bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arterialized tendocutaneous venous flap for dorsal finger reconstruction
Authors: Chen Chung‐Lin , Chiu Haw‐Yen , Lee Jing‐Wei , Yang June‐Tse 
Published: March 2007

AbstractWe 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

AbstractThe 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 For chronic evaluation the cremaster was withdrawn from the leg and prepared for in vivo observations after days 1, 3, 7, and 14.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

AbstractMethods 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

AbstractThe 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

AbstractThe 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

AbstractColor 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

AbstractThe 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

AbstractFrom 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

AbstractTwenty‐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

AbstractA 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

AbstractIndividual 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

AbstractIn 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

AbstractRecurrent 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

AbstractPracticeRat® (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

AbstractPoor 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

AbstractCross‐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

AbstractThis 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.