The vascularity of the flexor pollicus longus tendon.
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Biomedical subjects
Publications and source records attributed to A Zbrodowski.
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An anatomical study was made of the dorsal digital apparatus, a complex anatomical structure responsible for the extension of the fingers, and it was found to have an adequate blood supply. The relative abundance of blood vessels supplying the dorsal digital apparatus, their anastomoses and the details of their branching should be of interest to those involved in the surgical repair of this structure.
The importance of the arterial blood supply of the median nerve in the carpal tunnel depending on the type of hand vascularization was examined in view of surgical intervention in this region. Special attention was given to the anastomoses of the arterial branches which take part in the median nerve blood supply.
From a series of 84 cases of arterio-venous fistula, created for regular haemodialysis in end-stage chronic renal failure patients, the authors observed only one case of median nerve pathology at the level of the carpal tunnel. They propose three aetiologies: segmental ischaemia of the median nerve from perfusional redistribution, a mononeuritis syndrome aggravated by ischaemia and extrinsic compression of the median nerve by oedema secondary to distal venous reflux following creation of the vascular anastomosis. The authors recommend a termino-lateral anastomosis of a superficial vein (the superficial radial or the cephalic) with the radial artery. Using this approach, they did not observe any distal oedema nor any venous reflux into the hand. When a carpal tunnel syndrome is discovered in a case of arterio-venous fistula, the patient needs to be investigated for venous reflux into the hand and needs fistulography to exclude aspiration of blood from the cubital artery by the palmar arcade.
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The arterial supply to the flexor tendons of the fingers was studied by means of angiography, by the injection of coloured latex, and by microdissection. It was established that there were no anastomoses between the intra-osseous circulation and that of the synovial sheath. Two separate sources of blood supply to the sheath were found: the digitopalmar arches and the specific arteries of the sheath. The findings indicate that the ideal location for incision into the digital sheath is in the midline of the palmar surface. The flexor tendons within the sheath are supplied only by branches of the digitopalmar arches. Considerable differences were observed in the details of blood supply of the tendon of flexor superficialis and that of flexor profundus.
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In ten human hands the mesotendons of m. extensor digitorum longus and m. extensor indicis have been examined and described in detail. The various sources of their blood supplies have also been demonstrated and described.
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