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PubMed2003

Vascular dominance in the forearm.

The dominance of the radial or ulnar artery at the forearm level and their contributions to the circulation of the hand remain a matter of contention. Therefore, the authors proposed to investigate the predominance of one of these arteries first by anatomic studies on 40 fresh cadaver upper extremities, and then by dynamic studies. The dynamic studies included color Doppler sonography in 22 individuals (44 hands) and five-channel plethysmography in 40 individuals (40 right hands). It was found that the ulnar artery is dominant at the elbow, but after originating its collateral branches, the radial artery becomes the dominant artery in the distal forearm and, consequently, constitutes the major source of vascularization to the hand. The ulnar artery is rarely dominant at the forearm level and is physiologically less important. Therefore, there is no hemodynamic reason to prefer the radial artery to the ulnar artery for any invasive maneuvers.

Forearm↗
PubMed2004

Total lower lip reconstruction with a composite radial forearm-palmaris longus tendon flap: a clinical series.

Large, full-thickness lip defects after head and neck surgery continue to be a challenge for reconstructive surgeons. The reconstructive aims are to restore the oral lining, the external cheek, oral competence, and function (i.e., articulation, speech, and mastication). The authors' refinement of the composite radial forearm-palmaris longus free flap technique meets these criteria and allows a functional reconstruction of extensive lip and cheek defects in one stage. A composite radial forearm flap including the palmaris longus tendon was designed. The skin flap for the reconstruction of the intraoral lining and the skin defect was folded over the palmaris longus tendon. Both ends of the vascularized tendon were laid through the bilateral modiolus and anchored with adequate tension to the intact orbicularis muscle of the upper lip. This procedure was used in 12 patients. Six patients had cancer of the lower lip, five patients had a buccal cancer involving the lip, and one patient had a primary gum cancer that extended to the lower lip. Total to near-total resection (more than 80 percent) of the lower lip was indicated in six patients. In two other patients, the cancer ablation included more than 80 percent of the lower lip and up to 40 percent of the upper lip. A radial forearm palmaris longus free flap was used in all cases for reconstruction of the defect. Free flap survival was 100 percent. At the time of final evaluation, which was 1 year after the operation, all patients had good oral continence at rest (static suspension) and had achieved sufficient oral competence when eating. Ten patients were able to resume a regular diet, and two patients could eat a soft diet. All patients regained normal or near-normal speech and had an acceptable appearance. The described refinement of the composite radial palmaris longus free flap technique allows the reconstruction of the lower lip with a functioning oral sphincter; the technique can be recommended for patients who need large lower lip resection. It provides functional recovery of the reconstructed lower lip synchronizing with the remaining upper lip.

Adult↗
PubMed2006

Outcome assessment after reconstruction of complex defects of the forearm and hand with osteocutaneous free flaps.

BACKGROUND: Complex defects of the forearm and hand often require microvascular reconstruction with osteocutaneous free flaps for limb salvage. METHODS: Fifteen patients with osseous and soft-tissue defects of the forearm and hand were treated with osteocutaneous flaps (1992 to 2004) and evaluated for postoperative results. Assessment focused on range of motion, pain, grip strength, and Disabilities of Arm, Shoulder, and Hand questionnaire score. Donor- and recipient-site morbidity was documented. RESULTS: The defects resulted from trauma, infection, or malignancy. Reconstruction was possible by microvascular osteoseptocutaneous fibula transplantation (n = 8), osteocutaneous scapular or parascapular flaps(n = 6), and osteocutaneous lateral arm flap (n = 1). The average patient age was 38 years. The median osseous defect was 11.7 cm, and all patients needed additional soft-tissue reconstruction. All defects could be reconstructed in a one-step procedure after serial débridement or oncologic resection. Patients' hand function was markedly reduced compared with the unaffected extremity, but functional results were still satisfactory, with a mean Disabilities of Arm, Shoulder, and Hand score of 25.3 reflecting a moderate disability in activities of daily living. Two patients developed pseudarthrosis, and one had to undergo an ablation procedure because of persistent infection. Two patients developed wound dehiscence at the donor site, and one patient required a fasciotomy due to an imminent compartment syndrome after fibula harvest. For all patients, the functional results were acceptable when the potential alternatives were taken into consideration. This was also reflected by a high individual satisfaction rate. CONCLUSION: This analysis demonstrates that limb salvage with osteocutaneous free flaps is the treatment of choice for three-dimensional defects of the forearm and hand.

Bone Transplantation↗
PubMed2004

Free adipofascial flap interposition for pediatric posttraumatic forearm synostosis with closed head injury.

A case report is presented of a 12-year-old male after a motor vehicle accident: head injury and multiple fractures, including bilateral both bone forearm fractures. The patient developed bilateral extensive forearm synostosis that required release and interpositional free flap at 6 months postinjury. At 3-year follow-up, the patient has maintained full forearm rotation and reports unrestricted sports and other recreational activities.

Child↗
PubMed2006

Acellular dermal composite allografts for reconstruction of the radial forearm donor site.

PURPOSE: Since its description in the 1970s, the radial forearm free flap has earned a clearly defined role in the armamentarium of reconstructive head and neck surgery. Three decades later, the donor site remains an intrinsic drawback primarily due to its esthetic impact, although functional morbidity is significant in a minority. These points do not outweigh significant advantages but are occasionally reasons for the choice of alternative flaps. Modifications evolved in an effort to improve these undesirable features include primary closure, rotation-advancement, proximal paddle placement, full-thickness skin graft (FTSG) and suprafascial dissection. We describe a novel technique of engineering a composite graft of cadaveric acellular dermal matrix and autologous split-thickness skin graft (STSG) for a better donor-site closure. METHODS: From December 1995 to August 2003, 23 patients underwent radial forearm reconstruction of head and neck defects. Control patients (Group I; n = 5) had donor sites closed by conventional STSG technique (0.014-0.016 inch). In 18 patients (Group II), the donor site was closed with a composite technique (dermal allograft, 0.020-0.030 inch, and an ultrathin STSG, 0.0080 inch). Both groups of patients were retrospectively studied for comparative defects. Contralateral upper extremities also served as controls. All patients underwent a standardized functional examination of the donor and contralateral extremities, as well as an outcome questionnaire. All extremities were photographed for visual comparison by the author. RESULTS: Three of the 5 group I patients were available for follow-up, which averaged 64 months (60-72 months). Thirty-three percent had a decrease in functional parameters and 67% complained of paresthesia. Patient satisfaction was 3.5/5. Six of the 18 patients were excluded from Group II due to insufficient follow-up or inability to follow. Follow-up averaged 8 months (1-24 months). Functional parameters in all patients were comparable to the contralateral extremity, except in 1 patient. In this case, a 0.030-inch allograft was used which never revascularized, inhibiting wrist motion. Other patients exhibited excellent range of motion of the wrist and fingers. This was the only patient in this group that exhibited paresthesia of the donor site. Patient satisfaction was 4.6/5. Esthetic results were extremely gratifying as judged by the author. Esthetic results were better than those observed in Group I. CONCLUSIONS/SIGNIFICANCE: Composite grafting with acellular dermal matrix and STSG provides a comparable (trending to superior) result with traditional STSG for the treatment of radial forearm graft donor sites. Even if functionally equivalent, it is esthetically superior and therefore a technique warranting further investigation.

Collagen↗
PubMed2003

Number, incidence, and projections of distal forearm fractures admitted to hospital in Australia.

BACKGROUND: This study documents the number, incidence, and relative risk (RR) of distal forearm fractures requiring admission to hospital in Australia in 1997 and estimates of the projected numbers for 2021. METHODS: Distal forearm fracture numbers from 1993 to 1998 were obtained. The incidence and RR were calculated by gender and 5-year age groups for 1997. Projected numbers for 2021 were estimated using population projection data. RESULTS: In 1997, fracture numbers were 12357 for male patients and 19319 for female patients. The incidence was 152 per 100000 for male patients and 157 per 100000 for female patients. The highest incidence and RR was in the 10- to 14-year age group for male patients and in the 85 years and over age group for female patients. If fracture incidence remains constant (on the basis of predicted population changes in Australia), by 2021, it is estimated that fracture numbers for people 50 years of age and over will increase by 81%, compared with 11% for people under 50. In the older age group, the number for women will be 4.7 times higher than for men. CONCLUSION: This study quantifies the potential disproportionate increase in distal forearm fractures requiring admission in Australia, particularly for female patients, because of an aging population.

Adolescent↗
PubMedDate not supplied

Ipsilateral injuries of the elbow and forearm in children.

Fracture of the forearm with ipsilateral injury of the elbow joint is a rare traumatic entity in children. Twenty-four such cases were treated in our clinic during the last 4 years (1981-1984). The treatment was surgical in six cases and related to the elbow injuries, while the forearm underwent closed treatment. The results of these cases, regardless of treatment and severity of the injury, did not differ appreciably from the results of common forearm or elbow injuries.

Accidents↗
PubMed1990

The effects of propofol and thiopentone on forearm circulation.

Some effects of propofol and thiopentone induction on the peripheral circulation of healthy patients are examined using mercury strain gauge venous occlusion plethysmography of the forearm. Results indicate that both drugs produce a statistically significant decrease in mean arterial blood pressure and forearm blood flow. Forearm vascular resistance remains unchanged after either drug. These data suggest that bolus dose induction of anaesthesia with propofol does not cause arterial vasodilatation of the limb and that a cause for the reduction in mean arterial pressure must be sought elsewhere.

Adult↗
PubMed1991

The effect of intravenous clonidine on the forearm circulation.

The effect of two doses of clonidine on forearm blood flow was compared with an inert treatment using mercury strain gauge venous occlusive plethysmography. In the clonidine treated groups, forearm blood flow was unaffected in the resting state, but decreased sharply with tracheal intubation. In the saline group, blood flow increased with intubation. Forearm vascular resistance increased in the clonidine treated groups, but decreased in the saline group. These results suggest that clonidine has a peripheral action in anaesthetised normotensive individuals, and is not a purely centrally acting drug.

Adult↗
PubMed1993

Effect of voluntary tetanus on recovery of vecuronium block in the isolated forearm.

This study was conducted to investigate the effect of voluntary tetanus on the recovery from neuromuscular block produced by a nondepolarising drug, vecuronium, in the isolated forearm. We have studied the recovery indices and train of four fade at different levels of recovery following vecuronium in both isolated forearms simultaneously, in six sets of experiments. In one hand the volunteer performed a maximum contraction of his thumb repeatedly at fixed intervals. We found that following voluntary tetanus there is an increased rate of recovery from nondepolarising neuromuscular block; mean Recovery Index (7.4, SD 0.97) compared to control Recovery Index (10.55, SD 2.58), p < 0.05. The train-of-four fade also showed a sustained reduction in the isolated forearm which underwent voluntary tetanus. During the later phase of recovery the train-of-four fade showed significant difference statistically (p < 0.01). The findings of this study supports the hypothesis that more rapid recovery associated with voluntary tetanus is due to a reduction in the presynaptic block thus resulting in an increased rate of transmitter release.

Forearm↗
PubMed1995

No effect of circulating drug upon isolated forearm block.

Controversy exists as to whether the recovery of isolated arm blockade is primarily determined by resultant plasma drug concentrations, or by the affinity of the drug for the biophase. We have investigated the effect of the circulating drug produced by the isolated forearm experiment upon its recovery profile. Paralysis from retrograde spread of drug after the intravenous injection of 20 ml saline containing vecuronium 0.3 mg into a forearm isolated from the circulation was achieved in three groups of five experiments. Group 1 were used as controls, the tourniquet being released after 3-4 min and the recovery of block observed. In group 2 the tourniquet was similarly released but a repeat dose of vecuronium 0.3 mg was administered into the systemic circulation at 10% recovery. In group 3 the tourniquet was released at 50% twitch depression and the repeat dose of vecuronium 0.3 mg given when the twitch height had recovered to that level. The mean (SD) 25% to 75% recovery indices of groups 1, 2 and 3 were: 9.2 (2.4), 8.7 (1.2) and 9.9 (1.9) min. There was no noticeable effect on the recovery slope of any of the traces when the second dose of myoneural blocker was given systemically in groups 2 and 3. The findings indicate that the main determinant of recovery of the isolated forearm experiment is not its plasma drug concentration but a mechanism which maintains the drug in the effect compartment.

Forearm↗
PubMed1990

Cutaneous blood flow responses in the forearms of Raynaud's patients induced by local cooling and intradermal injections of CGRP and histamine.

1. The cutaneous responses of the forearm to local cold exposure and intradermal injection of CGRP and other vasoactive mediators were compared in primary Raynaud's sufferers and normal volunteers. 2. Skin responses in the forearm were measured in terms of erythema reddening and skin blood flow. Visual responses were recorded by tracing and then area calculated by computerised planimetry. Skin blood flow was measured using a laser Doppler blood flow meter. 3. Cooling (5-6 degrees C for 2 min) of a 1 cm2 area of the forearm caused a localised reactive hyperaemia response in normal volunteers, measured using the last Doppler blood flow meter. The peak response in Raynaud's patients was significantly smaller than that of normal volunteers. 4. The cutaneous responses of Raynaud's patients and normal volunteers to intradermal injections of CGRP, histamine and PGE2 were not significantly different. 5. The results suggest that Raynaud's sufferers do not exhibit a diminished response to CGRP in the cutaneous microvasculature and can respond normally to histamine with an axon reflex mediated flare.

Adult↗
PubMed1991

Sensitivity to angiotensin II of forearm resistance vessels in pregnancy.

Resistance vessel sensitivity to angiotensin II in vivo was studied in 13 primigravid normotensive women (16-24 weeks gestation), and in 10 non-pregnant control women. Angiotensin II was infused into the brachial artery at doses of 10, 100, 1,000 and 10,000 fmol min-1 and forearm blood flow measured by plethysmography. Reduction in forearm blood flow at all concentrations of angiotensin II was significantly greater in non-pregnant than in pregnant women. The dose-response relationships, plotted semi-logarithmically, were similar in shape in each group but sensitivity to angiotensin II was reduced in pregnant subjects compared with non-pregnant women. This is most simply explained by an effect of pregnancy on the sensitivity to angiotensin II of vascular smooth muscle in forearm resistance vessels.

Adult↗
PubMed1993

Inhibition of prostaglandin synthesis does not affect contractile responses to noradrenaline, serotonin, angiotensin II nor endothelin-1 in human forearm isolated veins.

1. The functional role of endogenous cyclo-oxygenase products was examined in the human forearm isolated vein. 2. Six healthy normal adult males (age > 18 years old) were recruited. Forearm veins were biopsied and ring segments mounted in standard organ baths for recording of isometric force. 3. Noradrenaline (-log molar EC50: 7.75 +/- 0.19; -log molar threshold concentration: 8.80 +/- 0.20), 5-hydroxytryptamine (-log molar EC50: 7.52 +/- 0.17; -log molar threshold concentration: 9.50 +/- 0.64), angiotensin II (-log molar threshold concentration: 9.00 +/- 0.28) and endothelin-1 (-log molar threshold concentration: 9.13 +/- 0.47) were equipotent in this preparation. Indomethacin (10 microM) had no effect on either the threshold concentration or EC50 of noradrenaline, 5-hydroxytryptamine nor the threshold concentration of angiotensin II nor endothelin-1. 4. Sodium nitroprusside (1 nM-10 microM) relaxed noradrenaline-precontracted preparations. Evidence of minimal endothelial influence was confirmed by the lack of relaxant response to acetylcholine (1 nM-10 microM). Histology using silver staining confirmed that endothelial cells were absent over greater than 90% of the lumen surface. 5. We conclude that endogenous prostanoids derived from smooth muscle cells, either released basally or agonist-stimulated, do not play a role in the regulation of vascular tone in the human forearm isolated vein.

Adult↗
PubMed1994

Inhibition of bradykinin-induced vasodilation in human forearm vasculature by icatibant, a potent B2-receptor antagonist.

1. The effect of icatibant (D-Arg-[Hyp3, Thi5, D-Tic7, Oic8] bradykinin) a potent B2-kinin receptor antagonist, was studied on bradykinin-induced vasodilation in the human forearm. 2. Eight healthy normotensive men were studied in a rising dose random-placebo controlled study. Placebo and icatibant (20, 50 and 100 micrograms kg-1 i.v.) were administered double-blind. Forearm blood flow was measured by venous occlusion plethysmography during rising dose brachial artery infusions of bradykinin (10-3,000 ng min-1) 60-90 min after placebo or icatibant. 3. Plasma concentrations of icatibant fell exponentially following each of three doses, up to the final measurement. Elimination half-lives calculated from linear regression of the mean data were 25, 27 and 29 min after 20, 50 and 100 micrograms kg-1 doses respectively. 4. Icatibant inhibited the effect of bradykinin (P < 0.001 at each dose of icatibant) in a dose-dependent manner. Bradykinin (100 ng min-1) increased mean blood flow in the infused arm by 238 +/- 31% when infused following placebo, by 112 +/- 21% after icatibant 20 micrograms kg-1, by 71 +/- 14% after icatibant 50 micrograms kg-1 and by 48 +/- 9% after icatibant 100 micrograms kg-1. 5. These results demonstrate that icatibant antagonises B2-receptor mediated vasodilation in human forearm resistance vessels. The findings provide a quantitative basis for future studies of the role of bradykinin in the response to angiotensin converting enzyme inhibitors and in circulatory disease.

Adrenergic beta-2 Receptor Antagonists↗
PubMed1995

The effect of HN-65021 on responses to angiotensin II in human forearm vasculature.

We studied the effect of (2-butyl-4-chloro-1[[2'-(1H-tetrazol-5-yl) [1,1'-biphenyl]methyl]-1H-imadazole-5-carboxylic acid,-1-(ethoxycarbonyloxy) ethyl-ester (HN-65021), on angiotensin II induced vasoconstriction in forearm vasculature of eight healthy men. Placebo and HN-65021 (5, 10 and 100 mg) were administered orally. Forearm blood flow was measured by venous occlusion plethysmography during rising dose brachial artery infusions of angiotensin II (0.3-1000 pmol min-1) 2 h after dosing. HN-65021 inhibited angiotensin II, causing a shift to the right of the dose-response curve. Angiotensin II (100 pmol min-1) decreased mean blood flow in the infused arm by 63.1 +/- 3.2% when infused following placebo and by 49.9 +/- 4.3%, 50.7 +/- 3.5% and 36.4 +/- 2.8% following HN-65021 doses of 5.10 and 100 mg respectively. These results demonstrate that HN-65021 antagonises angiotensin II receptor mediated vasoconstriction in human forearm resistance vessels.

Adult↗
PubMed1992

Bone mass of spine and forearm in osteoporosis and in German normals: influences of sex, age and anthropometric parameters.

We measured forearm bone mineral density (BMD) using single photon absorptiometry (SPA) and bone mineral content (BMC) and BMD of lumbar spine by dual photon absorptiometry (DPA). The population consisted of 463 bone healthy subjects, 346 females and 117 males aged 20-85 years. Any underlying bone disease or other diseases known to affect bone mass were excluded by physical examination, thoracic and lumbar radiographs and laboratory screening. Patients with osteoarthritis of lumbar spine were excluded as well as patients taking drugs known to affect bone mass. All bone mass values declined with age. Body height also declined with age by 1.2 cm and 1.8 cm per 10 years (-0.7% and -1%) in females and males respectively. Main effects of age, body height, -surface, -weight and -mass index on bone mass were calculated using multiple regression models. In males and females lumbar BMC measured in gHA depended primarily on body height and secondarily on age. Spinal BMD as measured in g cm-2 was primarily dependent on age and then on height. In females forearm BMD depended primarily on age and then on body surface, in males on body surface only. Using receiver operating characteristic (ROC) analysis the ROC area increased from 0.81-0.85 (n.s.) including body height into spinal BMD values leading to a higher sensitivity of measurements of spinal bone mass in recognizing 58 patients with spinal postmenopausal osteoporosis. Including body surface into forearm BMD measurements ROC area increased from 0.66-0.69 (P = 0.055).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Non-invasive assessment of unstimulated forearm arterial compliance in human subjects. Impaired vasoreactivity in hypercholesterolaemia.

A study was carried out in order to determine the feasibility and reproducibility of a direct plethysmographic assessment of unstimulated forearm arterial compliance (FAC) in hypercholesterolaemic and normocholesterolaemic subjects. Simultaneous recordings of forearm pulse volume and blood pressure over the whole cardiac cycle are used to establish the pulse volume-blood pressure relationship. FAC was measured on-line by computing the ratio of dV/dP. The area under the curve (FAC(AUC)) of FAC/blood-pressure curve was determined in a standard range of blood pressure (70-130 mmHg). The method was validated by demonstrating its capacity to detect changes in FAC(AUC) induced by nitrate and by muscarinic stimuli. The results show a reduced FAC(AUC) in hypercholesterolaemic patients vs. controls (2.28 +/- 0.8 x 10(-3) vs. 4.12 +/- 1.06 x 10(-3) (mL 100 mL-1 forearm mmHg-1) mmHg; P = 0.0001). The method appears to be highly sensitive to nitrate and muscarinic stimuli. The new technique provides a potentially useful tool to detect and monitor in vivo, without stimulating arterial dilatation, e.g. by acetylcholine infusion, the functional arterial changes in subjects with a major risk factor for arterial disease as well as the effects of dietary/drug treatments.

Acetylcholine↗