconstructive surgery in a variety of soft tissue defects of the the pelvi-perineal area. Often oncological surgery, trauma or severe soft tissue infections such as Fournier’s gangrene, produce functional and morphological deformities of this region. An appropriate soft tissue reconstruction may limit the development of scar contractures and stenosys. The possibility to better localize the main vascular perforators may help the surgeon in a safe flap mobilization. Methods. To objectively document the topografical location of external and internal pudendal arteries and respectively perforators branches, an anatomo-radiological study on 24 CT angiographies of 12 lower limbs (multidetector CT 16 slides), and analysis of multiplannar images and 3D reconstructions (Terarecon™) were performed. The origin, number, course and location of perforators of the internal pudendal artery in vivo were recorded. Results. Superficial landmarks (anus, external urethral meatus and ischiatic tuberosity) may describe a safe cutaneous perineal region in which is possible to localize all internal pudendal perforator arteries. In this area the mean number of perforators was 2,6 (range: 0-4). In one case (4%) the perforators vessels originated from the inferior gluteal artery. The mean diameter of perforators was 2,3 mm (0,47SD; range 1,4-3,4). The most proximal perforator of the internal pudendal artery presented a mean caliber of 2,6 mm (range 2-3,4). Discussion. This study confirms the presence of a rich vascular network between the internal and external pudendal artery. Moreover a reliable caliber and constant location of the perforators of the internal pudendal artery are documented. These observations are also confirmed intraoperatively during the mobilization of perforators flaps for the reconstruction of perineal area. The knowledge of the rich vascular plexus allows to plan a variety of fascio-cutaneous perforator flaps that may guarantee better reconstruction results then the past

The profunda artery perforators: Anatomical study and radiological findings using computed tomography angiography in patients undergoing PAP flap breast reconstruction

Background: The popularity of the profunda femoris artery perforator (PAP) flap is increasing; however, knowledge concerning the standardization of radiological findings and their clinical implications is limited. We evaluated the radiological architecture of posterior thigh perforators using Computed Tomography Angiography (CTA) to identify landmarks to facilitate flap dissection. Methods: A retrospective study was conducted on 35 patients who underwent unilateral breast reconstruction with a PAP flap. The preoperative CTA scans were analyzed, and the perforator characteristics were evaluated. The perforators were mapped using a Cartesian coordinate system. Data were normalized by anatomical landmarks and overlapped. Perioperative and postoperative results were analyzed. Radiological and intraoperative were compared. Results: Two CTA scans were excluded; 66 thighs were examined. The mean perforator number was 3.2. The mean diameter of chosen perforators was 2.7 mm (DS ± 0.6 mm) at the origin, 2.2 mm (DS ± 0.4 mm) at the adductor space midpoint, and 1.7 mm (DS ± 0.3 mm) at the deep fascia. The mean adipose tissue thickness was 3.35 cm (DS ± 0.94) at the deep fascia and 3.59 cm (DS ± 1.19) at the adductor space midpoint. Intraoperatively, the perforator was located 3.22 cm (DS ± 0.87) from the posterior border of the gracilis muscle and 8.98 cm (DS ± 1.44) from the inferior gluteal crease. A radiological area located 9.33 cm (DS ± 4.81) from the y-axis and 7.48 cm (DS ± 1.88) from the x-axis was identified. Conclusions: CTA using the volume-rendering technique is a valuable method to study in vivo the radiological anatomy of the posterior thigh perforators

Gaze, visual, myoelectric, and inertial data of grasps for intelligent prosthetics

A hand amputation is a highly disabling event, having severe physical and psychological repercussions on a person’s life. Despite extensive efforts devoted to restoring the missing functionality via dexterous myoelectric hand prostheses, natural and robust control usable in everyday life is still challenging. Novel techniques have been proposed to overcome the current limitations, among them the fusion of surface electromyography with other sources of contextual information. We present a dataset to investigate the inclusion of eye tracking and first person video to provide more stable intent recognition for prosthetic control. This multimodal dataset contains surface electromyography and accelerometry of the forearm, and gaze, first person video, and inertial measurements of the head recorded from 15 transradial amputees and 30 able-bodied subjects performing grasping tasks. Besides the intended application for upper-limb prosthetics, we also foresee uses for this dataset to study eye-hand coordination in the context of psychophysics, neuroscience, and assistive robotics

Gaze, visual, myoelectric, and inertial data of grasps for intelligent prosthetics

A hand amputation is a highly disabling event, having severe physical and psychological repercussions on a person’s life. Despite extensive efforts devoted to restoring the missing functionality via dexterous myoelectric hand prostheses, natural and robust control usable in everyday life is still challenging. Novel techniques have been proposed to overcome the current limitations, among them the fusion of surface electromyography with other sources of contextual information. We present a dataset to investigate the inclusion of eye tracking and first person video to provide more stable intent recognition for prosthetic control. This multimodal dataset contains surface electromyography and accelerometry of the forearm, and gaze, first person video, and inertial measurements of the head recorded from 15 transradial amputees and 30 able-bodied subjects performing grasping tasks. Besides the intended application for upper-limb prosthetics, we also foresee uses for this dataset to study eye-hand coordination in the context of psychophysics, neuroscience, and assistive robotics

In vitro and in vivo study of a novel biodegradable synthetic conduit for injured peripheral nerves

In case of peripheral nerve injury (PNI) with wide substance-loss, surgical reconstruction is still a challenge. Bridging the gap by autologous sensory nerves as grafts is the current standard; nevertheless, the related issues have prompted the research towards the development of effective artificial synthetic/biological nerve conduits (NCs). Here, we manufactured a novel NC using oxidized polyvinyl alcohol (OxPVA) that is a biodegradable cryogel recently patented by our group [1]. Thus, its characteristics were compared with neat polyvinyl alcohol (PVA) and silk-fibroin (SF) NCs through in vitro/in vivo analysis. Considering in vitro studies, a morphological characterization was performed by Scanning Electron Microscopy (SEM). Thereafter, cell adhesion and proliferation of a Schwann-cell line (SH-SY5Y) were evaluated by SEM and MTT assay. Regarding in vivo tests, the NCs were implanted into the surgical injured sciatic nerve (gap: 5 mm) of Sprague-Dawley rats, and the functional recovery was assessed after 12-weeks. The NCs were then processed for histological, immunohistochemical (anti-CD3; -β-tubulin; -S100) and Transmission Electron Microscopy (TEM) analyses. In particular, morphometric analyses (section area, total number and density of nerve fibers) were performed at the level of proximal, central and distal portions with respect to NC. In vitro results by SEM showed that PVA and SF supports have a smoother surface than OxPVA scaffolds. Moreover, unlike SF scaffolds, PVA-based ones do not support SH-SY5Y adhesion and proliferation. Regarding the in vivo study, all animals showed a functional recovery with normal walk, even though only animals implanted with PVA and SF NCs sometimes showed spasms while walking. On the contrary, animals implanted with OxPVA NCs exhibited a normal movement. Anti-CD3 immunohistochemistry assessed the absence of severe inflammatory reactions in all the grafts. A strong positive immunoreaction for β-tubulin and S100 demonstrated the good regeneration of nervous fibers. TEM highlighted regeneration of myelinated/un-myelinated axons and Schwann cells in all the grafts. However, morphometric analysis demonstrated that OxPVA assure a better outcome in nerve regeneration in terms of total number of nerve fibers. Our results sustain the potential of OxPVA for the development of NCs useful for PNI with substance loss with the advantage of biodegradation