The adductor canal block has become a common analgesic technique in patients undergoing knee arthroplasty. Dispersion of local anesthetic outside the adductor canal through interfascial layers and blockade of smaller nerves that confer innervation to the knee could contribute to the analgesic efficacy of the adductor canal block. We studied the diffusion of local anesthetic mixed with dye after injection into the adductor canal in fresh human cadavers. In all 8 legs, injectate was found in the popliteal fossa in contact with the sciatic nerve and/or popliteal blood vessels. Interfascial spread patterns were identified.

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A 38-year-old man had his left hand avulsed and the middle third of his right upper extremity irretrievably injured in a mine accident. The right hand was replanted onto the left forearm. The operative procedure is summarized and problems associated with such a procedure are briefly discussed. JOURNAL OF MICROSURGERY 3~251-254 1982Replantation is now being done with increasing frequency and success. Ideally, replantation involves reattaching the amputated part to its original anatomic position. In certain special situations, however, the amputated part may have to be replanted in a new position in order that some function may be obtained in the extremity .This preliminary report describes the replantation of an amputated hand onto the contralatera1 upper limb performed in December 1981. A similar case has been previously reported by Wang, Young, and Wei.' The combination of injuries that dictated this salvage procedure is very uncommon. CASEREPORTA 38-year-old man working in a strip mine was caught between a passing truck and a rock wall and suffered major injuries to both upper limbs, including avulsion of the left hand. On admission to the hospital three hours after the accident, the left hand (Fig. 1) was found to be unsalvageable. In addition to the avulsion injury, which had torn out many tendons and the median and ulnar nerves to the level of the proximal forearm, the hand itself had suffered a mangling injury. On the right side (Fig. 2), the elbow, the proximal half of the forearm and the distal half of the arm were crushed beyond the possibility of reconstruction. The only option available short of bilateral amputation was to replant the right hand onto the left forearm. His other injuries, which included mandibular fractures and a neck laceration, did not preclude this procedure.The right hand was amputated through the distal radius and ulna, but the flexor and extensor tendons and the major vessels and nerves were divided as far proximally in the forearm as possible. All forearm muscle tissue was stripped from the tendons. The amputation of the right arm was then formalized at the mid-humeral level.