ABSTRACT
No abstract available in English.
ABSTRACT
The normal vascularization of peripheral nervesand the vascular factor in peripheral nerve les ons have regained increasing interest among surgeons. So, several attempts have been made to assess the relative importance of the vasa nervorum and intrinsic longitudinal vascular plexuses of nerve in maintaining the blood supply.of a segment of nerve trunk. The purpose of our experiment was to determine in laboratory animals the maximum extent to which a nerve can be mobilized without impairing its vascular supply so much that nerve function is jeopardized. All our studies were carried out on both sides of the sciatic-tibial nerve of thirty-two rabbit which were anesthetized intraperitoneally with urethane. The experimental procedure differed in three groups, Group I in which the sciatic nerve was mobilized 3 cm in length, Group II was mob lized 7 cm length and Group III was mobilized 10cm long. The tibialis post. muscles of each group were analyzed at intervals ot 1,2,4,6 and 8 weeks after neurolysis. Each muscles were examined grossly and histologically after hematoxylin and eosin staining. Experimental studies showed that a peripheral nerve is a well vascularized structure with a considerable reserve capacity in its microirculation. The intrinsic collateral system is well developeed and experimental deta supported the view that peripheral nerves may be mobilized over a cons derable length with or the only minium interference with their microvascular flow. The results were as follows: 1. The first evidence of histologic change in the muscle fibers was in the sarcolemmal neclei. 2. Localized atrophy of muscle fibers were observed at the six weeks after neurolysis. 3. With increasing length of neurolysis, abnormal finding were developed in early stage. 4. Massive atrophy of muscle fibers were noted in the muscle fibers which neurolysed more 7cm.
Subject(s)
Animals, Laboratory , Atrophy , DEET , Eosine Yellowish-(YS) , Hematoxylin , Muscles , Peripheral Nerves , Sciatic Nerve , Surgeons , Urethane , Vasa NervorumABSTRACT
It is notoriously difficult to obtain a sound bony union of large segmental bone defects secondary to trauma or following tumor resection, infected nonunion, congenital pseudarthrosis of the tibia, and avascular necrosis of the femoral head with conventional methods. Recent advances in microsurgery have made it possible to provide a continuing circulation of blood in bone grafts so as to ensure viability. With the nutrient blood supply preserved, healing of the graft to the recipient bone is facilitated without the usual replacement of the graft by creeping substitution. Thus, the grafted bone is achieved more rapid stabilization of bone fragments separated by a large defect without sacrificing viability. Thirty nine cases of the free vascularized fibular graft had been performed in the Department of Orthopedic Surgery, Kyung Hee University Hospital during the period of 3 years from October 1978 to December 1981. Of these, ll cases were congenital pseudarthrosis of the tibia, 4 cases were tuberculous spondylitis, 4 cases were infected nonunion, 7 cases were large segmental bone defects secondary to trauma, 9 cases were avascular necrosis of the femoral head and the other was one case. The results were obtained as follows: 1. The advantages of free vascularized living fibular graft are one stage procedure, resistance of torsion and angular stress, union with rapid hypertrophy of the graft, a shorter immobilization period and more rapid incorporation of the graft into the recipient area. 2. Free vascularized fibular graft can be widely used in the field of Orthopedic surgery. 3. The fibula is the bone best suited for reconstruction of a defect in a long bone. 4. In children, distal tibiofibular synostosis must be performed. 5. For prevention of clawing toe, the muscles around the bone is meticulously dissected, 6. Evaluation by selective arteriography and isotopic scanning both before and after operation may be used to assess the viability of the fibula graft.