Repair of mixed peripheral nerves using muscle autografts: a preliminary communication.

Twelve patients were reviewed following the reconstruction of mixed motor/sensory nerves using freeze-thawed skeletal muscle autografts. A total of 13 nerves were reconstructed-6 median and 7 ulnar. All the repairs were secondary procedures, with a mean time from injury to grafting of 17 months. Sensory and motor evaluation was carried out and the patients asked to complete a pain questionnaire. Five patients achieved an S3+ level of sensory recovery. Two underwent revision of their muscle grafts to nerve grafts. Motor recovery was universally poor.

Distal and very distal digital replantations.

Ninety-five patients with 98 complete or incomplete amputations of digits are reviewed. Three levels are considered according to the bony lesion, zone III being distal to the nail matrix. In this area, artery, nerve and vein repair need special techniques. The use of leeches in the absence of vein repair does not preclude an acceptable survival rate (68%), compared to the overall series (65.5%); however, smoking is detrimental (52%). Distal replantation is a fast and worthwhile procedure providing acceptable sensibility, no PIP limitation and good appearance at the price of a mean 74 days off work.

Comparison of results of repair of digital nerves by denatured muscle grafts and end-to-end sutures.

A further report is made on patients with primary and delayed repair of digital nerves with autogenous denatured muscle grafts. There was evidence of continued improvement in threshold response to tactile stimuli, and discriminative function. These results were superior to those in 24 patients with conventional end-to-end sutures on clinical testing.

A comparison of immediate and delayed repair of peripheral nerves using freeze-thawed autologous skeletal muscle grafts--in the rat.

A group of rats in which each animal received immediate repair of a transected sciatic nerve using freeze-thawed muscle autografts was compared with groups where repair was carried out after delays of 3, 5, 7, 14, 28 and 56 days following transection. All rats were studied 100 days after graft insertion. A delay of 56 days was found to be incompatible with useful recovery. In the groups studied after shorter delays, myelinated nerve fibre numbers and diameters were not found to differ significantly from those seen after immediate repair. There was, however, a significant reduction in the rate of remyelination of the fibres following a delay. The implications of this are discussed.

Peripheral nerve repair in humans using muscle autografts. A new technique.

Coaxial autografts of skeletal muscle which had been frozen then thawed were used to repair injured digital nerves in eight patients. Assessment from three to 11 months after operation showed recovery to MRC sensory category S3+ in all but one patient, an excellent level of recovery. We conclude that bespoke muscle grafts treated and used in this way may offer significant advantages over conventional nerve grafts or cable grafts especially where large peripheral nerves are involved.

The venous dorsal digital island flap or the "neutral" flap.

Over a 4 1/2 year period, 23 patients with an age range of 13 months to 66 years have undergone reconstruction of palmar or dorsal digital and hand defects using a "venous" island flap. The reconstructive surgery was carried out in the S.O.S. Main, Strasbourg. The results of this form of reconstruction are presented. The indications and clinical applications of this controversial flap are discussed.

The dorsal approach in harvesting the second toe.

The dorsal approach, with early section of the second metatarsal bone, allows direct access to the plantar structures of the second toe (arteries, nerves, and flexor tendons). A "multiple set arterial transfer" then becomes possible, improving the blood supply to the toe. Early walking is encouraged on the fifth postoperative day when the patient leaves the hospital. No vascular complications have occurred in any microvascular reconstruction after the fifth postoperative day. Close approximation of the first and third toe of the donor foot not only improves the overall appearance of the foot, but also avoids a possible hallux valgus deformity as a postoperative complication.

The treatment of tattoos with trichloracetic acid: experience with 670 patients.

A review of out-patient treatment of tattoos with trichloracetic acid has been undertaken. Six hundred and seventy patients have been treated during the 6-year period between 1979 and 1984. The simple and inexpensive technique is described and the results presented.

Tissue expansion for head and neck reconstruction.

Tissue expansion is a new reconstructive technique with enormous potential. Although popularized over 10 years ago, its place in the management of soft tissue reconstruction for head and neck malignancy is undefined. In this paper 3 clinical cases are illustrated.

A new surgical approach to duplications of the intestine.

Two unusual intestinal duplications are described. In each case the mesenteric duplication had a separate muscular coat from the normal bowel permitting complete excision of the duplication without interference with the blood supply to the normal intestine.

The proximal interphalangeal joint in systemic sclerosis and its surgical management.

During the 10 year period between 1974 and 1983, 20 replacement arthroplasties of the proximal interphalangeal joints have been performed in six patients with long standing systemic sclerosis. A recent review of 5 of the 6 patients revealed significant improvement in hand function and appearance, accompanied by a much lower than expected complication rate.

In vitro studies on optimum preparation of coagulum for surgery of renal calculi.

In renal calculus surgery, human dried fibrinogen produces a coagulum with a much greater tensile strength, stickiness deformability and extractability than cryoprecipitate, which produces a relatively weak and friable clot. A useful coagulum may be prepared at room temperature at any convenient time prior to use if a mixture of 19 ml human dried fibrinogen solution and 1 ml thrombin solution is used. If mixed in a single syringe and injected within 35 s through a butterfly needle into the renal pelvis, complete mixing of the solutions is guaranteed. By using this simple method, the unpredictability of the coagulum can now be eliminated and a strong and elastic clot can be produced.