Part 2 book “Key notes on plastic surgery” has contents: The upper limb, the lower limb, the trunk and urogenital, burns, aesthetic surgery, ethics, the law and to reference. | CHAPTER 5 The Upper Limb CHAPTER CONTENTS Embryology, 309 Congenital deformities, 311 Hand trauma, 329 Hand infections, 351 Complex regional pain syndrome (CRPS), 355 Nerve compression, 357 Traumatic brachial plexus injury, 371 Obstetric brachial plexus palsy, 382 Tendon transfers, 384 Dupuytren’s disease, 388 Tumours, 396 Arthritis, 401 Miscellaneous tendinopathy, 417 Further reading, 419 Embryology Developmental anatomy • Upper limb bud appears in the flank of the embryo on day 26. • Consists of a core of lateral plate mesoderm covered by ectoderm. ∘ This mesoderm will differentiate into bone, cartilage and tendon. • Ectoderm thickens at the tip of the bud in the anteroposterior (AP) axis to form the apical ectodermal ridge (AER). ∘ In the embryo, the AP axis is analogous to the radio-ulnar axis. • The limb bud is initially supplied by a capillary network. • This coalesces into a main stem artery that drains into a marginal vein. ∘ Artery becomes the subclavian-axillary-brachial axis. ∘ Vein becomes the basilic-axillary-subclavian axis. • The brachial artery branches into interosseous and median arteries. ∘ The median artery provides the main blood supply to the hand. ∘ It is usually replaced by ulnar and radial arteries around day 44. ∘ Regresses to provide the blood supply of the median nerve. • By day 33 a paddle-shaped hand is present. Key Notes on Plastic Surgery, Second Edition. Adrian Richards and Hywel Dafydd. © 2015 John Wiley & Sons, Ltd. Published 2015 by John Wiley & Sons, Ltd. 309 310 Chapter 5 • Prechondrogenic condensations of mesenchyme appear where skeletal elements will form. • Around day 36, nerve trunks enter the arm. • Somitic mesoderm invades the limb and aggregates into dorsal and ventral masses. ∘ These differentiate into myoblasts that become muscle. • By day 42, digital rays are present and the hand assumes a webbed appearance. • During the 7th week, upper limbs rotate 90∘ laterally to bring the palm anteriorly. • At the same .
