Reconstruction of a posterior defect of the elbow joint using an extensor carpi radialis longus myocutaneous flap: case report

An extensor carpi radialis longus (ECRL) myocutaneous flap was successfully used for the repair of a posterior defect of the elbow joint in a physically handicapped female with Parkinsonism. This muscle is of value for a one-stage reconstruction of an elbow lesion.     

Avulsion of both extensor carpi radialis tendons: a case report

Closed traumatic avulsion of both extensor carpi radialis tendons is reported in a young healthy patient. Early diagnosis important because the tendons tend to retract and anatomic repositioning is more difficult to perform with passing time. Diagnostic markers are the inability to actively extend the wrist and the presence of dorsal bone fragments on the lateral radiograph of the wrist. We recommend fixation of the avulsed fragments to restore the length and strength of the wrist extensors.     

The extensor carpi radialis longus muscle flap for anterior elbow coverage.

A muscle group resection for treatment of malignant fibrous histiocytoma of the distal arm exposed a 15 cm length of radial nerve. The soft tissue defect and radial nerve were covered with an extensor carpi radialis longus muscle island flap. The proximal dominant vascular pedicle enabled extensive mobilization and transposition of this muscle to cover the defect while preserving normal elbow, radial nerve, and hand function. Because of its ease of elevation, extensive arc of rotation, and its expendability, the extensor carpi radialis longus muscle flap should be considered as an option for reconstruction of defects about the elbow joint.     

An unusual rupture of the flexor carpi radialis tendon: a case report

We present the unusual case of a flexor carpi radialis tendon that ruptured after extended strenuous physical activity by a patient with paralysis of the opposite limb secondary to poliomyelitis.     

The distally based radial artery/flexor carpi radialis muscle flap for dorsal hand reconstruction: a clinical and cadaver study

Complex soft tissue defects of the hand often require vascularized tissue for protection and coverage of exposed underlying structures. Pedicled local flaps from the forearm are one reconstructive option, but its use is limited by relatively high donor-site problems, including a disagreeable forearm scar and potential division of superficial forearm nerves. We describe a pedicled local flap option--the distally based radial artery/flexor carpi radialis flap, which potentially decreases forearm donor-site morbidity while still providing for coverage of small hand soft tissue defects. Six cadaver forearm dissections were performed to confirm that the vascular supply to the middle and distal portion of the flexor carpi radialis comes off the radial artery. Four clinical cases are presented in which the flexor carpi radialis muscle based on the distal radial artery was used to cover complex wounds of the dorsum of the hand. We believe the lack of damage to the superficial sensory forearm nerves and the ease of flexor carpi radialis muscle flap elevation make this a versatile flap for small, complex, soft tissue defects of the hand.     

The extensor carpi radialis intermedius tendon

I examined 312 arms from 156 cadavers in the anatomy laboratory of Loma Linda University to find the incidence of the extensor carpi radialis intermedius tendon. I found 29 bodies (12%) that had a good extensor carpi radialis intermedius. In 17 of these 29 bodies, an extra tendon was found bilaterally. Thirty-two extensor carpi radialis intermedius tendons were suitable for transfer operations, and seven were unacceptable. One must be careful to differentiate between a true extensor carpi radialis intermedius tendon and accessory tendinous bands. The relatively high incidence rate and percentage of tendons suitable for transfer operations make this tendon potentially valuable in treating severe quadriplegia with tendon transfers. It can be used successfully for thumb opposition, to motor the flexor pollicis longus, or as a motor for the extensor pollicis longus of the thumb.     

Brachialis-to-extensor carpi radialis longus selective nerve transfer to restore wrist extension in tetraplegia: case report

Active wrist extension allowing tenodesis grip is the key function in high-level tetraplegic patients. It is absent and cannot be restored by traditional tendon transfer in patients who have no transferable muscle below the elbow. We present a 36-year-old man with high-level tetraplegia treated 12 months after injury who regained active wrist extension after transfer of the brachialis muscle branch of the musculocutaneous nerve to the extensor carpi radialis longus muscle branch of the radial nerve. No functional deficit of elbow flexion occurred after reconstruction.     

Spontaneous rupture of the extensor carpi radialis brevis in a 51-year-old man: case report

Dorsal hand osteophytes are common findings in the general population, frequently presenting with dorsal pain and treated with surgical excision. We report the spontaneous rupture of the extensor carpi radialis brevis in association with a previously asymptomatic dorsal scaphoid spur. Following conservative management, surgical excision of dorsal hand osteophytes should be considered for both resolution of pain and prevention of attritional tendon rupture.     

Radial forearm skin with flexor carpi radialis muscle: a useful composite free flap

Four patients were treated successfully with a simple modification of the standard radial forearm free flap. The flexor carpi radialis was harvested along with the radial artery vascular pedicle and forearm skin, producing a tennis racket-shaped flap. The entire flexor carpi radialis can be transferred based on radial artery perforators that enter the distal half of the muscle. The flexor carpi radialis can extend the versatility of the radial forearm free flap, principally by providing good-quality coverage of the vascular anastomoses.     

Radical surgery with myocutaneous flap for advanced penile carcinoma: case report

A 55-year-old male with penile epidermoid carcinoma of stage C (T3N3N0) underwent radical surgery. Emasculation with profuse skin removal, including the bilateral groins, and inguinal and pelvic lymphadenectomy were performed. A urethrostomy was created at the perineum, and the skin defect was covered with tensor fascia lata myocutaneous skin flaps. Immediately after recovery from surgery, 3 cycles of chemotherapy with cyclophosphamide, adriamycin and CDDP and radiation (5,000 rad) of the local area were given. The patient is now free from tumor recurrence 12 months after the surgery.     

Flexor carpi radialis tendon rupture as a complication of a closed distal radius fracture: a case report

Although extensor pollicis longus tendon ruptures have been noted as a complication of distal radius fractures, flexor tendon ruptures in association with acute fractures of the distal radius are rare. We report a rupture of the flexor carpi radialis tendon as a complication of an acute distal radius fracture that was discovered during operative management of the fracture.     

尺、桡侧腕屈肌内神经分布和血供特点的研究

目的研究人尺侧腕屈肌和桡侧腕屈肌内神经分布、血供模式及肌肉结构。探讨将其分成两个或两个以上具有独立神经和血管支配肌肉束的可能性,指导临床切取部分肌肉移植重建运动功能的应用。方法以解剖学、血管造影、肌内神经染色等方法,研究神经和血管在两肌内的分布特点;电刺激神经支,检测相应肌束可否具有独立收缩功能及正常血供;测量肌肉的生理横截面积和肌纤维长度,并与相关肌肉比较。结果支配和供应两肌肉的主要神经和血管均在肌腹的近、中1/3结合部入肌,神经在肌内分成2支,分别在肌中央腱两侧沿长轴走向远端,直至肌肉的末端,且与血管紧密伴行;电生理证实,沿中央腱将肌肉分成的两部分在功能上具有独立性;该两肌的尺侧部和桡侧部生理横截面积和肌纤维长度与支配手的有关肌肉相近。结论尺侧腕屈肌和桡侧腕屈肌都可分成两个具有独立的神经支配及血管供应、功能上相对独立的肌束,可用于转位移植重建运动功能,而且对供区的功能影响也较小。     

A lower trapezius myocutaneous free flap in facial reconstruction: A case report

The free transfer of a myocutaneous flap is the procedure of choice in the reconstruction of facial defects. A case is reported in which a lower trapezius myocutaneous free flap was successfully transferred with microneurovascular anastomoses to repair a facial defect. The advantages of the lower trapezius myocutaneous flap also are discussed.     

Survival of a myocutaneous free flap after prolonged ischemia: A case report

A case is presented in which a myocutaneous free flap survived with only superficial marginal necrosis after being subjected to 15 hours of ischemia. The role of hypothermia and perfusion in preserving the flap are discussed.     

Double skin island pectoralis major myocutaneous flap with nipple-areola complex preservation: a case report.

A horizontal double skin island pectoralis major myocutaneous flap with preservation of nipple-areola complex is described, a different modification used to reconstruct a complex defect following radical resection of a locally advanced gingival carcinoma. The skin islands are horizontally separated by a distance of 2.5 cm but rely on one vascular pedicle for their blood supply. The muscle between the skin islands provides the soft tissue bulk between the internal mucosal and external skin lining. The need for a separate segmental flap or a split-thickness skin graft for mucosal lining was eliminated.     

A case report of cross-leg free latissimus dorsi myocutaneous flap transplantation

One of the significant reconstructive challenges is closure of large soft tissue defects of the lower extremity. A patient with a large traumatic defect in the lower extremity was treated with a cross-leg free latissimus dorsi myocutaneous flap. The size of the flap was 32×12 cm. The pedicle was divided 22 days after the initial operation. The result was satisfactory after a 2-year follow-up. This technique allows the transfer of large flaps to cover compromised wounds, with the advantage of using suitable recipient vessels. Received: 4 March 1998 / Accepted: 25 March 1999