The radial forearm flap without fascia and other refinements

The radial forearm flap is generally classified as a fasciocutaneous flap. The skin of the forearm is, however, supplied by branches from the radial artery which pierce the fascia of the forearm to course and branch subcutaneously. We have used the flap as a skin flap in 300 cases over 11 years. It is not necessary to take the fascia with the flap. Two other refinements of the forearm flap, also used over the past 11 years, are described. The venous drainage of the flap is simplified by utilising the usual anatomical confluence of deep and superficial veins at the elbow. Secondly, draping a large loop of pedicle in the neck during intraoral reconstruction enables a larger calibre vein to be used for the anastomosis, thus increasing its reliability.     

经软组织扩张前臂逆行筋膜皮瓣的临床应用

为了避免以往的皮瓣、皮片方法修复手部外伤、烧伤晚期、先天性手畸形而造成的软组织缺损，我们采用经软组织扩张的前臂逆行筋膜皮瓣的新方法。１９８８年８月至１９９１年１月，３０例手、腕部软组织缺损的患者接受了治疗，除１例皮瓣远端部分坏死外，其余全部成活，随访３个月效果满意。该方法主要优点是不切断知名动静脉，增加了皮瓣供给面积，供区不需植皮，移植后的组织功能重建满意。     

Bone mineral content by photon absorptiometry of the mandible compared with that of the forearm and the lumbar spine

Summary A new method for measuring the bone mineral content (BMC) of the mandible by dualphoton absorptiometry (DPA) has recently been introduced. The purpose of the present investigation therefore was to examine the long-term precision for 32 monthsin vitro andin vivo for assessment of BMC in the mandible and to examine the relationshipin vivo among BMC of the mandible, the forearms, and the lumbar spine as measured by DPA and/or single-photon absorptiometry (SPA). For comparison, the relationship between forearm BMC as measured by DPA and SPA was studied. The long-term precision of the mandibular BMC was 0.8%in vitro, independent of age and change of radioactive source, and 2.1% by assessmentin vivo. A significant relationship (P<0.01) was found between BMC of the lumbar spine and the forearms and between the two sets of forearm BMC measured by DPA and SPA. Thus, relative BMC changes of the forearms can be compared without respect to type of forearm bone scanner used. The BMC changes of the mandible can only be evaluated by scanning of the mandible itself. The present DPA bone scanner is suitable for follow-up analyses of the BMC changes of the mandible and the forearms.     

Acute Effects of Local Hyperglycaemia on Peripheral Blood Flow in Man

To determine whether local hyperglycaemia affects peripheral blood flow in man, total forearm and skin microcirculatory blood flow were studied in healthy subjects before, during, and after a 1-h infusion of different concentrations of glucose or mannitol in the brachial artery. Mild or high forearm hyperglycaemia, induced by 5% glucose infusion (? 10 mmol l^-1 and ? 18 mmol l^-1, respectively) did not induce any changes in forearm muscle or skin blood flow. However, mild forearm hyperglycaemia (? 8 mmol l^-1), induced by 20% glucose infusion, acutely increased forearm blood flow, decreased forearm vascular resistance, but did not change skin blood flow. Twenty percent Mannitol infusion, as an osmotic control, did not result in any changes. We conclude that intra-arterial administration of 5% glucose does not acutely affect peripheral blood flow. The glucose-related effect induced by 20% infusion is probably due to marked hyperglycaemia at the catheter tip.     

带前臂外侧皮神经营养血管筋膜皮瓣的应用解剖

目的：为带前臂外侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法：在３２侧成人上肢标本上，观测前臂外侧皮神经营养血管及其周围皮肤的供血情况。结果：前臂外侧皮神经近侧的血供为肱动脉末端和桡动脉起始部的肌皮支，起始处外径分别为１．４ｍｍ、１．１ｍｍ，穿出深筋膜前长为１．９ｃｍ、１．４ｃｍ；远侧主要为桡动脉的粗大皮支，起始处外径为０．８ｍｍ，穿出深筋膜前长０．８ｃｍ；此外，桡动脉的茎突返支及掌浅支的皮支营养其远端。其神经支在神经束间或神经旁相互吻合构成纵向（链式）血管网，并借分支与筋膜皮支所形成的皮下筋膜血管网沟通。结论：可设计带前臂外侧皮神经及其营养血管的筋膜皮瓣，顺行或逆行转位修复邻近部位的软组织缺损。     

Re-displacement of paediatric forearm fractures: role of plaster moulding and padding

Re-displacement of paediatric forearm and wrist fractures following manipulation and cast application is a common complication. Poor plaster application technique is an important risk factor for re-displacement. However, there are no reliable and validated objective radiological measurements to differentiate a well-applied plaster cast from a poorly padded and moulded cast. This study was conducted in the background of this fact. We have attempted to define simple, reliable and objective radiological measurements to determine the quality of moulding and padding of the plaster thereby predicting re-displacement of fractures in this group. The two radiographic measurements used in this study are Cast index and Padding index, which are a guide to plaster moulding and padding, respectively. Case records and radiographs of 142 children who underwent a manipulation for a displaced fracture of forearm or wrist were studied. Angulation, translation displacement, Cast index and Padding index were measured on radiographs. The sum of the Cast index and Padding index was termed as the Canterbury index. Re-displacement was seen in 44 cases (32.3%). Cast index, Padding index and Canterbury index were significantly greater in the re-displacement group as compared to the cases where no re-displacement was seen (p<0.005). Improvement in the plaster application skills as monitored by these indices reduced the re-displacement rate by 50%. We suggest that a high Cast index of more than 0.8, Padding index of more than 0.3 and the combined Canterbury index of 1.1 are important risk factors for re-displacement of these fractures.     

弹性髓内钉治疗儿童前臂骨折的疗效评价

目的:通过使用弹性髓内钉治疗患儿前臂骨折,评价其对骨折术后功能恢复的影响。方法:2005年至2011年90例移位的患儿前臂骨折,其中8例开放性骨折,77例双前臂骨折。均采用手法或开放复位,弹性髓内钉内固定,并随访平均6.6个月。结果:骨折全部愈合,愈合时间平均2.9个月。功能评价优秀或良好76例(84%),并发症包括8例创口相关并发症,1例桡神经浅支麻痹,1例畸形愈合和1例术后骨筋膜室综合征。骨折愈合率与患儿骨折部位之间无统计学意义。结论:弹性髓内钉技术在儿童前臂骨折中是一种容易使用的,预后良好的治疗技术。     

前臂游离皮瓣移植修复口腔癌术后软组织缺损的护理

目的 探讨护理干预对前臂游离皮瓣移植修复口腔癌围手术期软组织缺损患者的经验.方法 2005年6月-2009年6月,对收治的63例口腔癌术后软组织缺损应用前臂挠侧游离皮瓣修复患者的围手术期护理方法进行回顾性分析,并做好术前心理护理及相关准备,术后严密观察皮瓣移植情况,以便及时发现血管危象,同时做好口腔、呼吸道、体位及皮瓣...     

Urban-rural differences in distal forearm fractures: Cohort Norway

Summary

The prevalence of forearm fractures increased with increasing degree of urbanization for both genders in the population-based study “Cohort Norway” with more than 180,000 participants. The differences were not explained by available risk factors. Prospective studies with information on bone mineral density and falls are warranted.

Introduction

The purpose was to investigate urban-rural gradients in self-reported forearm fractures and assess the contribution of possible explanatory factors.

Methods

“Cohort Norway” comprises ten population-based surveys inviting 309,742 individuals age 20 years and older. All 181,891 participants underwent a standardized examination and answered 50 common questions, including one concerning former forearm fractures. Based on the home-addresses, participants were divided into three population density groups: cities, densely populated areas and sparsely populated areas. Analyses were limited to 149,725 participants 30 years or over with valid information on exposure and outcome. Of these, 21,627 reported having suffered a forearm fracture.

Results

The prevalence of forearm fractures increased with increasing degree of urbanization for both genders. After adjustment for age and explanatory factors, the odds ratio of having sustained a forearm fracture in men living in densely populated areas and in cities were 1.12 (95% CI, 1.04–1.21) and 1.38 (95% CI, 1.30–1.46), respectively, compared to rural areas. Similar odds ratios were observed among women.

Conclusions

Prospective studies are needed to verify whether lower bone mineral density, different lifestyle and/or more falls may explain the higher proportion of self-reported forearm fractures found in urban compared to rural areas.