© 2009 Wiley-Liss, Inc. Microsurgery, 2010. “
“Tremor is the most common involuntary
disease that is characterized by swinging of a body part caused by contraction of agonist and antagonist muscles in a sequential order.[1] Free flap surgery needs immobilization for the high rates of success especially when there is a potential risk of pedicle torsion, kinking, or predictable pressure.[2] Microsurgery including vascular anastomosis makes itself elegance to some factors like friction, tissue pressure, thrombosis, torsion, and mobilization.[3] In this letter, we present a free flap surgery for Roxadustat manufacturer reconstruction of soft tissue defect in a patient with essential tremor. A 43-year-old male patient suffered donkey bite presented with a dorsal soft tissue defect a 5 × 9 cm in size on his left hand and proximal phalanx fracture of second digit.
Extensor digitorium communis tendons of second and third digits and extensor indicis proprius were exposed, and there was a requirement of soft tissue for covering of tendons. Initially the wound was debrided and vacuum assisted wound therapy was applied three times. Reconstructive surgery was postponed until a clean wound was achieved. In his systemic examination hereditary essential tremor was observed. The patient did not go to any physician to be examined for tremor in his life. He was not reluctant for GS-1101 in vitro neurologic examination so no medication was given during hospitalization. A
free lateral arm flap was planned in the same arm. The flap 6 × 10 cm in size was raised based on radial collateral artery of the profunda brachii artery with vena comitantes. The radial artery in the anatomic snuff box with a dorsal cutaneous vein was recipient vessels. Bone fracture was reducted and fixed with a K-wire. The surgery was successfully done for 5 hours. The patient was operated under general anesthesia so the arm was not trembling during surgery. A plaster was placed on the volar surface of the hand and forearm for extremity immobilization. We observed that the arm Benzatropine was trembling after patient’s recovery from anesthesia despite putting the extremity in a plaster. We thought that tremor could be irritation on vascular anastomosis by causing rhythmic contraction. However, we did not observe any problem about artery or venous circulation of lateral arm flap. All microsurgeons must take some safety precautions to ensure flap viability in the postoperative period. Flap monitorization by checking color, temperature, recapillarization, turgor, immobilization for preventing pedicle torsion or kinking, and removing any forces applying pressure on the flap are essential safety mechanism.[3] It is well known that immobilization is very important for free flap surgery for the safety of vessel anastomosis.[2] We can think that if tremor cause similar but not the same affect in anastomosis area as early mobilization.