Reconstruction of the Superficial Palmar Arch Using the Subscapular Arterial System
Bibliographic record
Abstract
Hypothenar hammer syndrome is a rare entity warranting urgent exploration of the ulnar artery if signs of critical digital ischemia are present. To the authors' knowledge and based on review of the relevant literature, this case report is the first to describe the harvest of the subscapular arterial system for reconstruction of an extensive arterial defect involving the ulnar artery, superficial palmar arch, and associated branches for a case of hypothenar hammer syndrome. The patient presented with an ischemic and exquisitely painful fourth digit. After undergoing the aforementioned reconstruction, all digits were subsequently well perfused with normal capillary refill, color, warmth, and sensation. A strong ulnar pulse was palpated at the volar wrist crease. Patency of the interposition graft was verified by CT angiography (6 weeks postoperatively) and Doppler ultrasound (4 months postoperatively), showing strong radial and ulnar digital pulses of all digits. CT angiography was repeated at 6 months postoperatively and showed graft occlusion. Despite this, no signs of critical ischemia developed, and clinical symptoms were still much improved from initial presentation, with only residual cold intolerance noted 13 months postoperatively. As an arterial graft donor site, the subscapular system is easily accessible, offers generous length, and provides for multiple branches, making it ideal for the reconstruction of large, complex arterial defects in the hand.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".