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Journal of the American Academy of... Feb 2022In distal upper extremity surgeries, there can be a choice to use an upper arm or forearm tourniquet. This study examines discomfort and tolerance in healthy volunteers... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
In distal upper extremity surgeries, there can be a choice to use an upper arm or forearm tourniquet. This study examines discomfort and tolerance in healthy volunteers to determine whether one is more comfortable.
METHODS
Forty healthy, study participants were randomized to an upper extremity laterality and site. Tourniquets were inflated to 100 mm Hg over systolic blood pressure. Participants experienced an upper arm and a forearm tourniquet sequentially. Visual analog scores (VAS) were recorded at 2-minute intervals. Time until request and VAS at tourniquet deflation were recorded. Time until the complete resolution of paresthesias was also recorded. Participants subjectively stated which tourniquet felt more comfortable.
RESULTS
Tourniquets were inflated longer on the forearm than the upper arm (mean 16.1 minutes versus 12.2 minutes; P < 0.0001). VAS at tourniquet removal was not different between the sites (means 7.3 and 7.3) (P = 0.839). Time until paresthesia resolution after the tourniquet was deflated was not different (means 8.1 and 7.7 minutes) (P = 0.675). Time until paresthesia resolution was proportional to tourniquet inflation time for both sites (regression coefficient 0.41; P < 0.00001). Participants found the forearm more comfortable (95% confidence interval, 0.63 to 0.92).
CONCLUSION
Forearm placement allows the tourniquet to be inflated for an average of 4 minutes longer. Forearm tourniquet is subjectively more comfortable.
Topics: Arm; Forearm; Humans; Paresthesia; Tourniquets; Upper Extremity
PubMed: 35167505
DOI: 10.5435/JAAOSGlobal-D-21-00229 -
International Wound Journal Feb 2022Negative-pressure wound therapy (NPWT) is often used for skin graft site dressing, and several studies have reported that its use improves skin graft failure in the... (Meta-Analysis)
Meta-Analysis
Negative-pressure wound therapy (NPWT) is often used for skin graft site dressing, and several studies have reported that its use improves skin graft failure in the forearm flap donor site. The present systematic review aimed to evaluate the efficacy of NPWT with skin graft for donor-site closure in radial forearm free flap (RFFF) reconstruction. A systematic search in PubMed, Web of Science, and Cochrane Library databases was conducted. The search terms used for PubMed were ([radial forearm]) AND ([donor]) AND ([negative pressure or vacuum]). This review was registered in the International Prospective Register of Systematic Reviews and performed in accordance with the preferred reporting items for systematic reviews and meta-analyses statement. Three prospective randomised controlled trials and three retrospective comparative studies were included. Compared with conventional bolster dressing, the use of NPWT dressing did not lead to significant improvements in partial skin graft loss, tendon exposure, and other complications. NPWT improved hand functionality earlier; nonetheless, the cost of the device and dressings was a disadvantage. The use of NPWT for skin graft fixation in the RFFF donor site is not generally recommended.
Topics: Forearm; Free Tissue Flaps; Humans; Negative-Pressure Wound Therapy; Plastic Surgery Procedures; Retrospective Studies; Skin Transplantation
PubMed: 34101358
DOI: 10.1111/iwj.13632 -
In Vivo (Athens, Greece) 2018The radial forearm flap (RFF) and the anterolateral thigh flap (ALT) are commonly used for the reconstruction of head and neck soft-tissue defects. The aim of the study...
BACKGROUND
The radial forearm flap (RFF) and the anterolateral thigh flap (ALT) are commonly used for the reconstruction of head and neck soft-tissue defects. The aim of the study was to investigate and compare the surgical outcomes, complications and systemic condition of the patient after reconstruction of extensive head and neck defects with ALT or RFF following cancer extirpation.
PATIENTS AND METHODS
Between August 2011 and November 2013, a total of 36 patients affected by head and neck cancer (31 males and five females; mean age=64.7 years, range=40-86 years) underwent microsurgical reconstruction with 29 RFF and 10 ALT procedures. The surgical outcomes and complications among these two groups were retrospectively analyzed.
RESULTS
The success rate was 97% for the RFF group and 90% for the ALT group, with one total flap loss in each group. Donor-site complications occurred in 6% of the RFF group and in 7% of the ALT group. Seven RFF-treated patients (24%) and two treated with ALT (20%) experienced systemic complications. Statistical analysis confirmed no significant difference between the two groups regarding the variables investigated (p>0.05).
CONCLUSION
In our experience, ALT and RFF demonstrated analogous practicability and reliability for the reconstruction of head and neck soft-tissue defects, with similar local and systemic complications and donor-site morbidity rates.
Topics: Adult; Aged; Aged, 80 and over; Female; Forearm; Head and Neck Neoplasms; Humans; Male; Middle Aged; Neck; Postoperative Complications; Plastic Surgery Procedures; Skin Transplantation
PubMed: 29936476
DOI: 10.21873/invivo.11325 -
Annals of the Royal College of Surgeons... Sep 2016A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a...
A term neonate was born with a grossly swollen and discoloured left hand and forearm. He was transferred from the local hospital to the plastic surgical unit, where a diagnosis of compartment syndrome was made and he underwent emergency forearm fasciotomies at six hours of age. Following serial debridements of necrotic tissue, he underwent split-thickness skin grafting of the resultant defects of his forearm, hand and digits. At the clinic follow-up appointment two months after the procedure, he was found to have developed severe flexion contractures despite regular outpatient hand therapy and splintage. He has had further reconstruction with contracture release, use of artificial dermal matrix, and K-wire fixation of the thumb and wrist. Despite this, the long term outcome is likely to be an arm with poor function. The key learning point from this case is that despite prompt transfer, diagnosis and appropriate surgical management, the outcome for neonatal compartment syndrome may still be poor.
Topics: Compartment Syndromes; Forearm; Hand; Humans; Infant, Newborn; Male
PubMed: 27138850
DOI: 10.1308/rcsann.2016.0159 -
Hand (New York, N.Y.) Jul 2020Both bone forearm infective nonunions represent a rare but functionally limb threatening condition. We report a successful salvage of a severe near total both bone... (Review)
Review
Both bone forearm infective nonunions represent a rare but functionally limb threatening condition. We report a successful salvage of a severe near total both bone diaphysial osteomyelitis by conversion to a one-bone forearm with free fibula flap. A literature review on forearm salvage addressing both bone defects was performed. Bony union was achieved at 4 months with a highly functional extremity salvage in our case. While very little prior experience has been reported for long segmental both bone forearm infected nonunions, we report of this highly satisfactory salvage using one-bone free tissue transfer strategy. We also provided our literature review with history, indication and evolution of individualized treatment options for this difficult surgical condition.
Topics: Diaphyses; Fibula; Forearm; Free Tissue Flaps; Humans; Radius
PubMed: 31215792
DOI: 10.1177/1558944719857168 -
Indian Pediatrics Jun 2014
Topics: Child; Ecthyma; Forearm; Humans; Male; Skin
PubMed: 24986304
DOI: No ID Found -
Hand Surgery & Rehabilitation Apr 2022This study aimed to investigate load distribution and forearm muscle activity from strong to weak grip strength, using a cylindrical device (Grip Sensor). We invited 15...
This study aimed to investigate load distribution and forearm muscle activity from strong to weak grip strength, using a cylindrical device (Grip Sensor). We invited 15 students and measured the pressure distribution and forearm muscle activity during grip tasks at 25%, 50%, 75%, and 100% maximum voluntary force (MVF). Pressure data from the Grip Sensor were assigned to seven anatomical regions; the sum of the data from the seven regions (Total force) and proportionate load distribution for each grip task were calculated. Electromyography recorded activity in the extensor carpi radialis longus (ECRL), flexor carpi radialis (FCR), extensor carpi ulnaris (ECU) and flexor carpi ulnaris (FCU) muscles. Forearm muscle activity increased significantly with grip strength (p < 0.05). The load proportion corresponding to the thumb did not significantly change with increasing strength. On the other hand, the fingertip ratio significantly decreased, and the palm ratio significantly increased with increasing strength (p < 0.05). The Grip Sensor showed a shift in the load distribution in the hand from fingertips to palm as grip strength increased. This result indicates that more detailed evaluations of hand function may be possible.
Topics: Electromyography; Forearm; Hand Strength; Humans; Muscle, Skeletal; Thumb
PubMed: 35074561
DOI: 10.1016/j.hansur.2021.12.010 -
Folia Morphologica 2021The radial forearm flap (RFF), including the radial artery (RA) and venous components, is used for hand reconstruction surgery. Updating the knowledge of the vascular...
BACKGROUND
The radial forearm flap (RFF), including the radial artery (RA) and venous components, is used for hand reconstruction surgery. Updating the knowledge of the vascular anatomy in the forearm and associated flaps, such as the RFF, is useful in bringing innovations into reconstructive surgery. This study aimed to describe the morphometric anatomy of the RA and the associated RFF in human cadavers.
MATERIALS AND METHODS
A total of 16 forearms from 8 human cadavers were dissected. The group consisted of 5 men and 3 women with a mean age at death of 59.05 ± 14.06 years. The inclusion criteria consisted of no history of trauma or surgery; thus, only apparently normal cadavers were included. The measurement of the following parameters was performed on these human cadavers: the mean diameter of the RA, the length of the RA, the average diameter of the cephalic vein, the length of the pedicle of the flap, and the average area of the radial forearm flap.
RESULTS
In males, the mean diameter of the RA at the wrist was 2.58 ± 1.1 mm. In females, the mean diameter of the RA was 2.60 ± 0.99 mm, and the mean length of the RA was 20.55 ± 1.7 cm. The average diameter of the cephalic vein was 1.8 ± 0.8 mm. The length of the pedicle of the flap was 8.88 ± 1.6 cm. The average area of the RFF was 5 × 7 cm2.
CONCLUSIONS
This study demonstrates the morphometric anatomy of the RA and lateral forearm radial artery flaps in human cadavers, which could be useful in improving the success rate during transradial coronary interventions and performing complex hand injuries.
Topics: Female; Forearm; Humans; Male; Radial Artery; Plastic Surgery Procedures; Surgical Flaps; Veins
PubMed: 33241849
DOI: 10.5603/FM.a2020.0139 -
Skin Research and Technology : Official... Mar 2023Skin measurements of transepidermal water loss (TEWL) and stratum corneum hydration (SCH) reflect different aspects of skin physiology. Since epidermal water loss...
BACKGROUND
Skin measurements of transepidermal water loss (TEWL) and stratum corneum hydration (SCH) reflect different aspects of skin physiology. Since epidermal water loss depends on epidermal-to-air water vapor gradients, a possible quantitative relationship between TEWL and SCH may exist. This investigation's purpose was to test the possible TEWL-SCH relationship.
MATERIALS AND METHODS
SCH and TEWL were measured noninvasively on forearm and palmer thenar eminence (hand) in 40 young adults (20 males) along with total body fat percentage (FAT) via bioimpedance.
RESULTS
A significant positive nonlinear correlation (p < 0.001) was detected between SCH and TEWL in hands of the male cohort that occurred when SCH exceeded a threshold level. This threshold level was not exceeded in male or female forearms and forearms did not display a SCH-TEWL correlation. There was a weak inverse dependence of TEWL on FAT on both forearm and hand (p < 0.05), but no SCH-FAT relationship was observed. TEWL values on the forearm and hand were moderately correlated with each other (p = 0.002) but SCH values were not.
CONCLUSION
The findings clarify the relationship between forearm and palmer hydration and TEWL values, and their relationship to total body fat percentages in young healthy adults. The significant correlation between palmer stratum corneum hydration and palmer TEWL that was discovered in the male but not the female cohort suggests a threshold hydration level for which TEWL depends both on skin barrier function and stratum corneum hydration. This implies that conditions with increased SCH may in part account for elevated TEWL values.
Topics: Female; Humans; Male; Young Adult; Epidermis; Forearm; Hand; Skin; Skin Physiological Phenomena; Water Loss, Insensible; Steam; Organism Hydration Status
PubMed: 36973986
DOI: 10.1111/srt.13218 -
BMC Musculoskeletal Disorders Apr 2022Early detection and timely prophylaxis can retard the progression of osteoporosis. The purpose of this study was to determine the validity of peripheral Dual Energy...
BACKGROUND
Early detection and timely prophylaxis can retard the progression of osteoporosis. The purpose of this study was to determine the validity of peripheral Dual Energy X-ray Absorptiometry (DXA) test for osteoporosis screening. We examined peripheral bone mineral density (BMD) using AKDX-09 W-I DXA densitometer. Firstly, we acquired BMD data from manufacturer-supplied density-gradient phantoms and 30 volunteers to investigate its accuracy and precision, then we measured BMD for 150 volunteers using both AKDX (left forearm) and Hologic Discovery Wi (left forearm, left hip and L1 - L4 vertebrae) simultaneously. Correlation relationship of BMD results acquired from two instruments was assessed by simple linear regression analysis, the Receiver Operating Characteristic (ROC) curves and Areas Under the Curves (AUCs) were evaluated for the diagnostic value of left forearm BMD measured by AKDX in detecting osteoporosis.
RESULTS
In vitro precision errors of AKDX BMD were 0.40, 0.20, 0.19%, respectively, on low-, medium-, and high-density phantom; in vivo precision was 1.65%. Positive correlation was observed between BMD measured by AKDX and Hologic at the forearm (r = 0.670), L1-L4 (r = 0.430, femoral neck (r = 0.449), and total hip (r = 0.559). With Hologic measured T-score as the gold standard, the sensitivity of AKDX T-score < - 1 for identifying suboptimal bone health was 63.0 and 76.1%, respectively, at the distal one-third radius and at any site, and the specificity was 73.9 and 90.0%, respectively; the AUCs were 0.708 and 0.879. The sensitivity of AKDX T-score ≤ - 2.5 for identifying osteoporosis at the distal one-third radius and at any site was 76.9 and70.4%, respectively, and the specificity was 80.4 and 78.0%, respectively; the AUCs were 0.823 and 0.778.
CONCLUSIONS
Peripheral DXA appears to be a reliable tool for prescreening for osteoporosis.
Topics: Absorptiometry, Photon; Bone Density; Femur Neck; Forearm; Humans; Osteoporosis
PubMed: 35459140
DOI: 10.1186/s12891-022-05325-6