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At least 1,207 records · Page 67Linked to original sources
PubMed2003

The radial forearm flap as a carrier for the osteocutaneous fibula graft in mandibular reconstruction.

According to the concept of a free flap carrier we transferred an osteocutaneous fibula graft after microanastomosis to a pedicled radial forearm flap for reconstruction of the lower face in a patient with a total occlusion of the left and a subtotal occlusion of the right common carotid artery. The fibula was osteotomized in three segments to form the new mandible, and the skin paddle was placed extraorally. An external fixation device was connected to the radial bone, and a halo frame was fixed to the skull, and the forearm was thus stabilized rigidly in a suitable position. After 2 weeks, serial occlusion of the pedicle was begun twice daily. Blood flow and haemoglobin oxygenation of the skin paddle were measured by laser Doppler flowmetry and photometry. At the 14th day of ischaemic preconditioning, the flap could tolerate 3h of occlusion. Then the carrier vessels and the forearm flap were excised. The flap survived completely based on neovascularization from the recipient site.

Bone Transplantation↗
PubMed2002

Forearm reactive hyperemic blood flow and arm-cranking exercise capacity in healthy and heart failure subjects.

BACKGROUND: The relationship between lower limbs maximal vasodilatory capacity and exercise capacity in congestive heart failure (CHF) and healthy subjects has been well-documented. However, the relationship between upper limbs maximal vasodilatory capacity and exercise is less well-established. METHODS AND RESULTS: Twelve patients with CHF, 16 age-matched normal subjects, and 11 very fit individuals underwent an arm-cranking exercise test using maximal oxygen uptake (arm VO(2max)) and measurements of peak forearm reactive hyperemic blood flow. Despite similar forearm strength, arm VO(2max) was significantly reduced in patients with CHF when compared to normal and very fit individuals (13.9 +/- 2.9, 23.5 +/- 4.8, and 36.4 +/- 8.5 mL/kg/min, respectively, P <.05). Similarly, peak reactive hyperemia was lower in CHF patients as compared to normal and very fit individuals (18.6 +/- 5.9, 24.3 +/- 5.8, and 41.1 +/- 8.1 mL/100 mL/min, respectively, P <.05). There was a strong relationship between peak reactive hyperemic blood flow and arm VO(2max) (r =.75; P <.001) in all subjects. CONCLUSIONS: These results suggest a significant relationship between forearm vasodilatory capacity and arm-cranking VO(2max) in CHF patients, sedentary, and very fit individuals.

Adult↗
PubMed1999

In vivo MR studies of dynamic changes in the interosseous membrane of the forearm during rotation.

In vivo dynamic changes in the interosseous membrane (IOM) during forearm rotation were studied using magnetic resonance imaging (MRI). The right forearms of 20 healthy volunteers were examined in five different rotational positions. Axial slices were obtained at the proximal quarter, the middle and the distal quarter of the forearm. The changes in shape of the IOM during rotation were observed in an axial MR plane. For each image, we measured the interosseous distance and the length of the interosseous membrane. Images of the tendinous and membranous parts of the IOM could be differentiated by thickness. There were minimal dynamic changes in the tendinous part on the MRI while the membranous part showed numerous changes during rotation. The interosseous distance and the length of the interosseous membrane were maximum from a neutral to a slightly supinated position. The tendinous part is considered to be taut during rotation to provide stability between the radius and the ulna, but the membranous part which is soft, thin and elastic, allows smooth rotation.

Elasticity↗
PubMed2000

Efficacy of forearm versus upper arm tourniquet for local anaesthetic surgery of the hand.

A prospective study was undertaken to compare the use of forearm and upper arm tourniquets for local anaesthetic procedures on the hand. One hundred consecutive patients with an upper arm tourniquet were compared with a further consecutive 100 patients in whom a forearm tourniquet was used. The tourniquet time was always less than 20 minutes and the scoring of perceived pain was not significantly different in the two groups. Use of a forearm tourniquet was well tolerated and was not associated with an increase in complications.

Adult↗
PubMed1998

Glucose concentration in human subcutaneous adipose tissue: comparison between forearm and abdomen.

There is still controversy about the relation between the glucose concentration in the subcutaneous (sc.) adipose tissue and the blood plasma. Depending on the technique applied, the glucose concentration in sc. tissue varies between 50% and 100% of the plasma glucose concentration. In the present study the sc. glucose concentration of forearm and abdomen in seven healthy volunteers was compared with plasma glucose by applying the microdialysis technique with very low flow rates. A microdialysis probe implanted into the subcutaneous tissue of abdomen and forearm was perfused with a flow rate of 1 microl/4 min. The dialysate was sampled in three 2-h-fractions in the fasting state and in one 2-h-fraction during a hyperglycemic clamp (216.9+/-3.4 mg/dl) (mean +/- SEM). The mean recoveries of the plasma glucose were 91.1+/-4.1% in the forearm and 82.7+/-18.0% in the abdomen. The recoveries in the sc. tissue of abdomen and arm were not significantly different. However, the arm showed significantly (p < 0.014) less interindividual variance (range 73.2- 103.2%) than the abdomen (range 50.6-117.1%) and appears to be the preferable implantation site. The recovery remained constant during the investigation.

Abdomen↗
PubMed2000

[Ulnar lengthening in osteochondroma (multiple cartilagenous exostoses) of the forearm].

The osteochondroma is the most frequent bone tumor to occur during the period of growth. The multiple hereditary form often involves the forearms. Depending on localisation and size of the tumor, shortening of the bones in the forearm, angular malalignments and functional impairment of the wrist and elbow joints may result. Early diagnosis and surgery in the growing child can prevent these complications. 13 children were operated on altogether 15 forearms. In nine cases lengthening of the ulna was necessary to correct ulnar instability of the wrist as well as improving the support of the carpus and preventing dislocation of the radial head.

Adolescent↗
PubMed2000

Sensory recovery of innervated and non-innervated radial forearm free flaps: functional implications.

Findings reported in the literature on the sensation provided by intraorally applied innervated vs. non-innervated radial forearm free flaps differ. In an effort to understand these differences in sensory recovery, the authors carried out sensory evaluations in 12 patients who had undergone radial forearm free flaps. Seven patients had innervated flaps for defects of the tongue and floor of mouth; five had non-innervated flaps to various sites. Flap sensitivity to temperature, light touch, dull touch, and sharpness and two-point discrimination was assessed at the donor site and contralaterally, and at the recipient site and contralateral mirror-image oral mucosa. Patients subjectively rated post-reconstruction sensation and provided quality of life (QOOL) data. The innervated flaps demonstrated better sensory recovery than the non-innervated flaps, although the latter did restore reasonable sensation. This paper describes the results, compares the study to other similar studies, and discusses various factors in the sensory recovery of both innervated and non-innervated intraoral radial forearm free flaps. The authors conclude that, although the trend in this study is toward improved function with the innervated flaps, these flaps do not appear to offer major intraoral functional advantage over the non-innervated flaps, which attain reasonably effective sensory recovery from neural ingrowth, if the lingual nerve is intact.

Adolescent↗
PubMed2001

Radial forearm fasciocutaneous free-tissue transfer in ankle and foot reconstruction: review of 17 cases.

Seventeen patients who underwent soft-tissue reconstruction of various anatomic regions of the foot and ankle, using the radial forearm fasciocutaneous free flap, are reported. The procedures were performed between January, 1992 and December, 1998. Indications for reconstruction included diabetes and/or vascular insufficiency (four patients), soft-tissue defects (six patients), and chronic osteomyelitis (seven patients). The weight-bearing surface of the foot was involved in 16 patients. Defects ranged in size from 35 to 206 cm2 (mean: 86.2 cm2). At a mean follow-up of 3.8 years, the radial forearm flap was successful in all cases (100 percent). Flap complications included superficial infection (three patients), and minor wound dehiscence at the flap-leg-skin interface (two patients). Recurrent ulceration occurred in two patients; both were diabetics with weight-bearing flaps. Donor-site complications included partial skin graft loss with tendon exposure in one patient, which healed with conservative management. Recurrent or persistent osteomyelitis was not demonstrated in any of the patients. Of the 16 patients with weight-bearing flaps, 12 were ambulatory, three had limited ambulation, and one was non-ambulatory. Three patients required modified shoes. No debulking of the transferred flaps was necessary. The radial forearm flap is one of the preferred flaps for reconstruction of moderate-sized ankle and foot defects, for weight-bearing surfaces, and in the treatment of osteomyelitic and diabetic wounds. It meets most of the anatomic prerequisites for an ideal foot coverage; it also facilitates the restoration of normal foot contour, allowing patients to wear ordinary shoes. The flap provides a durable and stable weight-bearing plantar surface during ambulation, and achieves excellent aesthetic results; when used as a neurosensory flap, it permits adequate reinnervation.

Ankle↗
PubMed2001

Burned ear reconstruction using a prefabricated free radial forearm flap.

Postauricular skin, postauricular fascia, temporoparietal fascia (pedicle or free), the free radial forearm flap (fascial or fasciocutaneous), and free lateral arm fascial flap, have been used for burned ear reconstruction reported in the literature. Patients who did not have normal tissue around the ear region, because of severe thermal injuries to the external ear, are not available for draping the costal cartilage framework; these patients require free flaps. The author reports a burned ear reconstruction, using a prefabricated free radial forearm fasciocutaneous flap, included an autogenous costal cartilage framework. In this case, the front and back of the cartilage framework were covered with the skin of the forearm flap. This is the main difference from other techniques in the literature. This flap is valuable for burned ear reconstruction, when local tissue and other free flaps are not available.

Burns↗
PubMed2001

Usefulness of free sensate osteofasciocutaneous forearm and fibula flaps for neophallus construction.

Female-to-male transsexuals have been treated by the authors since the 1970's, using different operative methods. Since 1981, these patients have received neophallus construction with free sensate osteofasciocutaneous forearm flaps and, since 1993, with free sensate osteofasciocutaneous fibula flaps. In order to evaluate the usefulness of these flaps, the authors performed, in 24 patients (12 with forearm and 12 with fibula flaps), the following examinations: clinical and radiologic evaluations of the neophallus and its donor site, as well as patient questionnaires. In all patients, subjective findings and clinical examinations showed no significant variations in neophallus size and form. Patients with fibula flaps had better sexual intercourse, although their neophallus sensibility was minor, when compared to the forearm flap patients. Donor-site morbidity was moderate in both groups. On radiologic examination, robust, calcified bone structure, and no fracture of the neophallus bone and its donor site, as well as no instability of the ankle joint (in the fibula flap patients) were found. These findings further support the use of these free sensate osteofasciocutaneous flaps for neophallus construction. In the authors' opinion, it is the patient who must decide which method should be used for neophallus construction.

Female↗
PubMedDate not supplied

[Reliability of active range-of-motion measurement of the rotation in the forearm: comparison of three measurement devices].

AIM: The aim of this study is to prove the intra- and interobserver reliability of three different methods to measure the active range-of-motion in the forearm. METHODS: These three different methods were tested on forty volunteers. In the first method pictures were made in full supination and pronation, measurement of the two angles was performed with a dedicated software. Active range-of-motion was defined as the magnitude of forearm rotation between maximum pronation and supination. The second method used a standard goniometer. The third method of assessment used a gravity goniometer (plurimeter). We randomised both the side of the patient to be examined and the sequence of the methods. Two examiners measured subsequently the range-of-motion twice with these three devices. RESULTS: We found a significant intraobserver reproducibility with the gravity goniometer. There was no significance with the goniometer or pictures. The intraobserver reproducibility of the latter two methods was poor. The interobserver reproducibility of the gravity goniometer and pictures was significant, for the goniometer it was poor. Agreement between the pictures and gravity goniometer assessment of the range-of-motion was good. None of these two methods was significantly correlated with the goniometer assessment. CONCLUSION: For reproducibility of measurement of range-of-motion in the forearm the gravity goniometer is the best method, although the measured values were 5 % greater.

Adult↗
PubMed2002

Determination of the modulus of elasticity of bone material by an acoustical approach at the forearm distinguishes women with and without vertebral fractures independent of bone mineral density.

The modulus of elasticity is a parameter characterizing fracture stability of bone independent of bone mineral density. Measurement of acoustical properties of the forearm by determination of the resonant frequency of the ulna in longitudinal direction as a function of sound transmission velocity after adjustment of the measuring result by ulna length yields information about the modulus of elasticity. It was the aim of this study to investigate whether this parameter may distinguish between subjects with and without vertebral fractures independent of bone mineral density. Fifty females (61.1 +/- 9.1 years) were enrolled into the study, 25 with, and 25 age-matched without prevalent osteoporotic vertebral fracture(s). Especially low bone mineral density was not considered an exclusion criteria for enrollment into the control group. Resonant frequency of the ulna multiplied by ulna length was significantly lower in the group with prevalent fractures (53.6 +/- 6.8 m/s versus 56.8 +/- 5.2 m/s) after adjustment for age and after additional adjustment for forearm bone mineral density. Linear regression analysis showed complete independence of the acoustical parameter from bone mineral density. This study demonstrates that the modulus of elasticity of bone material is an independent risk factor for osteoporotic fractures. Acoustical measurement at the forearm by analyzing the resonant frequency of the ulna and correcting it by ulna length as geometrical parameter is capable of determining the modulus of elasticity in vivo.

Acoustics↗
PubMed2003

Fail-safe drainage procedure in free radial forearm flap transfer.

The reliability of the free radial forearm flap is widely accepted; however, postoperative venous thrombosis still occurs occasionally. Thus, establishment of a fail-safe drainage system has been a challenging frontier. A total of 405 consecutive free radial forearm flap transfers, carried out in the authors' department between 1987 to 2002, were reviewed retrospectively. The most reliable drainage method comprised the dual flap drainage veins of the superficial venous system (the cutaneous vein) and the deep system (the radial vena comitans), including their connecting cubital perforating vein, and the two neck recipient veins of the internal jugular and the external jugular venous systems. None of the flaps transferred by this method incurred venous failure, regardless of the surgeons conducting the operation. This study on the venous network in drainage systems of the free radial forearm flap demonstrated that the described method functions in a self-sustaining manner, and contributes to protection against venous catastrophe.

Anastomosis, Surgical↗
PubMed2004

Aberrant branch of the radial artery encountered during elevation of the radial forearm free flap.

Although the radial arterial system is fairly consistent in structure, rare anomalies have been encountered. During the elevation of a radial forearm free flap for floor of mouth reconstruction, the authors have encountered an accessory branch of the radial artery arising from the main radial artery at the level of the mid forearm, extending laterally over the brachioradialis muscle, and descending into the dorsal wrist in the subcutaneous plane. This artery, named as the superficial radial artery, is a very rare vascular anomaly of the radial arterial system in the forearm. The reconstructive surgery literature is relatively silent about this particular variant. Knowledge of possible anatomic anomalies and careful identification of vessels are important to prevent damage to the arterial system and enable optimal flap harvest.

Carcinoma, Squamous Cell↗
PubMed2005

Evaluation of the donor site in patients who underwent reconstruction with a free radial forearm flap.

A major disadvantage of free radial forearm flaps is the conspicuous donor site. However, there have been few studies on donor scars. The authors evaluated the donor site in patients who underwent oral-floor reconstruction with a free radial forearm flap. The subjects were 23 patients (19 males and four females) who underwent reconstruction with a free radial forearm flap following resection of a malignant oral tumor, and were followed for 1 year or longer. The fasciocutaneous flap collection site was closed by full-thickness skin graft (FTSG) from the groin with tie-over dressing. All grafts took perfectly. At the scar at the donor site, five items (pigmentation, scar width, depression, wrist mobility, and sensory abnormalities) were evaluated. Depression and pigmentation were often observed, but patient dissatisfaction was slight. While their main postoperative concern was the oral reconstruction site, after about 1 year, the donor site became more important to patients. However, the results were good. A 100 percent take of the FTSG at the donor site should produce good results. Surgeons should pay adequate attention not only to the outcome at the reconstruction site, but also to the closure of the donor site.

Adult↗
PubMed1997

Mucosal prelamination of a radial forearm flap for intraoral reconstruction.

For reconstruction of intraoral soft-tissue defects after radical resection of squamous-cell carcinomas, the microvascular jejunal patch has been a reconstructive graft option of first choice. in addition to other advantages, these jejunal grafts are able to produce mucus. In cases in which the use of jejunal grafts is contraindicated, the fasciocutaneous radial forearm flap has enlarged the spectrum of reconstructive options. A disadvantage is that mucus production will be absent, because mucosal and lining reconstruction is performed with tissue lacking mucus-providing qualities. The authors successfully prelaminated a distal radial forearm flap with buccal mucosa in five patients. Mucosal prelamination of the distal radial forearm flap enables a physiologic reconstruction with resultant mucus production, in combination with the provision of thin, pliable, and resistant flaps. The technique lowers donor-site morbidity because of the preservation of skin and subcutaneous tissue. Reconstruction with fasciomucosal, osteomyomucosal, and myomucosal flaps by this method seems feasible.

Adult↗
PubMed1995

Vascular variation of the radial forearm flap: a case report.

Anomalies of the radial forearm flap have been reported; however, rarely does one encounter variations that jeopardize the vascular supply of the flap. In the reported case, an anomalous superficial vessel in the forearm supplied the skin island of the radial forearm flap. In addition, there were no perforating vessels from the radial artery.

Aged↗
PubMed2002

Diadenosine pentaphosphate vasodilates the forearm vascular bed: inhibition by theophylline and augmentation by dipyridamole.

BACKGROUND: In rats, diadenosine pentaphosphate (AP(5)A) has been implicated in the pathogenesis of essential hypertension. This study describes for the first time the vasomotor action of AP(5)A in humans by means of the "perfused forearm technique." RESULTS: AP(5)A evoked a dose-dependent forearm vasodilator response equal to that of adenosine but less than that of adenosine triphosphate (ATP) at equimolar doses. The P(1)-purinoceptor antagonist theophylline (0.28 micromol/min per deciliter) reduced the percentage decrease in forearm vascular resistance (FVR) to AP(5)A (0.6, 6, and 20 nmol/min/dL): -8% +/- 6%, -50% +/- 6%, and -68% +/- 4% during saline solution versus -7% +/- 4%, -33% +/- 5%, and -45% +/- 6% during theophylline (mean +/- standard error [SE]; ANOVA for repeated measures; P <.05 for the interaction between purine dose and theophylline; n = 10). An inhibitor of equilibrative nucleoside transport, dipyridamole (7.4 nmol/min per deciliter), augmented the AP(5)A (0.6 and 6 nmol/min per deciliter)-induced reduction in FVR as follows: -34% +/- 6% and -67% +/- 5% during saline versus -49% +/- 5% and -80% +/- 3% during dipyridamole (P <.05 for the effect of dipyridamole; n = 6). The bivalent cation chelator ethylenediaminetetra-acetic acid (EDTA) inhibited the rapid degradation of AP(5)A in vitro. In vivo, the highest tolerated intra-arterial EDTA dose was not sufficient to inhibit AP(5)A metabolism. CONCLUSION: Intra-arterial AP(5)A caused a dose-dependent reduction in FVR. This is, at least in part, mediated by its degradation product adenosine. The data do not support an in vivo vasoconstrictor action of AP(5)A, and as such AP(5)A does not seem likely to contribute to the pathogenesis of primary hypertension in humans.

Adult↗