bluuebunny/crossref_metadata_2025 huggingface dataset:
Experimental study and clinical observations on hypertrophy of vascularized bone grafts
Authors: Fujimaki Arihisa , Suda Hitoshi
Published: March 2007

In order to understand the mechanisms involved in the hypertrophy of vascularized bone grafts, a series of animal experiments were carried out and 32 clinical cases were studied. A defect in the tibial shaft was created in puppies and the ipsilateral fibula was transferred into the medullary cavity of the tibia with the anterior tibial artery and vein. The same procedure was performed on a control group but without vessel supply. Radiologically, in the vascularized group mild hypertrophy in the fibula was seen at 2 weeks, became marked by 4 weeks, but in no case did the thickening (hypertrophy) of the graft ever exceed the diameter of the recipient tibia. The control group did not show hypertrophy but fracture callus formed in the recipient tibia at both ends of the graft. On histological evaluation no reactive bone formation was evident in the control group but some reactive bone formation was seen in the vascularized group just beneath the periosteum. There was no change in the periosteum itself. In the clinical cases 47% of patients showed hypertrophy. Hypertrophy was noted mainly in the fibulae but rarely in other bones such as ilium or rib. The important factors were age and good vascularity of the grafted bone. During the period of study, weight‐bearing was eliminated, so that the effects of mechanical force did not explain hypertrophy. We conclude from these studies that true hypertrophy is an essentially different process from reactive callus which forms normally in response to fracture healing. Vascularized bone grafts show remarkable hypertrophy of the grafted bone, but the exact mechanism is ill defined. In order to investigate the mechanisms, a series of animal experiments were carried out and clinical cases were studied. © 1994 Wiley‐Liss, Inc.
Bernard O'Brien: The microsurgical transfer of immature bone
Authors: Bowen C. Vaughan A. , Singer Steven
Published: March 2007

Bernard O'Brien was one of the pioneers of vascularized epiphyseal plate transfer. His clear understanding of the wide array of potential applications for reconstructive microsurgery stimulated his interest in the transfer of growing long bones. Investigations have been carried out in his laboratory since the earliest days of skeletal free tissue transfers. This paper describes the work done with epiphyseal plate transfers in O'Brien's laboratory. Research from other centers is then reviewed. Finally, the experience with clinical application is described. © 1994 Wiley‐Liss, Inc.
Transsphenoidal microsurgical management of pituitary adenomas
Authors: Yang Shu‐Yuan , Zhu Tao , Zhang Jian‐Ning , Sun Yin‐Shui
Published: March 2007

The transsphenoidal microsurgical operation is the best choice for most pituitary adenomas, whether or not there is an extension into the sphenoid or a supra‐sellar extension without lateral spread. The advantage of this approach is that it allows selective removal of the adenoma and therefore can preserve normal pituitary function. In our series of 249 cases 79% had achieved a remission at follow‐up one year or more after surgery. The surgical failure rate was 21%, and the mortality rate 0.8%. Complications occurred in 5.6%; most were temporary and minimal. The recurrence rate after transsphenoidal microsurgery was lower than that quoted in the literature after craniotomy. The smaller the size of the adenomas and the less the hormone abnormality preoperatively, the better the outcome. © 1994 Wiley‐Liss, Inc.
Brachial plexus surgery: Our concept of the last twelve years
Authors: Berger Alfred , Becker Michael H.‐J.
Published: March 2007

In patients with brachial plexus injuries restoration of complete function is seldom seen. The diagnosis is a clinical one; investigations such as MRI or myelography are not sufficiently reliable to base surgical indications on them. Surgery has to be performed within the first six months after the trauma. The surgical procedure firstly includes an exact intraoperative definition of the extent of the lesion. Depending on the type of the lesion, microsurgical neurolysis, nerve grafting, or reneurotization is performed. When regeneration is complete, secondary operations may follow if necessary as part of our integrated concept. The spectrum of secondary operations in our patients includes arthrodesis, tenodesis, tendon transfers, muscle transfers, and free neurovascular tissue transfer. In selected cases with extensive lesions a bifunctional latissimus dorsi transfer allows restoration of minimal grip with simultaneous elbow flexion. Our concept includes a series of hierarchical steps:

Diagnosis and indication

Nerve repair

Intensive physiotherapy, control in intervals

Secondary operations—if necessary

Intensive physiotherapy

Ergotherapy, orthosis

In the last 12 years 362 patients with brachial plexus lesions have been operated on in our clinic. In these patients we performed 104 neurolyses, 126 nerve grafting procedures, 87 reneurotizations, and 191 secondary operations in 96 patients. Only the combination of nerve repair with both conventional and newer methods of tendon and muscle transfers can restore the maximum function for the individual situation. © 1994 Wiley‐Liss, Inc.
Techniques of postoperative blood flow monitoring after free tissue transfer: An overview
Authors: Machens Hans‐Guenther , Mailaender Peter , Rieck Bernd , Berger Alfred
Published: March 2007

Ever since free tissue transfer has been established in microsurgery, success rates have greatly improved over the years, partly due to improved technical performance of microvascular anastomoses with better optical and instrumental aids. However, flap failure still occurs in 5–10%, mainly due to blood vessel thrombosis within the first 24 postoperative hours. Salvation rates of failing free tissue transfers can be optimized by in‐time diagnosis of irreversibly compromised tissue blood flow and immediate operative reexploration. Therefore, there is a special demand for adequate and reliable postoperative monitoring techniques. This article gives an overview of all monitoring techniques, which have been performed both in the experimental and clinical setting thus far. © 1994 Wiley‐Liss, Inc.
Closure of the second toe transfer donor site without disruption of the deep transverse metatarsal ligament
Authors: Webster Howard R. , Inglefield Christopher J.
Published: March 2007

The second metatarsal is routinely excised to facilitate closure of the defect created by the harvest of a second toe transfer. However, if the deep transverse metatarsal ligament is not disrupted by the harvest, it seems unnecessarily destructive to remove the metatarsal. A small arterialized venous flap provides a logical solution to the problem of wound closure in this circumstance. This paper describes such a reconstruction, discusses the reasons for its selection and the long term outcome, which has been very satisfactory. © 1994 Wiley‐Liss, Inc.
Flushing the vessel ends: The effect on ischemic free flap survival
Authors: Giele Henk P. , Ritz Morris , Morrison Wayne A. , O'Brien Bernard Mcc.
Published: March 2007

During vascular anastomosis of experimental ischemic free flaps it is common to observe that stagnant blood in the vessel ends has clotted. A study was performed to investigate if flushing away the stagnant blood on division of the vessels would increase flap survival. Flushing did not influence flap survival. Clinically, clot is rarely seen, except in conditions of prolonged ischemia or damaged vessels. Current surgical practice does not involve flushing the vessel ends upon division of the vessels and this approach is affirmed by our results. © 1994 Wiley‐Liss, Inc.
Afferent arteriovenous anastomosis for thumb replantation: A case report
Authors: Theile David R. , Berger Anthony C. , Wilson Yvonne T. , Tham Stephen K.
Published: March 2007

Described is a case where an afferent arteriovenous anastomosis was successfully employed in the replantation of a large piece of composite tissue amputated from a patient's thumb. The operative procedure is described and aspects of arterialized venous vascular networks are discussed. © 1994 Wiley‐Liss, Inc.
Inflammation and repair in the mammalian fetus: A Reappraisal
Authors: Hurley John V.
Published: March 2007

Review of our recent experimental findings and published studies indicates that the mammalian fetus responds to injury in a similar way to adult animals. Persistent inflammatory stimuli evoke an extensive cellular response whose composition varies with the stage of gestation and which is succeeded by formation of typical scar tissue. In fetal sheep excisional skin wounds and wounds in bone, muscle, tendon, and nerve heal by scar. There is disagreement whether, early in gestation, sutured incised skin wounds heal without scar, but this cannot justify a claim of scarless fetal healing. In the immature fetuses of rats and rabbits sutured wounds heal rapidly but open wounds remain unhealed until birth. Injury to deeper tissues has not been examined. The little evidence available suggests that inflammation and repair in the human fetus is similar to that in fetal sheep. © 1994 Wiley‐Liss, Inc.
In vivo microscopy of a rat abdominal skin flap: A new model
Authors: Whan Elizabeth B. , Hurley John V. , Morrison Wayne A.
Published: March 2007

This study describes a rat abdominal skin flap model of in vivo microscopy which provides a reliable, easy to perform system in which to examine the microcirculation of flaps. The island flap, which is based on the superficial inferior epigastric vessels caudally, and drained proximally by the lateral thoracic vein, can be mounted directly on a Perspex microscope stage. In vivo microscopy of the subdermal plexus of the flap allows detailed study of blood flow pattern, capillary flow, microvessel diameter, and margination of leucocytes, in a skin flap with versatile blood supply and innervation. © 1994 Wiley‐Liss, Inc.
Training model for microvessel anastomosis
Authors: Kim David C. , Niazi Zahid B. M. , Hayward Peter G. , Morrison Wayne A.
Published: March 2007

In the early stages of microsurgical training a model is required which is accessible, inexpensive, and approximates human tissue. In this research centre initial training exercises utilize cold stored vessels harvested from sacrificed animals used in other experiments. This model serves as an initial training tool prior to the progression to live animal research which maximizes use of animal specimens and approximates the in vivo qualities of blood vessels. The costs involved are minimal and a large number of vessels can be efficiently harvested and stored using basic equipment. As a training model, cold stored vessels have balanced cost with practicality, given an excellent approximation to living tissue and have markedly reduced our usage of live animals for teaching. This latter effect is significant at a time of increased scrutiny of the ethical use of laboratory animals. © 1994 Wiley‐Liss, Inc.
Present status of replantation in Japan
Authors: Fukui Akihiro , Tamai Susumu
Published: March 2007

We conducted a survey among 94 members of the Japanese Society of Reconstructive Microsurgery on the present status of replantation in Japan. The results indicate that 9,664 extremities were replanted (157 upper arms, 415 forearms, 471 hands, 8,320 digits, 33 thighs, 103 calves, 37 feet, and 128 toes); 8,227 replants survived, for a success rate of 85%. The survival rate was over 90% in 23 hospitals, and 7 of these hospitals replanted more than 100 limbs. Postoperative treatment consisted of continuous intravenous infusion of urokinase (120,000‐240,000 U/day), heparin (10,000‐20,000 U/day), and prostaglandin E1 (80–120 μg/day) for 3–10 days. Fifty‐six surgeons attempted replantation whenever the patient requested it. At Nara Medical University, continuous local intra‐arterial infusion of anticoagulants and fibrinolytic agents has increased the survival rate of the replantation to 97%, compared with 88% when using intravenous infusion. © 1994 Wiley‐Liss, Inc.
Influence of joint injury on motor and functional recovery of finger replantation
Authors: Chiu Haw‐Yen , Lee Jing‐Wei
Published: March 2007

A series of 82 consecutive cases were studied concentrating on the influence of joint injury on the final motor and functional recovery of the successfully replanted or revascularized finger. In this series a 32.0% (41/128) incidence of joint injury was found. When the proximal interphalangeal (PIP) joint was injured and preservation was not possible, arthrodesis was done. This would cause a significantly lower Tamai's score (70.9), total active range of motion (TAM; 99.4°) and TAM‐minus the metacarpophalangeal joint TAM‐MP; (15.6°). The influence of arthrodesis on the distal interphalangeal (DIP) joint was relatively minor. When preservation of the joint was possible, the PIP arthroplasty group had a significantly higher Tamai's score (83.7, P < 0.01), TAM (157.9°, P < 0.05), and TAM‐MP (70.0°, P < 0.001). Preservation of the DIP joint also significantly increased the TAM and TAM‐MP degrees, yet with no significant improvement in Tamai's score. Our study proves what most hand surgeons would expect, in that sacrifices of the PIP and MP joint would cause a significantly detrimental effect on the functional recovery of a finger. We also recommend joint preservation during replantation surgery whenever possible, especially for the PIP and MP joints, in order to achieve better functional recovery of the finger.
Primary common bile duct anastomosis in the rat using microsurgical techniques
Authors: Chansmorn Chuphan , Lineaweaver William C. , Tonken Heidi , Zhang Feng , Campagna‐Pinto Dante , Newlin Leonard , Yim Kenneth , Buncke Harry J.
Published: March 2007

In a rat model, we attempted to describe the natural healing course of the common bile duct (CBD) after primary microsurgical repair. Fifty‐three rats were divided into experimental groups with CBD microsurgical anastomoses and control groups with CBD mobilization and ligation. Examination of three experimental groups at 1 week, 1 month, and 3 months showed evolving inflammation and stricture changes with eventual patent, healed ducts in 92% of animals at the end of 3 months following transection and repair. There were no histologic abnormalities in the livers. There were fibrotic ducts and hepatic stasis and cirrhosis changes in the control group with CBD ligation. This study demonstrates that microsurgical techniques can achieve successful primary biliary repair in the rat. © 1994 Wiley‐Liss, Inc.
Experimental challenge for the treatment of duchenne muscular dystrophy using a vascularized free muscle graft
Authors: Dohi Daisuke , Ikuta Yoshikazu , Ishida Osamu , Kimori Kenji , Kuroki Hidenao
Published: March 2007

Following free vascularized normal muscle graft in mice, a study was made to determine whether dystrophin expression is possible in dystrophin‐deficient muscles. In this study, dystrophic C57BL/10 ScSn‐mdx mice were used as recipients and normal C57BL/10 ScSn mice as donors. A free vascularized quadriceps muscle 8.0 × 6.0 × 6.0 mm in size was orthotopically transplanted into a muscle defect produced in the recipient mouse. The diameter of the sutured vessels was about 0.4 mm. Transplantation was successful in 7 of 20 mice. At 12 weeks after the transplantation, the grafted muscle was examined by immunocytochemical stain using antidystrophin antibody. This study showed that dystrophin was expressed in the transplanted muscle but not in the adjacent recipient quadriceps muscle, suggesting that grafted donor cells with dystrophin failed to migrate into dystrophic muscle cells and fuse together. However, since the grafted normal skeletal muscle successfully survived and normal dystrophin was expressed in almost all the grafted muscle fibers, the possibility was suggested that the function of muscular dystrophy muscle can be compensated by complete replacement with a larger muscle. © 1994 Wiley‐Liss, Inc.
Prefabrication of a vascularized nerve graft by vessel implantation: Preliminary report of an experimental model
Authors: Cavadas Pedro C. , Vera‐Sempere Francisco J.
Published: March 2007

Regeneration through vascularized nerve grafts (VNG) seems to be better than nonvascularized nerve grafts (NVNG), especially in hostile beds. We report on an experimental technique of prefabrication of VNG by direct vessel implantation. An arteriovenous fistula was created in the groin region with autologous vein grafts in the Wistar rat model, and implanted into the sciatic nerve. Five weeks later the sciatic VNG was elevated on the prefabricated pedicle. The flap was free‐transferred orthotopically over a silicone sheet to impede plasmatic imbibition. Flap viability at 3 days was complete. India ink injection of the AV fistula resulted in capillary ink filling within the nerve and surrounding tissues. Histologic sections of the flap were examined, revealing its neovascularity. In an ongoing study, the regeneration through this prefabricated VNG is being compared to native VNG. © 1994 Wiley‐Liss, Inc.
Tendocutaneous free flap transfer from the dorsum of the foot
Authors: Lee Kwang Suk , Park Sang Won , Kim Hak Yoon
Published: March 2007

Tendocutaneous free flap transfer has been used to treat troublesome wounds involving skin and tendons, with the dorsum of the foot being the most frequent donor site. Free flaps consist of the dorsalis pedis artery, saphenous vein, branch of the superficial peroneal nerve, long extensor tendons, and overlying skin. We analyzed 13 cases of skin and tendon loss from the dorsum of the hand and wrist that were treated with tendocutaneous free flap from the dorsum of the foot. The size of the flap was from 6 × 5 cm to 11.5 × 7.1 cm (average, 9.2 × 5.9 cm), and the transferred tendons ranged from 1 to 5 in number (average, 2.9), and 5 to 17 cm in length (average, 9.2 cm). The transferred flaps survived in all cases, and the transferred tendons were functioning well except in two cases of electrical burn. The complications included two cases of tendon adhesion, one case of marginal necrosis of the flap, and three cases of donor‐site wound problem.
Arterialized tendocutaneous venous flap for dorsal finger reconstruction
Authors: Chen Chung‐Lin , Chiu Haw‐Yen , Lee Jing‐Wei , Yang June‐Tse
Published: March 2007

We describe three cases of combined loss of skin and tendon on the dorsum of the finger that were reconstructed with venous flaps. The technique is feasible and offers a good treatment modality for the small but complex defect on the dorsum of the finger by a one‐stage operation. © 1994 Wiley‐Liss, Inc.
Effect of muscle flap denervation on flow hemodynamics: A new model for chronic in vivo studies
Authors: Siemionow Maria , Andreasen Troy , Chick Leland , Lister Graham
Published: March 2007

The purpose of this study was to evaluate microcirulatory dynamics following muscle flap denervation. A modification of standard cremaster muscle flap was used. Fifty male Sprague‐Dawley rats were studied in two experimental groups of 25 rats each, as follows: Group I (control), after flap isolation, the nerovascular pedicle was left intact; group II (denervation), following muscle isolation a 1 cm segment of genitofemoral nerve was excised and denervated muscle was preserved in the medial border of rat hind limb. For chronic evaluation the cremaster was withdrawn from the leg and prepared for in vivo observations after days 1, 3, 7, and 14. The following measurements were taken: vessel diameters, red blood cell velocities, and number of perfused capillaries. In groupII a 15% iuncrease in artriolar diameter was observed. Throughout the entire 14 day period denervated flaps presented 27% more perfused capillaries. Flap denervation proved to increase capillary perfusion significantly (P < 0.05). The cremaster muscle tube‐flap model introduced in this study allows for chronic observtion of the microcirculation. © 1994 Wiley‐Liss, Inc.
Preoperative assessment of the adult plexus patient
Authors: Brunelli Giorgio A. , Brunelli Giovanni R.
Published: March 2007

Methods of assessing brachial plexus lesions are presented in relation to the type of lesion, the severity, the prognosis, and the timing of nerve repair and reconstructive surgery. A careful physical examination of both muscles and sensory function, the sweating concordance, and the Tinel sign are considered the most important aspects of assessment which is completed by electromyography (evoked potentials), radiographs, magnetic resonance imaging, and contrast computerised axial tomography (CT scanning). Contrast‐CT is considered the most reliable investigation to reveal root avulsion from the cord. An assessment chart able to show the extent and location of the lesion at a glance is included. © Wiley‐Liss, Inc. © 1995 Wiley‐Liss, Inc.
Secondary surgery following brachial plexus injuries
Authors: Berger Alfred , Brenner Peter
Published: March 2007

The favourable treatment of post‐traumatic brachial plexus lesions based on our experience of 362 cases over a 12 year period is reported. Twenty‐five percent of the patients needed secondary operations. The spectrum of the latter consisted of arthrodesis, tenodesis, and musculotendinous transfer, including free neurovascular tissue transfer partially innervated by nerve transposition. Functionally, secondary tendon transfer can help to improve the effect of nerve repair techniques. To restore shoulder function the trapezius transfer (n = 22) has been used mainly; elbow flexion has been regained by pedicled latissimus dorsi translocation (n = 22), triceps‐to‐biceps transfer (n = 18), bipolar latissimus muscle transfer, and free neurovascular tissue transfer (n = 8). The Steindler flexorplasty was performed in four plexopathies, and finally a pedicled serratus muscle transfer was used. A unipolar latissimus dorsi transfer results in an ability to lift 10–15 kg, whilst the bipolar latissimus transfer and the triceps‐to‐biceps transfer produced a maximal strength of 5–8 kg. Epitrochlear flexor‐pronator mass transfer produced a strength of 2–5 kg, whereas free neurovascular latissimus dorsi transfer developed a maximal muscular strength of 2–4 kg in the unipolar variation and 1–2 kg for the bipolar LD. In 97 secondary procedures to the lower arm and hand the following secondary operations were indicated: in 29 cases of radial nerve palsy transfers according to Merle d'Aubigne, a further 21 wrist tenodeses and 8 wrist arthrodeses were performed. To restore median nerve function, coupling tendon transfer (n = 4) and free neurovascular gracilis transfer (n = 3) were selected. Ulnar nerve palsy was corrected by seven Zancolli procedures. To improve rotation, two pronation plasties were applied. For dynamic opponensplasty the superficial flexor of the ring finger was the primary choice (n = 8). Static fusions between the first and second metacarpal bones served as a static opponensplasty of the thumb ray. Motor‐driven orthoses should be reserved for boosting any voluntary muscle contraction or for frustrating cases in which restoration of useful pinch with the previously described surgical procedures is impossible. Improving the function of the formerly paralysed upper extremity in patients with a brachial plexus injury results in a greater independence in everyday activities and a superior psychological status. © Wiley‐Liss, Inc. © 1995 Wiley‐Liss, Inc.
Effects of enoxaparin, standard heparin, and streptokinase on the patency of anastomoses in severely crushed arteries
Authors: Chen Long‐En , Seaber Anthony V. , Korompilias Anastasios V. , Urbaniak James R.
Published: March 2007

The effects of topical irrigation with three antithrombotic agents on the patency of anastomosed arteries following crush injury were examined. Following an impact crush injury with a 25 kg crush load, the femoral arteries of rats were divided and then anastomosed. During anastomoses, the vessel lumina were topically irrigated with saline, streptokinase, standard heparin, or enoxaparin (a low molecular weight heparin). The results were evaluated by patency test and histology up to day 56. The thrombosis rate at days 1 and 7 was statistically lower (P<0.05) in the standard heparin and the enoxaparin groups than in the other two groups. The difference between the standard heparin and the enoxaparin groups was not statistically significant. Histology at day 1 showed that thrombus in the occluded vessels adhered to the exposed adventitia in the crushed area or the adventitia was covered by fibrin, red blood cells, and platelet mesh in the patent vessels. The results showed that 1) topical irrigation with standard heparin or enoxaparin solution significantly reduced the thrombosis rate at the anastomosis site of the crushed arteries; and 2) enoxaparin was as effective an antithrombotic agent as standard heparin when topically applied during microvascular anastomoses. © 1995 Wiley‐Liss, Inc.
Blood flow in free muscle flaps measured by color Doppler ultrasonography
Authors: Salmi Asko M. , Tierala Esko K. , Tukiainen Erkki J. , Asko‐Seljavaara Sirpa L.
Published: March 2007

Color Doppler ultrasonography, a noninvasive method for studying changes in blood flow, has been used to monitor 18 patients with free microvascular lower limb muscle flaps. The peak, mean, and minimum velocities, resistance indices, and diameters of the flap pedicle arteries and also of the limb recipient arteries proximal to the microvascular anastomoses were measured at 2 and 6 weeks and 3, 6, and 9 months after surgery. The peak velocities did not significantly differ from each other, but the mean velocity in the flap pedicle arteries was 12.5% higher than that in the recipient arteries throughout the study period. End diastolic velocity in the pedicle was positive (toward the ultrasound probe) at 2 weeks (mean, 2 cm/sec, SD 10), 6 weeks (mean, 5 cm/sec, SD 16), and 3 months (mean, 3 cm/sec, SD 13) after surgery and significantly higher (P<0.05) than at 6 months (mean, 7 cm/sec, SD 11), when the pattern of blood flow was normal forward/backward flow during systole/diastole. The resistance indices of the pedicle at 2 weeks (Ri = 0.978), 6 weeks (Ri = 0.936), and 3 months (Ri = 1.001) were significantly lower (P<0.05) than at 6 months (Ri = 1.108), when the pedicle and recipient artery indices were the same. The diameter of the pedicle arteries was 14% smaller than those of the recipient arteries, but did not change during follow‐up. This prospective clinical study shows that blood flow in the pedicle of a free microvascular muscle flap is increased until 6 months after surgery, mainly due to the increased minimum velocity of the pedicle in diastole and decreased resistance index. These findings can be attributed to the loss of vessel tone after denervation and are in accordance with earlier studies showing that denervated muscles lose their autoregulation and that blood flow increases, but that these phenomena subside with time. Increased blood flow in free muscle flaps can explain the high success rate of microanastomoses and positive effect on wound healing. © 1995 Wiley‐Liss, Inc.
Elongation of wallerian degenerating nerve with a tissue expander: A functional, morphometrical, and immunohistochemical study
Authors: Fujisawa Kohzou , Hirata Hitoshi , Inada Hitoshi , Morita Akimasa , Hibasami Hiroshige
Published: March 2007

The purpose of this experimental study was to investigate the usefulness and mechanism of the expansion of wallerian degenerating nerve. The study consisted of two experiments: Experiment I, functional and morphometrical analysis, and Experiment II, immunohistochemical analysis. In Experiment I, the rat nerve crush model was used to assess the effects of mechanical expansion of wallerian degenerating nerves on axonal regeneration. In Experiment II, the rat sciatic nerve cut model was used to investigate the effects of nerve expansion on Schwann cell events in wallerian degenerating nerves. In both experiments, nerve expansion was carried out between days 5 and 9 after nerve injury, using a rubber tissue expander placed beneath the sciatic nerve. In Experiment I, rats were divided into the following three groups according to the volume of saline injected: control group (nerves were crushed, without saline injection); 8‐ml injection group; and 11‐ml injection group. Functional recovery was assessed using the sciatic functional index until 54 days after nerve injury. Rats in all three groups showed good functional recovery, and the morphometrical analysis revealed no significant differences among the three groups.

In Experiment II, anti‐S‐100 protein polyclonal antibody and anti‐proliferating cell nuclear antigen monoclonal antibody were used to identify proliferating Schwann cells. Rats were divided into two groups: control group (nerves were cut, without expansion) and nerve expansion group. In the control group, proliferating Schwann cells were observed only between days 3 and 7. By contrast, these cells continued to be seen in the expanded nerves until day 16.

These results suggest that the expansion of wallerian degenerating nerve does not have a deleterious effect on the axon‐promoting property of Schwann cell tubes and that the expansion is dependent not only on the viscoelasticity of the nerves but also on enhanced proliferation of Schwann cells. © 1995 Wiley‐Liss, Inc.
Thumb reconstruction with a free neurovascular wrap‐around flap from the big toe: Long‐term follow‐up of thirty cases
Authors: Lee Kwang Suk , Chae In Jung , Hahn Seung Beom
Published: March 2007

From March 1982 to December 1992, 30 cases of thumb reconstruction with a free neurovascular wrap‐around flap from the big toe were performed at Korea University Hospital. Twenty‐nine of a total of 30 cases were successful and obtained excellent functional and cosmetic results. Postoperative complications included 1 case of graft failure, 6 partial skin necroses, 1 malunion, and 15 cases of resorption of iliac bone graft including 1 case of fatigue fracture of grafted bone. Even for the first metacarpal neck amputations, thumb reconstruction with a free neurovascular wrap‐around flap was possible; however, limitation of motion of the reconstructed thumb and resorption of the grafted bone occurred. Thumb reconstruction with a wrap‐around free flap from the big toe gives excellent cosmetic and functional results and causes minimal morbidity on the donor site. © 1995 Wiley‐Liss, Inc.
One‐stage treatment of infected bone defects of the tibia with skin loss by free vascularized osteocutaneous grafts
Authors: Doi Kazuteru , Kawakami Fujio , Hiura Yasuhiro , Oda Tatsunori , Sakai Kazuhiro , Kawai Shinya
Published: March 2007

Twenty‐six patients who had an infected nonunion or segmental defect of the tibia with skin loss were treated in one stage with debridement and a free vascularized osteocutaneous fibula or iliac graft. Successful control of infection, closure of skin defects, and incorporation of bone union were achieved in all patients except one. In an average follow‐up of 39 months, no recurrence of infection was seen. There were four stress fractures of the grafted fibula; these healed within 2 months with cast immobilization. Graft hypertrophy was common in the fibula grafts, but it took 1 1/2 years for hypertrophy of the graft to be strong enough to remove external supports without stress fracture or an additional cancellous bone graft. The use of a one‐stage free vascularized osteocutanous graft for the management of infected bone defects of the tibia with skin loss is effective because extensive debridement can remove all devitalized and infected tissue and can increase vascularity in the region of infection and osseous defect to enhance antibiotic delivery. © 1995 Wiley‐Liss, Inc.
Multivariate analysis of factors influencing the functional recovery after finger replantation or revascularization
Authors: Chiu Haw‐Yen , Shieh Shyh‐Jou , Hsu Hsiu‐Yun
Published: March 2007

A multivariate statistical analysis was utilized to study the influence of the four preoperative (age, mechanism of injury, level of injury, and type of amputation) and one postoperative (rehabilitation) variables on the functional recovery of the replanted or revascularized finger. Statistically significant differences are summarized as follows. The young age group have a better functional recovery due to better sensory recovery than the old age group. The crush injury group have a better functional recovery, with better scores in motion and patient satisfaction, than the avulsion injury group. The middle phalangeal injury group have a better functional recovery, with better score in motion and sensation than the proximal phalangeal injury group. There is no statistically significant difference in functional recovery between the revascularized and replanted fingers, but there is a significantly better sensory recovery in the revascularized finger. The rehabilitation group has a better functional recovery, with better score in motion, subjective symptoms, and patient satisfaction, than the nonrehabilitation group. © 1995 Wiley‐Liss, Inc.
Free flap monitoring: A review of current practice
Authors: Hirigoyen Martin B. , Urken Mark L. , Weinberg Hubert
Published: March 2007

Individual techniques for the postoperative monitoring of free flaps vary considerably. In order to establish the currently preferred protocols, a survey was conducted among micro‐surgeons in North America using a mailed questionnaire. Data were received from 95 centers for the monitoring of 2,825 free flaps performed during 1994. Results indicate that rates for flap salvage and overall success with free tissue transfer are closely related to surgical experience (number of cases performed per month). Ninety percent of microsurgeons routinely use monitoring devices, with external and laser doppler having achieved greatest popularity. An account is given of the preferred postoperative regimens for flap surveillance, and the overall results are discussed. © 1995 Wiley‐Liss, Inc.
Microsurgery without a microscope: Laboratory evaluation of a three‐dimensional on‐screen microsurgery system
Authors: Franken Ralph J. P. M. , Gupta Subhas C. , Banis Joseph C. , Thomas Steven V. , Derr John W. , Klein Scott A. , Kon Moshe , Barker John H.
Published: March 2007

In microvascular surgery, procedures may be both technically and physically demanding. Precise movements sustained over long hours in addition to typically compromised surgeon and assistant positioning lead quickly to physical and mental fatigue. Many of the positioning problems encountered are related to the fact that the eyes of the surgeon must be continually fixed to the microscope eyepieces. This study explores a possible solution: a microscope system that eliminates the need to view the operative field through the microscope eyepieces. A Three‐dimensional On‐screen Mi‐crosurgical System (TOMS) was used and contrasted with conventional operative microvascular surgery in the laboratory setting. The surgeon's comfort, his ability to instruct microsurgical technique, pertinent technological performance, and the procedure itself were evaluated using a standardized questionnaire. Based on data collected in this study, we conclude that divorcing the surgeon's eyes from the microscope eyepieces using the TOMS may make prolonged microvascular procedures less physically demanding and may increase the comfort level of both the surgeon and his assistant, although refinements to the technology are required. © 1995 Wiley‐Liss, Inc.
Vein‐graft wrapping for the treatment of recurrent compression of the median nerve
Authors: Sotereanos Dean G. , Giannakopoulos Panayotis N. , Mitsionis Grigoris I. , Xu Jiangming , Herndon James H.
Published: March 2007

Recurrent compressive neuropathy of the median nerve due to cicatrix is an extremely challenging clinical problem. Available treatment techniques are difficult and results uncertain. Early experience with the autogenous vein graft wrapping technique has shown great promise for the treatment of chronic compressive neuropathy after other procedures have failed. We report on 3 patients with average follow‐up of 2 years. Postoperatively, all the patients had significant improvement on electromyograms, and the findings of both subjective and objective assessments were excellent or good for 2 patients. The procedure is simple; the donor is readily available; no complications were noted in the donor area, and the graft tissue has good compatibility. This technique can also be applied for chronic compression of any peripheral nerve. © 1995 Wiley‐Liss, Inc.
New model for microsurgical training and skills maintenance
Authors: Yen David M. , Arroyo Raul , Berezniak Ron , Partington Marshall T.
Published: March 2007

PracticeRat® (Sharpoint, Reading PA) is a system containing a simulation vein, artery and nerve, designed as an alternative to live animal use in microsurgical training. We find PracticeRat® to be more expensive than living models. However, it does decrease animal usage and provides a very convenient opportunity to practice microsurgical techniques and procedures in a fairly realistic manner. Trainees can practice anytime, for any length of time, wherever microscopes are available. In this regard we find PracticeRat® to be a useful addition to microsurgical training programs and an excellent tool for skills maintenance. © 1995 Wiley‐Liss, Inc.
Increased axonal regeneration over long nerve gaps using autologous nerve‐muscle sandwich grafts
Authors: Whitworth Ian H. , Doré Caroline J. , Green Colin J. , Terenghi Giorgio
Published: March 2007

Poor recovery is seen after repair of long defects in peripheral nerves when denatured muscle grafts or regeneration chambers providing physical support alone are used. The presence of Schwann cells and neurotrophic factors is required for axons to migrate significant distances. In this study we have used immunohistochemical techniques and axon counts to quantify the regeneration seen when 5 cm defects in rabbit sciatic nerve were repaired with a composite graft consisting of 2–3 mm lengths of fresh autologous nerve sandwiched between 1 cm frozen‐thawed muscle grafts. This technique led to a similar pattern of regeneration as that seen in autologous nerve grafts, used as controls, and a significantly (P<0.0001) greater axonal and Schwann cell regeneration compared with that seen in frozen‐thawed muscle grafts of the same total length. In conclusion, we present a simple technique for incorporating a depot of Schwann cells and other essential components into a nerve conduit which has a marked effect on axonal regeneration across long defects. © 1995 Wiley‐Liss, Inc.
Influence of the delay of denervation on slow striated muscle resistance to slow‐to‐fast conversion following cross‐innervation
Authors: Chammas Michel , Coulet Bertrand , Micallef Jean Paul , Prefaut Christian , Allieu Yves
Published: March 2007

Cross‐reinnervation, in cases of nerve repair or nerve transfer, can be the consequence of wrong connections which are surgically induced between the different types of motoneurons (fast and slow). A slow muscle nerve is able to convert a fast muscle virtually completely to the slow fibre type, whereas a fast muscle nerve exerts an incomplete control over the properties of a slow muscle. Our experiments show that following delayed cross‐reinnervation, a statistically significant slow‐to‐fast transformation of the soleus muscle was observed, with a maximum when nerve repair was performed 6 weeks following nerve section in the rat model. Thus, the negative consequences on nerve and muscle relationship due to cross‐reinnervation in the case of wrong connections between slow and fast motoneurons after conventional nerve suture or in the case of nerve transfer could be minimised by imposing a delay before nerve repair. © 1995 Wiley‐Liss, Inc.
Morphometric changes in free neurovascular latissimus dorsi flaps: An experimental study
Authors: Becker Michael H.‐J. , Lassner Franz , Dagtekin Falk‐Ziya , Walter Gerhard F. , Berger Alfred
Published: March 2007

This study was designed to investigate regeneration of reinnervated, free transplanted muscles. We used a rat model, consisting of eight rats per group, in which the latissimus dorsi muscle was transplanted orthotopically and then harvested and evaluated after 2 and 12 weeks. Age‐matched control animals were used to oppose non‐operated muscles. At date of removal the patency of the vascular anastomoses was checked clinically and histologically. Electrophysiological measurements were also performed and conventional and enzyme histochemical histological slides manufactured. Two weeks after the free neurovascular flap transfer the muscle was not yet innervated, and histologically a dissolved pattern of type I and type IIA muscle fibres was found. The muscle fibres demonstrated a decrease of more than 50% cross‐sectional area. After 12 weeks the muscles were reinnervated again; muscle contraction was positive with electrical stimulation and the cross‐sectional area had regained 80% of the activity of normal muscle fibres. With enzyme histochemical staining the typical type grouping of reinnervated muscles could be demonstrated. © 1995 Wiley‐Liss, Inc.
Sixty argon laser‐assisted anastomoses in rats: Macroscopic and histological studies
Authors: Martinot V. L. , Mitchell V. A. , Mordon S. R. , Schoofs M. , Pellerin P. N. , Brunetaud J. M.
Published: March 2007

The present in vivo study was undertaken to evaluate the patency rate and histological appearance of 30 venous anastomoses and 30 carotid anastomoses in Wistar rats using a laser. An argon laser was used with the following parameters: power, 100 mW; time, 3 seconds; continuous mode; spot, 200 μm (fluence, 950 J/cm2; irradiance, 320 W/cm2). The macroscopic appearance and patency rate were evaluated at different postoperative intervals (30 days and 60 days). In the venous group, the patency rate was 100% with no saccular pseudo‐aneurysm. In the arterial group, the patency rate was 93% with three saccular pseudo‐aneurysms and two thromboses. Histological studies noted slight and transitory modifications of the media in the arterial group. In the venous group, the modifications appeared under the endothelium. Since the procedure was similar in both groups, the lack of pseudo‐aneurysm formation in the venous group can be explained by a lower intravascular pressure. © 1995 Wiley‐Liss, Inc.
First web space reconstruction by a free flap from the contralateral paralysed hand
Authors: Adani Roberto , Castagnini Luca , Balsam Mustapha , Caroli Alessandro
Published: March 2007

In modern reconstructive surgery any composite tissue removed during an elective ablative operation may serve as a vascularised free‐tissue transfer for a possible distant reconstruction. The use of this technique does not create a donor deficit and may help in the reconstruction process. We report a case in which the dorsum of a paralysed and insensate right hand has been used as a free tissue transfer for the reconstruction of the first web space of the left hand. © 1995 Wiley‐Liss, Inc.
Urodynamic procedures: Recommendations of the Urodynamic Society. I. Procedures that should be available for routine urologic practice
Authors: Blaivas J. G. , Awad S. A. , Bissada N. , Khanna O. P. , Krane R. J. , Wein A. J. , Yalla S.
Published: March 2007

This report details the recommendations of the Urodynamic Society on urodynamic procedures. It was the unanimous opinion of the members of the task force that the practicing urologist should have access to cystometry, voiding cystourethrography, and estimation of urinary flow rate and postvoid residual urine volume. Knowledge of these parameters coupled with history, physical examination, and appropriate laboratory data permits effective treatment of the vast majority of patients with lower urinary tract disorders. Urethral pressure profilmetry, sphincter electromyography, and combined multichannel urodynamic procedures are not necessary for the routine practice of urology.
Differential diagnosis of impotence in diabetics: The validity of sexual symptomatology
Authors: Abel Gene G. , Becker Judith V. , Cunningham‐Rathner Jerry , Mittelman Mary , Primack Marshall
Published: March 2007

Sixty diabetic males complaining of impotence were administered a structured interview and completed nocturnal penile tumescence (NPT) monitoring to categorize their impotence as either organic, psychogenic, or undetermined. A summary score of seven sexual symptoms was found to be effective in differentiating organic from psychogenic impotence. By relying upon these seven sexual symptoms as a screening test, 38% of male impotent diabetics can be spared the expense of NFT monitoring, since the outcome of such monitoring can be predicted from the summary score of these seven symptoms. The correlation between the seven sexual symptoms and the subjects' NPT monitoring results was 0.78, accounting for 61% of the variance. Therefore the seven sexual symptoms can be useful in predicting NPT monitoring results before the monitoring is completed. The sensitivity, specificity, and efficiency of the seven sexual symptoms is discussed, as well as the cost efficiency of utilizing this screening device.
Precise urodynamic assessment of anatomic urethral obstruction in boys
Authors: Griffiths D. J. , Scholtmeijer R. J.
Published: March 2007

Repeated pressure/flow studies of micturition, with and without a thick catheter in the urethra, together with an on‐line plot of detrusor pressure against flow rate, enable real anatomic urethral obstruction to be distinguished from (possibly artifactual) functional effects and often allow a urodynamic caliber to be assigned to any anatomic narrowing in the urethra. Results from 103 boys aged 3–15 years without overt neurologic abnormality are reported. It is shown how the presence of a thick urethral catheter enhances the sensitivity to anatomic obstruction, and urodynamic criteria for recognizing such obstruction are set up. Although clinically diagnosed abnormalities such as meatal stenosis are often urodynamically obstructive, 40% of obstructions diagnosed on nonurodynamic grounds were ruled out urodynamically. The overall incidence of urodynamically demonstrated anatomic obstruction in this selected material was 19%.
Detrusor pressure versus wall stress in relation to ureterovesical resistance
Authors: Coolsaet B. L. R. A. , Van Venrooij G. E. P. M. , Blok C.
Published: March 2007

Measurements of the resistance to flow in the normal ureterovesical junction in the pig and in the human indicate that the resistance is related only to the detrusor pressure and is independent of the stress in the bladder wall.
Urodynamic evaluation of a bladder flap tube as urinary sphincter
Authors: Thüroff Joachim W. , Bazeed Mahmoud A. , Schmidt Richard A. , Tanagho Emil A.
Published: March 2007

The sphincteric properties of the normal urethra of seven female dogs were compared to those of a bladder flap tube pulled through the rectus muscle and anastomosed to the skin for urethral replacement. The functional length and distribution of closure pressure at rest were similar in the urethra and the bladder flap tube. When sneezing was triggered in the dogs to provoke a stress condition, contraction of the rectus muscle induced pressure changes in the distal neourethra similar to those obtained under the same stress condition from the striated urethral sphincter. However, with a full bladder, stress forced the newly fashioned bladder neck to open; yet, owing to sufficient resistance in the distal neourethra (rectus muscle), stress incontinence occurred only in two animals.