ISSN:0738-1085    

DOI:10.1002/micr.1920140702

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

年代:1993

数据来源: WILEY

摘要:

AbstractNeurolysis is a procedure which has to be performed if the gliding apparatus of a peripheral nerve does not function, and consequently, adhesions and fibrosis develop. The gliding tissue has to provide the ability for the nerve to adapt to the different position of the extremity by longitudinal passive movement. The paraneurium provides movements between the nerve and the surrounding tissue; the interfascicular epineurium provides the possibility of the movement within the nerve. Internal neurolysis is defined as surgery within the nerve if the epifascicular epineurium is completely transected. A classification of different degrees of fibrosis is given with special reference to the procedure which has to be done in each case. Neurolysis is a step‐wise procedure with the aim to decompress the fascicles and which is immediately stopped if this aim is achieved. In very severe cases, if the gliding tissue does not regenerate, a gliding tissue flap to envelope the nerve may solve the problem. © 1993 Wiley‐Liss

ISSN:0738-1085    

DOI:10.1002/micr.1920140703

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

年代:1993

数据来源: WILEY

摘要:

AbstractOur concept for the reconstruction of brachial plexus injuries includes an intercostal nerve transfer to the vascularized ulnar nerve graft. A free neurovascular latissimus dorsi is then transferred in a second stage operation. For optimization of the regeneration result, the operative planning of the second step includes nerve biopsies and enzymhistochemical evaluation for the distribution of motor axons. The staining method according to Scabolcz et al.13is described and clinical cases are presented. © 1993 Wiley‐Liss I

ISSN:0738-1085    

DOI:10.1002/micr.1920140704

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

年代:1993

数据来源: WILEY

摘要:

AbstractAfter radiation, chronic infection or previous operations recipient vessels for free tissue transfer become difficult to find. It may be necessary to locate vessels remote from the area of reconstruction and to construct long venous grafts. Long venous grafts can be compressed in the tissue tunnels that may be required. In this series of patients, an arteriovenous fistula was created with a long saphenous loop 10 to 21 days prior to tissue transfer. The saphenous loops were placed close to the area for reconstruction and when divided at the time of transplantation, provided one artery and one vein. In this series of 12 cases, adequate vascularization was achieved in 10 cases. In the other 2 cases, we believe that maturation of the fistula may have been necessary before proper function. The other advantages of the technique are: the procedure can be carried out under local anaesthesia, ease of positioning of the patient on the operating table, and a reduction in the time taken to perform the tissue transfer. © 1993 Wiley‐Liss I

ISSN:0738-1085    

DOI:10.1002/micr.1920140705

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

年代:1993

数据来源: WILEY

摘要:

AbstractMultiple secondary grafting procedures may be necessary in cases of complete or partial amputation of the lower limb if the aim is to preserve the initial limb length. The traditional concept of staged reconstruction often leads to a prolonged hospitalisation and a high complication rate, especially in cases with segmental nerve defects of more than one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a primary shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months after replantation, secondary limb lengthening is started, using an external or internal distraction device. Since 1985, 7 patients presenting with complete or partial amputation of the lower leg had been treated using this concept. The indications, operative technique, complications and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting. © 1993 Wiley‐Liss I

ISSN:0738-1085    

DOI:10.1002/micr.1920140706

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

年代:1993

数据来源: WILEY

摘要:

AbstractDuring a period of 4 years, we attempted replantation of an amputated thumb in 21 patients. We present the survival rate as well as the functional recovery in correlation with type of injury. In 21 thumbs, 16 survived surgery (76.2%); 2 out of 5 losses belonged to the guillotine category and 3 belonged to the crush‐avulsion category. Out of the 11 thumbs that belonged to the crush‐avulsion type, 8 survived, which is a 72.7% success rate. Eight out of 10 thumbs of the guillotine type survived, an 80% success rate. The cosmetic and functional result was satisfactory. © 1993 Wiley‐Li

ISSN:0738-1085    

DOI:10.1002/micr.1920140707

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

年代:1993

数据来源: WILEY

摘要:

AbstractPreservation of peripheral nerves may, in the near future, play an important role in reconstructive surgery, especially if recent advances in immunosuppressive therapy are taken into account. Therefore, it has to be investigated whether peripheral nerves can be stored for some time after harvesting without diminishing their regenerative potential. Previous experiments of our group could demonstrate only little benefit of organ storage solution (HTK) or normal saline (NaCI 0.9%) to peripheral nerves when kept at cold ischaemia of 4°C for 32 and 72 hours. In this presentation, we are reporting the results of peripheral nerve storage in Dulbecco's Modified Eagle Medium which has been used for Schwann cell culture. In 30 adult Sprague‐Dawley rats, a 2.5 cm segment of the right sciatic nerve was harvested and kept at 4°C for 14, 32, 72, and 120 hours. It was then reimplanted into the donor animal; regeneration quality was assessed clinically, histologically and morphometrically after 6 weeks. Best regeneration results were obtained in the 32 and 72 hour groups; regeneration here was comparable to the normal controls. These results are explained with the positive effect of nerve predegeneration. © 1993 Wiley‐Li

ISSN:0738-1085    

DOI:10.1002/micr.1920140708

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

年代:1993

数据来源: WILEY

摘要:

AbstractThe creation of a distal arteriovenous fistula for haemodialysais is made easier by using preventive haemostasis with an inflatable tourniquet. Preventive haemostasis reduces the duration of the surgery and reduces the arterial spasm provoked by the dissection. When microsurgical techniques and preventive haemostasis are used, it is possible to create fistulas even in very small children. © 1993 Wiley‐Liss I

ISSN:0738-1085    

DOI:10.1002/micr.1920140709

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

年代:1993

数据来源: WILEY

摘要:

AbstractFree flap transplantations and replantations of extremities are threatened by venous occlusion in the postoperative course. In rats, free autogenous groin flaps were transplanted to the neck using microsurgical techniques. On the first postoperative day, the draining vein of the flap was temporarily clamped. In the control group there was always a total loss of the flaps by haemorrhagic necrosis. The intraarterial flap perfusion by lloprost during the clamping was able to diminish the ischaemic effects; 80% of the flaps survived. The systemic application of lloprost by intravenous infusion reduced the ischaemic effects in a similar way. Serious complications such as intraabdominal bleeding or bleeding in the donor area were seen after intravenous administration. Cicaprost had a similar protective effect on flap ischaemia after intravenous infusion. Flap survival was comparable to lloprost. Severe complications seemed to be less. Prostacyclin analogues were able to diminish damage of secondary ischaemia caused by venous occlusion. © 1993 Wiley‐Liss I

ISSN:0738-1085    

DOI:10.1002/micr.1920140710

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

年代:1993

数据来源: WILEY

摘要:

AbstractA new form of correction of hypoplasia of the thumb is presented in a case of grade 3 thumb hypoplasia. The distal half of the second metatarsal together with its epiphyseal plate was used to lengthen the first metacarpal bone and improve thumb function. This method represents a promising alternative to pollicization in this type of thumb hypoplasia. © 1993 Wiley‐Liss I

ISSN:0738-1085    

DOI:10.1002/micr.1920140711

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

年代:1993

数据来源: WILEY