ABSTRACT
The restoration of voluntary muscle activity in posttraumatic paraplegia in both animal experiments and other clinical applications requires reproducibility of a technically-demanding microsurgical procedure, limited by physicians' understanding of Brunelli's spinal cord grafting paradigm. The insufficient clinical investigation of the long-term benefits of the CNS-PNS graft application warrants additional inquiry. The objective of this study is to explore the potential benefits of the first replicated, graft-induced neuroregeneration of denervated skeletal muscle regarding long-term clinical outcomes and to investigate the effect of Cerebrolysin on neuromodulation. A randomized study evaluating 30 rats, approved by the National Animal Ethics Advisory Committee was performed. The medication was administered postoperatively. For 14 days, 12 rats received Cerebrolysin (serum), 11 received NaCl 0.9% (shams), and 7 were controls. For microsurgery, the lateral corticospinal tract T10 was grafted to the denervated internal obliquus abdominal muscle. On day 90, intraoperative proof of reinnervation was observed. On day 100, 15 rats were euthanized for fixation, organ removal, and extensive histology-morphology examination, and the Wei-Lachin statistical procedure was employed. After an open revision of 16 rats, 8 were CMAP positive. After intravenous Vecuronium application, two (Cerebrolysin, NaCl) out of two rats showed an incomplete compound muscle action potential (CMAP) loss due to glutamatergic and cholinergic co-transmission, while two others showed a complete loss of amplitude. Cerebrolysin medication initiated larger restored muscle fiber diameters and less scarring. FB+ neurons were not observed in the brain but were observed in the Rexed laminae. Brunelli's concept was successfully replicated, demonstrating the first graft induced existence of cholinergic and glutamatergic neurotransmission in denervated grafted muscles. Statistics of the histometric count of muscle fibers revealed larger fiber diameters after Cerebrolysin. Brunelli's CNS-PNS experimental concept is suitable to analyze graft-neuroplasticity focused on the voluntary restoration of denervated skeletal muscles in spinal cord injury. Neuroprotection by Cerebrolysin is demonstrated.
Subject(s)
Central Nervous System/physiology , Muscle, Skeletal/innervation , Nerve Regeneration/physiology , Peripheral Nervous System/physiology , Action Potentials/drug effects , Amino Acids/pharmacology , Animals , Central Nervous System/drug effects , Female , Muscle, Skeletal/drug effects , Nerve Regeneration/drug effects , Peripheral Nervous System/drug effects , Rats, Sprague-Dawley , Reproducibility of ResultsABSTRACT
Various types of sensory nerve transfer in the hand are presented. They were all performed after brachial plexus injury to restore sensation, mainly to the adjacent borders of the thumb and index finger or to the ulnar aspect of the little finger. Twenty one cases were assessed. Their outcomes according to the Highet-Zachary system were: S2 in nine cases, S2 in four cases, S1 in four cases and S0 in four cases.
Subject(s)
Brachial Plexus/injuries , Fingers/innervation , Nerve Transfer/methods , Brachial Plexus/physiopathology , Brachial Plexus/surgery , Humans , Radial Nerve/surgery , Recovery of Function/physiology , Sensation/physiology , Ulnar Nerve/surgeryABSTRACT
Permanent palsies of the median nerve cause severe impairment of hand functions. This chapter reviews both the various surgical methods able to restore functions and complex mechanisms necessary for brain adaptation to the new functions of the cortical areas. Different methods of reconstructive surgery, according to both the severity of palsy and patients' needs, are presented. The contemporary restoration of sensory function of the paralysed digits is recommended, as sensation is a prerequisite for good motor function. The various mechanisms and methods useful to obtain good gliding and strength of the transferred tendons are stressed. Reconstructive surgery for permanent palsy of the median nerve can supply improved function, provided that all the recommendations for a meticulous balance of the number of functions to be restored and available motors to be transferred, as well as of their strength and course, are addressed.
Subject(s)
Median Neuropathy/surgery , Nerve Compression Syndromes/surgery , Nerve Transfer/methods , Plastic Surgery Procedures/methods , Tendon Transfer/methods , Chronic Disease , Female , Humans , Male , Median Neuropathy/diagnosis , Nerve Compression Syndromes/diagnosis , Paralysis/diagnosis , Paralysis/surgery , Prognosis , Recovery of Function , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
After having hinted to the various component of the malformity caused by malunions of the distal radius fracture, the various possibilities of correcting this deformity are described. The difficulty to correct all the components of the deformity are considered. Then a Dome-shaped osteotomy of the distal radius is described that allows to correct all the deformities in all the directions as the gliding plane of the osteotomy is spherical. The ulnar plus and the DRUJ alterations are corrected by means of an added Sauvé-Kapandji procedure that guarantees against any painful movement of the DRUJ preserving effective prono-supination.
ABSTRACT
Surgery of the spinal cord is still experimental, and outcomes must be confirmed by more cases. In this field, knowledge and research are still figuratively in the Stone Age. Nevertheless, the author is confident that in the future, with the improvement of surgical and resuscitation techniques and with the introduction of new biotechnologic drugs and molecules that favor axon regeneration and inhibitor blocking, CNS-peripheral nerve connections can be performed with some functional improvement, even in tetraplegia.
Subject(s)
Spinal Cord Injuries/surgery , Animals , Humans , Nerve Regeneration , Nerve Transfer , Spinal Cord Injuries/physiopathology , Spinal Cord Injuries/rehabilitationABSTRACT
Sural nerve withdrawal in peripheral nerve surgery is commonly performed for grafting nerve lesions with gap. Notwithstanding its popular use, this procedure is not entirely without fault as painful neuromas can occur after the withdrawal. We have treated 24 cases of painful neuromas of sural nerve after withdrawal; 11 of which were treated surgically. A safe procedure to cure and to prevent such neuromas is described - the electrical coagulation of the stump of the nerve by slowly increasing the intensity of the current. This procedure has been devised based on the fact that electrically burnt patients do not produce painful neuromas. An experimental histological study performed on rats demonstrated that slow electrical burning of the stump of a severed nerve prevents the formation of intraneural fibrosis which, on the contrary, forms abundantly when the cut nerve is not coagulated.
Subject(s)
Electrocoagulation/methods , Neuroma/prevention & control , Postoperative Complications/prevention & control , Sural Nerve/surgery , Amputation Stumps/surgery , Animals , Neuroma/etiology , Rats , Rats, Wistar , Sural Nerve/pathologyABSTRACT
Arthritis of the trapezio metacarpal joint (TMJ) is a very frequent condition, which affects women more than men, especially in the fifth or sixth decade of life. It can be very painful and disabling and the patient will need surgery for relief even if it can result in painless stiffening (in adduction of the metacarpal and hypertension of the metacarpal, which in turn is very disabling). TMJ arthritis is rarely primary or idiopathic; in general, it is secondary to instability of the joint, which, in turn, may be primary or secondary.
