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PubMed2003

Closed reduction of forearm refractures with flexible intramedullary nails in situ.

BACKGROUND: Refractures of the forearm after flexible intramedullary nailing are rare. An alternative to nail replacement is closed reduction with the nails in situ. We successfully performed this maneuver on a thirteen-year-old boy. However, no data on the stability of previously bent nails are available. The purpose of the present study was to assess the mechanical stability of titanium and stainless steel flexible intramedullary nails after one cycle of reversed bending. METHODS: In an in vitro study, ten titanium and eighteen stainless steel 3.0-mm flexible intramedullary nails were subjected to an increasing lateral bending force until the point of first plastic deformation. As an analogy to the clinical case, they were then bent to an angle of 21 degrees and were manually reduced back to their original straight position and the experiment was repeated. The forces needed to achieve first plastic deformation and modified spring constants (force/deflection) were calculated and were compared between the native and previously bent nails. RESULTS: The average force required for permanent deformation of the previously bent nails was reduced by 37% for both titanium and stainless steel nails (from 21 to 13.2 N for titanium nails [p < 0.01] and from 25 to 15.7 N for stainless steel nails [p < 0.001]). The average modified spring constant decreased by 15.1% (from 0.814 to 0.691 N/ degrees ) for titanium nails (p < 0.001) and by 12.2% (from 0.991 to 0.870 N/ degrees ) for stainless steel nails (p < 0.001). Overall, steel nails were stiffer and stronger than titanium nails were. There was no macroscopic evidence of metal fracture or fatigue after one cycle of reversed bending to 21 degrees. CONCLUSIONS: Closed reduction of a forearm refracture with flexible intramedullary nails in situ is a safe, noninvasive, and effective alternative to nail replacement. However, mechanical stability of the nails is significantly reduced after the procedure. Therefore, the patient should be instructed to avoid any excessive forces to the forearm until fracture union has been documented radiographically, and casting for a limited time may be appropriate.

Adolescent↗
PubMed2003

Excessive purine degradation during semi-ischemic forearm test in patients with diabetes mellitus.

OBJECTIVE: The aim of this study was to investigate whether or not the purine degradation in the skeletal muscle during forearm exercise is augmented in patients with diabetes mellitus (DM). METHODS: We used the semi-ischemic forearm test to examine the release of lactate (deltaLAC), ammonia (deltaAmm) and hypoxanthine (deltaHX) before exercise, 0, 4, 10, and 60 minutes after exercise in eleven diabetic patients and seven normal controls. RESULTS: The sum of the increased HX (DM vs Controls: 26.1 +/- 21.2 vs 7.8 +/- 5.9 micromol/L, p < 0.05) was greater in diabetic patients. When patients were divided into the excessive response group (n = 7) and normal response group (n = 4), the maximum increments in deltaHX and deltaAmm in the excessive response group (16.8 +/- 3.2 micromol/l and 122 +/- 60 micromol/l) were greater (p < 0.05) than those in the control group (3.6 +/- 3.0 micromol/l and 32 +/- 34 micromol/l and the normal response group (2.9 +/- 2.9 micromol/l and 27.4 +/- 12.7 micromol/l). DeltaLAC both in the excessive response group (5.4 +/- 1.5 mmol/l) and the normal response group (3.6 +/- 1.0 mmol/l) were higher (p < 0.05) than that of the control group (1.7 +/- 0.5 mmol/l). The prevalence of diabetic retinopathy was higher in the excessive response group than in the normal response group (75% vs. 25%). CONCLUSION: These data suggest that patients with DM, especially with microangiopathy have augmented purine degradation during the semi-ischemic forearm test. Factors responsible for the augmented purine degradation in these patients remain to be determined.

Adolescent↗
PubMed1990

Electromyography of rapid forearm flexion and extension and aging.

This investigation examined several parameters of agonist- and antagonist-muscle activity and movement time in young and old males during rapid, forearm flexion and extension tasks. Maximal isometric strength of the forearm flexors and extensors and limb-volume measurements were also procured. The subject sample included sixteen males in each of the following groups: 1) thirty to forty year olds, 2) fifty to sixty year olds, and 3) sixty-one to seventy year olds. The averaged, electromyographic patterns (AEMG) of the biceps brachii and triceps brachii muscles were recorded during unloaded and loaded trials of forearm flexion and extension to a predetermined target. Sixteen temporal and ten quantitative parameters were examined. Significant differences between age groups were observed for only the quantitative-parameter accuracy. The conclusions were that an individual's agonist- and antagonist-muscle-activity parameters are maintained into the seventh decade. Flexion and extension strengths decrease progressively with age. Analysis of the limb-volume measures revealed that the oldest group had the greatest amount of fat in each of the segments evaluated.

Adult↗
PubMed1999

Blood flow monitoring by pulse oximetry during a forearm flap elevation.

The Allen's test for blood flow is performed before a forearm flap is elevated to examine vascularization through the ulnar artery. In this study, to ensure the survival of the donor site when a forearm flap was elevated, we monitored patients using a pulse oximeter. From oral cancer patients who were undergoing reconstructive surgery using the forearm flap, twenty patients were randomly selected to be served as subjects. A pulse oximeter probe was attached to the thumb on the side from which a skin flap was to be elevated. Oxygen saturation was measured when the tourniquet was released, and the radial artery was clamped and severed. The results showed that oxygen saturation temporarily decreased when the radial artery was ligated, but it recovered in one to two minutes.

Forearm↗
PubMed1983

The effects of ingested and intravenous glucose on forearm uptake of glucose and glucogenic substrate in normal man.

The forearm uptake of glucose, lactate, and alanine was determined in overnight fasted man following both oral glucose loading and the intravenous (i.v.) infusion of glucose in an absorption pattern. Arterial glucose concentrations were lower following oral than following i.v. loading and forearm glucose uptake was 50% higher after oral glucose. Arterial insulin levels were higher in the first 2 h during oral loading. Forearm lactate and pyruvate production did not change significantly during glucose administration by either route so that the increased plasma levels are due to splanchnic production.

Administration, Oral↗
PubMed1996

Potential role of bradykinin in forearm muscle metabolism in humans.

Using the euglycemic-hyperinsulinemic glucose clamp and the human forearm technique, we have demonstrated that the improved glucose disposal rate observed after the administration of an angiotensin-converting enzyme (ACE) inhibitor such as captopril may be primarily due to increased muscle glucose uptake (MGU). These results are not surprising because ACE, which is identical to the bradykinin (BK)-degrading kininase II, is abundantly present in muscle tissue, and its inhibition has been observed to elicit the observed metabolic actions via elevated tissue concentrations of BK and through a BK B2 receptor site in muscle and/or endothelial tissue. These findings are supported by several previous studies. Exogenous BK applied into the brachial artery of the human forearm not only augmented muscle blood flow (MBF) but also enhanced the rate of MGU. In another investigation, during rhythmic voluntary contraction, both MBF and MGU increased in response to the higher energy expenditure, and the release of BK rose in the blood vessel, draining the working muscle tissue. Inhibition of the activity of the BK-generating protease in muscle tissue (kallikrein) with aprotinin significantly diminished these functional responses during contraction. Applying the same kallikrein inhibitor during the infusion of insulin into the brachial artery significantly reduced the effect of insulin on glucose uptake into forearm muscle. This is of interest, because in recent studies insulin has been suggested to elicit its actions on MBF and MGU via the accelerated release of endothelium-derived nitric oxide, the generation of which is also stimulated by BK in a concentration-dependent manner. This new evidence obtained from in vitro and in vivo studies sheds new light on the discussion of whether BK may play a role in energy metabolism of skeletal muscle tissue.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1999

Hypoglycemia per se stimulates sympathetic neural as well as adrenomedullary activity, but, unlike the adrenomedullary response, the forearm sympathetic neural response is not reduced after recent hypoglycemia.

We tested the hypotheses that 1) hypoglycemia per se stimulates the sympathetic neural as well as the adrenomedullary component of the sympathochromaffin system, and 2) sympathetic neural responses to hypoglycemia, like adrenomedullary responses, are reduced after recent hypoglycemia. To this end, we studied 10 healthy young adults on 2 consecutive days on two separate occasions, on one occasion with euglycemia (5.0 mmol/l) and on the other occasion with hypoglycemia (2.8 mmol/l) from 1000 to 1200 and 1400 to 1600 on day 1 of each occasion. On day 2 of each occasion, plasma epinephrine and norepinephrine (NE) concentrations and rates of systemic NE spillover (SNESO) and forearm NE spillover (FNESO) were measured during hyperinsulinemic (12.0 pmol x kg(-1) x min(-1)) euglycemia (5.0 mmol/l) and hypoglycemia (2.8 mmol/l). Compared with values during euglycemia, plasma epinephrine and NE and rates of SNESO and FNESO all increased during hypoglycemia (P < 0.01). After day 1 hypoglycemia, there were reductions during hypoglycemia on day 2 in plasma epinephrine (2,050 +/- 500 vs. 2,960 +/- 400 pmol/l; P < 0.02), plasma NE (1.35 +/- 0.16 vs. 1.92 +/- 0.20 nmol/l; P < 0.01), and SNESO rates (5.13 +/- 0.84 vs. 6.87 +/- 0.81 nmol/min; P < 0.02). However, FNESO rates were unaltered (1.16 +/- 0.25 vs. 1.27 +/- 0.17 pmol x min(-1) x 100 ml tissue(-1). Thus we conclude that 1) hypoglycemia per se stimulates both the sympathetic neural and adrenomedullary components of the sympathochromaffin system and 2) adrenomedullary, but not forearm sympathetic neural, responses to hypoglycemia are reduced after recent hypoglycemia. The extent to which the lower plasma NE levels and reduced SNESO responses to hypoglycemia after day 1 hypoglycemia reflect reduced NE release from the adrenal medullae, sympathetic nerves other than those in the forearm, or both cannot be determined from these data.

Adrenal Medulla↗
PubMed1989

Gantzer's muscle-like variation inserted into the forearm flexor retinaculum.

A rare muscle variation belonging to the forearm flexor muscle group has been observed in three forearms out of nearly 200 Japanese cadavers. It arose from the well developed fascia of the superficial forearm flexor group, crossed the median nerve obliquely and posteriorly lying radial to that nerve, and was inserted into the flexor retinaculum. The muscle variations in the three cases were discussed according to the concept of "corrected" nerve-muscle specificity and conservative morphology. They were conclusively ascribable to the original antebrachial flexor group of Yamada. This seemed to indicate that the variations were related or identical to Gantzer's muscle, and that they showed a possible original or archaic pattern of the original antebrachial flexors.

Forearm↗
PubMed1996

Extended free lateral arm flap with preservation of the posterior cutaneous nerve of the forearm.

The free lateral arm flap has become a well-defined and reliable flap for various reconstructive purposes. Little attention has been paid, however, to the possibility of preservation of the posterior cutaneous nerve of the forearm (nervus cutaneus antebrachii posterior) sacrifice of which results in numbness of the dorsal part of the forearm. In this study, an anatomical dissection showed that in many cases it would be possible to preserve the nerve. We did 23 free lateral arm flaps in 22 patients during the period 1989-1994. The maximum flap length was 40 cm. Standard maximum width in most cases was 6 cm, and by using a new expansion technique it reached 10 cm in one case. Furthermore, with meticulous dissection the posterior cutaneous nerve of the forearm was either preserved or cut and rejoined in 21 patients, so minimising sensory loss at the donor site.

Adult↗
PubMed1997

Influence of indomethacin and L-NMMA on vascular tone and angiotensin II-induced vasoconstriction in the human forearm.

Stimulated release of vasodilator prostaglandins and nitric oxide by angiotensin II may counteract the vasoconstrictor effects of this octapeptide. We investigated the effects of inhibition of prostaglandin synthesis by indomethacin and of nitric oxide formation by NG-monomethyl-L-arginine (L-NMMA) on baseline forearm blood flow (FBF) and on angiotensin II-induced vasoconstriction in healthy subjects. For comparison, the effects of the AT1-receptor antagonist losartan on these parameters were determined. FBF was measured by venous occlusion plethysmography. Angiotensin II (0.01-10 ng/kg/min) was infused into the brachial artery, in the absence and presence of indomethacin (0.65 micrograms/kg/min; n = 8), L-NMMA (30 micrograms/kg/min; n = 5), and losartan (3 micrograms/kg/min; n = 12), respectively. Sodium nitroprusside was used to submaximally predilate the forearm vascular system. Baseline FBF remained unchanged with indomethacin and losartan, but was significantly decreased by -42 +/- 6% (mean +/- SEM) by L-NMMA. The dose-dependent angiotensin II-induced vasoconstriction was unaffected by indomethacin and L-NMMA, but was inhibited by losartan. Emax was -78 +/- 2% during control conditions, -84 +/- 3% during indomethacin (n.s.), -74 +/- 4% during L-NMMA (n.s.), and -17 +/- 6% during losartan infusion (p < 0.05). None of the interventions significantly changed the EC50 value of angiotensin II of -9.4 +/- 0.14 log M. In conclusion, in the human forearm of healthy subjects, neither endogenous angiotensin II nor cyclooxygenase-dependent prostaglandin synthesis plays a role in the genesis of vascular tone, whereas endogenous nitric oxide production does. The constrictor effects of angiotensin II are counteracted by neither stimulated release of prostaglandins nor by that of nitric oxide.

Adult↗
PubMed1999

Use of the radial forearm microvascular free-flap graft for cranial base reconstruction.

OBJECT: Reconstruction of the cranial base after resection of complex lesions requires creation of both a vascularized barrier to cerebrospinal fluid (CSF) leakage and tailored filling of operative defects. The authors describe the use of radial forearm microvascular free-flap grafts to reconstruct skull base lesions, to fill small tissue defects, and to provide an excellent barrier against CSF leakage. METHODS: Ten patients underwent 11 skull base procedures including placement of microvascular free-flap grafts harvested from the forearm and featuring the radial artery and its accompanying venae comitantes. Operations included six craniofacial, three lateral skull base, and two transoral procedures for various diseases. Excellent results were obtained, with no persistent CSF leaks, no flap failures, and no operative infections. One temporary CSF leak was easily repaired with flap repositioning, and at one flap donor site minor wound breakdown was observed. One patient underwent a second procedure for tumor recurrence and CSF leakage at a site distant from the original operation. CONCLUSIONS: Microvascular free tissue transfer reconstruction of skull base defects by using the radial forearm flap provides a safe, reliable, low-morbidity method for reconstructing the skull base and is ideally suited to "low-volume" defects.

Adult↗
PubMed2006

Quantitation of and landmarks for the muscular branches of the ulnar nerve to the forearm for application in peripheral nerve neurotization procedures.

OBJECT: In neurotization procedures, donor nerves--either whole or in part-with relatively pure motor function can be carefully chosen to provide the optimal nearby motor input with as little donor site morbidity as possible. In this context, the ulnar nerve branches to the forearm muscles are relatively dispensable; however, quantitation of and landmarks for these branches are lacking in the literature. METHODS: The ulnar branches to the flexor carpi ulnaris (FCU) and flexor digitorum profundus (FDP) muscles in 20 upper extremities obtained in adult cadaveric specimens were dissected and quantified. In the forearm, a mean of four nerve branches led to the FCU and FDP muscles. A mean of 3.4 branches led to the FCU muscle; of these, one to three were medial branches and zero to two were lateral. Medial branches to the FCU muscle originated a mean of 2.7 cm inferior to the medial epicondyle. Lateral branches to the FCU muscle originated at a mean of 3.3 cm inferior to the medial epicondyle. The mean length of the medial branches was 3.2 cm, whereas the mean length of the lateral branches was 3.3 cm. All nerves had a single trunk for the FDP muscle, and in all specimens this branch was located deep to the main ulnar nerve trunk, originating from the ulnar nerve a mean of 2.7 cm inferior to the medial epicondyle. These branches had a mean length of 5.6 cm. The mean diameter of all medial and lateral branches to the FCU muscle was 1 mm, and the mean diameter of the branch to the FDP muscle was 2.1 mm. All branches to both the FCU and FDP muscles arose from the ulnar nerve, over its first approximately 5 cm from the level of the medial epicondyle. Additionally, all branches could be easily lengthened by gentle proximal dissection from the main ulnar nerve. CONCLUSIONS: Ulnar branches to the forearm can be easily localized and used for neurotization procedures. The branch to the FDP muscle had the greatest diameter and longest length, easily reaching the median nerve and posterior interosseous nerve via a transinterosseous membrane tunneling procedure. Furthermore, this branch could be teased away from the main ulnar nerve trunk and made to reach the distal branches of the musculocutaneous nerve in the arm.

Aged↗
PubMed1993

Localization of electrocutaneous stimuli on the fingers and forearm: effects of electrode configuration and body axis.

Four experiments were done on the effects of electrode configuration (concentric vs. unifocal) and body axis (longitudinal vs. transverse) on localization of electrocutaneous pulse stimuli at the fingers and forearm. Subjects pointed to the apparent location of current pulses. For the transverse placement of electrodes, pulses were localized correctly, whatever the configuration and the body site might be. In addition, intrasubject variability at the forearm was smaller for the transverse axis than for the longitudinal axis. For the longitudinal placement of electrodes, pulses were localized as a function of configuration and body site. At the fingers, concentric electrodes provided precise localization but unifocal electrodes provided a great mislocalization; and intrasubject variability of localization was larger for the unifocal electrodes than for the concentric electrodes. At the forearm, whatever the configuration might be, the pulses were localized more proximally than the stimulus site; and intrasubject variability of localization did not differ between the configurations. These results are related to Boring's anchor theory, apparent distance between two points, and the localization of other somatosensory stimuli.

Adult↗
PubMed1985

Exposure to cutting oils and its relation to skin tumors and premalignant skin lesions on the hands and forearms.

In a cohort study the incidence of skin tumors on the hands and forearms of 682 turners exposed to cutting oils was compared to the incidence of the general male population and of office workers. Among the 682 turners, five premalignant squamous cell tumors and eight keratoacanthomas were found between 1960 and 1980. Five of this total of 13 turners with primary skin tumors had another skin tumor as well. Among the 682 men there were four cases of scrotal cancer. Among the 375 office workers examined, no malignant or premalignant tumors or keratoacanthomas were found on the hands or forearms. No primary skin tumors were found among the turners after 1975, when the acid-refined mineral oils were replaced by solvent-refined oils containing a far lower concentration of polyaromatic hydrocarbons, which are probably the cancerogenic agent in the oils. The study shows a greatly increased risk of skin tumors on the hands and forearms of workers exposed to acid-refined mineral oils. Individual susceptibility also seems to be indicated.

Adult↗
PubMed1990

Physiological skin surface water loss dynamics of human vulvar and forearm skin.

In order to estimate the influence of occlusion and sweating on forearm and vulvar skin surface water loss (SSWL), both were measured simultaneously and continuously for 30 min in 8 healthy women. Vulvar SSWL decreased significantly during the measuring period from 24.9 +/- 5.2 gm-2 h-1 (mean +/- standard error of the mean) in the first 5 min, to 13.4 +/- 1.7 gm-2 h-1 in the last 5 min (p less than 0.05), whereas no significant changes were observed in forearm SSWL. The vulvar SSWL decay curve followed a logarithmic equation of the form y = a*tb. Irregular SSWL increases ('bursts') were observed in vulvar (but not in forearm) skin of 7 out of 8 women. These SSWL bursts were considered to be caused by sweating. The study shows possible causes of systematic errors in vulvar irritation studies. Methods for error reduction are discussed.

Adult↗
PubMed1992

Transepidermal water loss related to volar forearm sites in humans.

The aim of this study was to demonstrate differences in human skin transepidermal water loss (TEWL) in vivo related to site on volar forearm. Fourteen healthy volunteers entered the study and seven sites were tested. After randomization of both forearm and measure order, TEWL measurements were performed using the Servo Med Evaporimeter. TEWL values next to the wrist were found statistically greater than on the other sites. Hence wrist region should preferably be excluded from TEWL measurements on forearm.

Adult↗
PubMed1998

[Restoration of supination of forearm by flexor carpi radialis transfer].

The dysfunction of supination of forearm following injury of brachial plexus or poliomyelitis always affects the function of hand. To find the dynamic muscle for restoration of the supination, the flexor carpi radialis was investigated on fifty male cadavers. The blood supply of the muscle was polygenic, mainly derived from the humoral and radial arteries. The movement of the muscle was innervated by median nerve. If the proximal 1/3 belly of the muscle was reserved, the blood supply and innervation of the complete muscle was reserved. According to the anatomic data, the operative procedure was designed as following: transfer the distal 2/3 of flexor carpi radialis over the ulnar aspect of the forearm to the dorsal-radial side, the tendon was fixed on the radius shaft 6 to 10 cm proximal to the styloid process with forearm in full supination. Four patients were treated and after followed up for 3.2 years average, the supination restored. It was discussed that in case of paralysis of the flexor carpi ulnaris and pronator teres, the optimal choice to restore the supination would be flexor carpi radialis.

Adult↗
PubMed1997

[Repairing bone and soft tissue defects of the forearm with a composite segmented-fibula osteoseptocutaneous flap].

The segmented-fibula osteoseptocutaneous flap has been used to repair the bone and soft tissue defects of the forearm. During the operation, the fibula is divided subperiosteally at proper site according to the bony defects. The two segments of the fibula were then inserted to the radial and ulnar defects before vascular anastomosis is performed. Experience shows that anastomosis of only one group of vessels can ensure survival of both the segmented fibula and the cutaneous flap. Care should be taken to protect the muscle cuff and periosteum of the fibula, which is the source of blood supply to one segment. Four patients with bone and soft tissue defects of the forearm have been treated using this method. All the flaps survived with good function. The success of this technique contributes to the application of the free fibular flap in repair of forearm injury or osteomyelitis.

Adult↗