• Archives of Plastic Surgery
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• v.38 no.6
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• pp.836-844
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• 2011

Purpose: Hands are the chief organs for physically manipulating the environment, using anywhere from the roughest motor skills to the finest, and since the fingertips contain some of the densest areas of nerve endings on the human body, they are continuously used organ with complex functions, and therefore, often gets injured. To prevent any functional loss, a detailed anatomical knowledge is required to have a perfect surgical treatment. Also it is necessary to have a thorough understanding of arrangements of the human extensor tendons and intertendinous connections when tenoplasty or tendon transfer is required. We performed a study of the arrangements of the human extensor tendons and the configuration of the intertendinous connections over the dorsum of the wrist and hand. Methods: A total of 58 hands from Korean cadavers were dissected. The arrangements of extensor indicis proprius, extensor digitorum communis, and extensor digiti minimi tendons and intertendinous connections were studied. Results: The most common distribution patterns of the extensor tendons of the fingers were as follows: a single extensor indicis proprius (EIP) tendon which inserted ulnar to the extensor digitorum-index (EDC-index); a single EDC-index; a single EDC-middle; a double EDC-ring; an absent EDC-little; a double extensor digiti minimi (EDM), a single EDC-index (98.3%), a single EDC-middle (62%), a double EDC-ring (50%), and an absent (65.5%) or a single (32.8%) EDC-little. A double (70.6%) EDM tendons were seen. Intertendinous connections were classified into 3 types: type 1 with thin filamentous type, type 2 with a thick filamentous type, and type 3 with a tendinous type subdivided to r shaped 3r type and y shaped 3y type. The most common patterns were type 1 in the 2nd intermetacarpal space, type 2 in the 3rd intermetacarpal space, and type 3r in the 4th intermetacarpal space. And in the present study, we observed one case of the extensor digitorum brevis manus (EDBM) on the boht side. Conclusion: A knowledge of both the usual and possible variations of the extensor tendon and the intertendinous connection is useful in the identification and repair of these structures.

• Archives of Plastic Surgery
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• v.50 no.4
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• pp.409-414
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• 2023

The anterior interosseous artery (AIA) perforator flap is not commonly used in hand dorsum reconstruction compared with alternatives. However, it is a versatile flap with several advantages. Literature on the AIA perforator flap is based on the dorsal septocutaneous branch (DSB), which branches from the AIA and passes through fascia between the extensor pollicis longus (EPL) and extensor pollicis brevis muscles. In the described case, the authors reconstructed a hand dorsum defect in a 78-year-old man using an AIA perforator flap with double perforators supplied by the DSB and a new perforator branching from the distal than DSB. No complication was encountered, and the flap survived completely. A retrospective computed tomography review revealed the presence of the new perforator in 14 of 21 patients. Two types of new perforator were observed. One passed through the ulnar side of the extensor indicis proprius (EIP) muscle and penetrated fascia between the extensor digitorum minimi and extensor digitorum communis tendons, whereas the other passed between the EPL and EIP muscles. This report describes the anatomical location and clinical application of the new AIA perforators. The double perforators-based AIA flap provides a straightforward, reliable means of reconstructing hand dorsum defects.

• Archives of Plastic Surgery
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• v.50 no.2
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• pp.177-181
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• 2023

Digital extensor hypoplasia (DEH) is a rare malformation that presents with loss of active finger extension at the metacarpophalangeal (MCP) joints. Descriptions of optimal treatment and outcomes in this population are sparse. We describe successful operative treatment of a child with DEH involving the extensor digitorum communis, extensor digiti minimi, and the extensor indicis proprius tendons. The 5-year-old male patient was referred for severe limitation on bilateral finger extension since birth. He had been previously diagnosed with arthrogryposis and managed conservatively. Due to lack of improvement, magnetic resonance imaging was done evidencing hypoplasia/aplasia of the extensor tendons. The patient underwent successful tendon transfers using extensor carpi radialis longus to the common extensor tendons, and one hand required an additional tenolysis procedure. 2 years postoperatively, his MCP position and finger extension are markedly improved, and he is able to grip objects without limitation or difficulty. The patient returned to full activity without restriction.

• Archives of Plastic Surgery
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• v.49 no.1
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• pp.76-79
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• 2022

Kienböck disease, a rare disease that can cause chronic pain and motor dysfunction, occurs due to avascular necrosis of the lunate bone, which leads to dislocation of the carpal bone. Among various other etiologies, Kienböck disease can cause closed tendon rupture of the finger. In this report, we introduce a case of total rupture of the second extensor digitorum communis and the extensor indicis proprius tendons caused by undiagnosed Kienböck disease in an elderly female patient.

• Journal of Korean Institute of Industrial Engineers
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• v.39 no.2
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• pp.99-104
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• 2013

With diversity of mobile services (e.g., messenger, and social network service) on smartphone, the demand of text input using a soft keyboard is increasing. However, studies on subjective and physiological responses of users for various touch locations are lacking. The present study investigated the ergonomic effects according to touch locations of a soft keyboard on smartphone. The experiment of the present study measured perceived discomfort using Borg's CR-10 scale and electromyography (EMG) on forearm (abductor pollicis longus, and extensor digitorum communis) and thumb (abductor pollicis brevis, and first dorsal interossei) muscles. Perceived discomfort was significantly varied from 0.7 (extremely weak discomfort) to 2.5 (weak discomfort) depending on touch locations. %MVC according to touch locations was only significant at abductor pollicis brevis which varied from 10% to 23%. The experimental results of the present study can be utilized in the ergonomic design of a soft keyboard.

• Therapeutic Science for Rehabilitation
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• v.3 no.1
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• pp.39-45
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• 2014

Objective : The purpose of this study was to investigate the efficacy of electromyogram-triggered neuromuscular stimulation in the treatment to Guillain-Barre Syndrome patients of through case Study. Methods : The subject was a 66-year old woman who has Guillain-Barre Syndrome, showed wrist and hand function decrease in FMA and JTHFT investigation. She received a electromyogram-triggered neuromuscular stimulation treatment for 4weeks, 1 per day, 30 minute for each(right, left). Results : After 4 week period, wrist and hand function of FMA was observed increase and JTHFT showed improvement in some items. Conclusion : The use of electromyogram-triggered neuromuscular stimulation in the treatment of Guillain-Barre Syndrome who had peripheral neuropathy could been effective to therapy for motor recovery.

• Archives of Reconstructive Microsurgery
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• v.24 no.2
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• pp.62-67
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• 2015

Purpose: Pollicization typically involves surgical migration of the index finger to the position of the thumb. This procedure facilitates the conversion of a useless hand into a well-functioning one in patients who are not amenable to the toe-to-hand transfer. However, middle finger pollicization has been rarely reported. Materials and Methods: We reconstructed a thumb by immediate pollicization of the remnants of the middle finger in two patients who sustained a tumor and a trauma, respectively. The former, after cancer ablation was performed, has not been reported literally, and the latter involved free devitalized pollicization of the middle finger using a microsurgical anastomosis. The distal third extensor communis tendon was sutured to the proximal extensor pollicis longus tendon and the distal flexor digitorum superficialis and profundus were sutured to the proximal flexor pollicis longus. The abductor pollicis brevis tendon was sutured to the distal end of the first palmar interosseous muscle. Coaptation of the third digital nerve and the superficial radial nerve branch was performed. Results: Patients showed uneventful postoperative courses without complication such as infection or finger necrosis. Based on the principles of pollicization, a wide range of pinch and grasp movements was successfully restored. They were pleased with the functional and cosmetic results. Conclusion: Although the index finger has been the digit of choice for pollicization, we could also use the middle finger on specific occasions. This procedure provides an excellent option for the reconstruction of a mutilated thumb and could be performed advantageously in a single step.