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Presentation of soft tissue anatomy of mirror hand: an anatomical case report with implications for surgical planning

01/19/2016 | Anatomic Variations | Edition 7/2016

Magazine:
Surgical and Radiologic Anatomy> Edition 7/2016
Authors:
Morad Askari, Kevin N. Christensen, Shaun Heath, Steven L. Moran, Nirusha Lachman

Abstract

Purpose

Mirror hand or ulnar dimelia is a rare and poorly studied congenital anomaly of the upper extremity. Understanding of its anatomy is limited by the rarity of the deformity and the variability in presentation. We present the case of an 80-year-old female donor with an incidental finding of mirror hand.

Methods

Medical history indicated no record of any surgical procedures or interventions to the right upper extremity suggesting that the donor had lived an independent life without the need for prosthetic aids. Unfortunately, no record of a hand examination or any visit to a hand specialist was identified within the medical record. Following imaging and disarticulation of the arm at the glenohumeral joint, an anatomical dissection was performed on the right upper extremity.

Results

Findings were recorded and compared to three earlier reports in the limited literature with a strong focus on understanding the anatomy of this deformity important for surgical planning. The anatomy is highlighted with a brief description of the embryology associated with mirror hand deformity. The case presents a classic example of ulnar dimelia. Arterial patterns compared favorably with those described in the literature. In addition to an aberrant branch of the median nerve and a deep branch supplying the extensor compartment were noted.

Conclusion

Based on the observations of this study (and the previous reports) we would recommend a study of the vascular tree of the hand either through conventional arteriography or CT angiography prior to pollicization. The surgeon should also be prepared to perform a microsurgical arterial anastomosis if pollicization is not possible in case of an incomplete arch similar to one we described.

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Literature About this article
title
Presentation of soft tissue anatomy of mirror hand: an anatomical case report with implications for surgical planning
Authors:
Morad Askari
Kevin N. Christensen
Shaun Heath
Steven L. Moran
Nirusha Lachman
Publication date
19.01.2016
DOI
https://doi.org/10.1007/s00276-015-1611-8
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