摘要:

AbstractThe purpose of this study was to establish the potential of the gracilis muscle to provide separate but controlled movement (e.g., independent finger flexion) when used as a free muscle transfer. The intramuscular neurovascular anatomy was studied in cadavers and in vitro. Through injection, dissection, and stimulation studies, it has been established that the distal gracilis can be separated longitudinally into at least two viable parts with independent neural control. This potential has been realized in ten clinical cases in which some separation of thumb and finger function has been achieved.

ISSN:0897-3806    

DOI:10.1002/ca.980030202

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe diagnosis of esophageal carcinoma carries an extremely poor prognosis. Even after apparently curative resection, with histologically normal resection margins, there is a high incidence of locally recurrent disease. This study was performed to determine if cell surface morphological abnormalities, indicative of a “field change,” are present in the esophageal mucosa of patients with squamous carcinoma of the esophagus. Seven patients with squamous cell carcinoma of the esophagus and seven patients with a normal esophagus were studied. Biopsies were examined using both light and scanning electron microscopy; they were taken from the midesophagus in the normal group and from the tumor, the normal mucosa adjacent to the tumor, and the proximal surgical resection margin in the tumor group. There was a characteristic pattern of abnormalities present in both the mucosa adjacent to tumor and the resection margin, indicative of a field change. The microplicae on the cell surfaces were reduced in number and were unfolded, and defects were found in the extracellular matrix giving rise to intercellular fissures. These changes reflect increased cell turnover and increased cell exfoliation. We conclude that scanning electron microscopy can detect widespread changes in the esophageal mucosa of patients with esophageal cancer that are not detectable by light microscopy. The fact that such field changes exist as far as the proximal surgical resection margin may help explain locally recurrent disease after apparently curative surg

ISSN:0897-3806    

DOI:10.1002/ca.980030203

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThis paper describes the morphological appearances of long‐term nerve repair using freeze‐thawed, coaxially aligned autogenous skeletal muscle grafts in rats. The presence of minifascicles (compartmentation) within the muscle grafts confirms earlier reports of compartmentation whenever nerve regeneration occurs in a nonnerural environment. However, in contrast to the reports in the literature, there was no evidence of a loss of compartmentation at long intervals after nerve repair. It was found that a number of minifascicles became enclosed by a further proliferation of perineural cell to form distinct minifascicular groups. The term “midfascicle” is used to describe these larger perineural defined groups of minifascicles. The role of the perineurium is di

ISSN:0897-3806    

DOI:10.1002/ca.980030204

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractNerve fiber regeneration into sciatic nerve branches was investigated in rats after repairing a 1 cm gap with freeze‐thawed autogenous muscle grafts in two configurations. “Prejunctional” grafts were introduced in the main trunk proximal to branching, while Y‐shaped “junctional” grafts replaced and reconstructed the site of division of the sciatic nerve into its tibial and peroneal branches. In addition to assessing functional and electrophysiological recovery, myelinated fibers in whole nerve cross sections were counted (i) in the sciatic nerve proximal to the site of transection, (ii) within the grafts themselves proximal to branching, and (iii) in individual tibial, peroneal, and sural branches.Fibers regenerated into all three branches but eventual relative and absolute fiber counts differed between the two graft types, and these in turn from values in these nerves in unoperated controls. Thus, any specific influences directing appropriate fibers into particular branches that might exist did not exert a marked effect on regeneration in vivo. Differences in fiber counts at successively more distal cross‐sectional levels were described in terms of elongation, branching, or regression of regenerating fibers. In either graft type, fiber branching coincided with close anatomical relationship with more than one distal stump, and was particularly marked 150–300 days after graft implantation with junctional grafts. However, subsequent penetration of such fibers into the three major branches was more effective if the anatomy of the original branch site was preserved, by using prejunctional grafts. The implications of these findings to clinical nerve repair involving large nerve territori

ISSN:0897-3806    

DOI:10.1002/ca.980030205

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractIn order to improve the survival of non‐physiologic flaps, the morphologic changes of the vessels that provide the circulation were studied in 178 rats by translucent, radiologic, and histologic methods. The flaps were divided into five groups: normal, simple venous, arterialized venous, simple arterial, and devascularized flaps. The differences of the survival area ratios among the normal, simple venous, and arterialized venous flaps were not statistically significant, and the revascularization of the flaps of these three groups was similar. Therefore, simple venous and arterialized venous flaps may be used in clinical practice. The arterial revascularization of the simple venous and arterialized venous flaps started on the fifth postoperative day, after which a normal circulation was reestablished. On the first postoperative day, the arterialized venous flap was nourished by the arterial blood passing through the anastomosed venous system in the flap. Before the fifth postoperative day in the simple venous flap, and by the third day in the arterialized venous flap, arteries have not been demonstrated but the veins appear distended. It is fair to assume that a true plasmatic circulation was present at this stage. The obstruction of the anastomosed segments of vessels in the arterialized venous flap group may permit a reduction of the edema and cyanosis of the fla

ISSN:0897-3806    

DOI:10.1002/ca.980030206

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractIn order to avoid injury to the marginal mandibular branch of the facial nerve during surgery in the face and neck, a simple method for locating this branch was devised. The anatomical relations between the marginal mandibular nerve and both the facial artery and vein were analyzed in 19 dissection preparations. The following distances were considered: (1) the angle of the mandible to the intersection point nerve‐vein; (2) mandibular angle to the facial artery; (3) inferior mandibular margin to the intersection point nerve‐vein; (4) facial artery to the intersection point projection nerve‐vein; (5) facial artery to the intersection point projection nerve‐vein on the inferior mandibular margin; and (6) facial vein to the facial artery. These data are useful for an easier localization of the marginal mandibular nerve in the submandibular region. All reference points employed are easily detected in a living

ISSN:0897-3806    

DOI:10.1002/ca.980030207

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980030209

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980030210

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980030211

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0897-3806    

DOI:10.1002/ca.980030212

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY