Biomechanical and histomorphological changes in expanded rabbit skin.

In 12 rabbits, biomechanical and histomorphological properties were determined in expanded, sham-operated and non-operated control skin. Results were evaluated in paired fashion. Both expanded and sham-operated skin showed a significant loss of stiffness of 60% and 35% respectively (rho less than 0.001 and rho less than 0.05). In addition, maximum stiffness in expanded skin was reached at a shorter extensibility than in sham-operated or non-operated control skin. Histomorphological examination revealed thickened dermal collagen bundles with loosened packing of collagen fibrils in both expanded and sham-operated skin. It is concluded that the surgical procedure of balloon implantation is responsible for a significant part of the reported biomechanical and histomorphological findings. Wound healing, in addition to the delay phenomenon, may therefore be a mechanism involved in skin expansion.

An improved model for tissue expansion and flap research in the rabbit.

A pocket for tissue expander implantation in the rabbit is described at the level between the skin and the panniculus carnosus. The vascular anatomy of the undermined skin was studied with microangiography which showed a functional (sub)dermal plexus. Expanders were placed in seven rabbits and inflated daily over a period of 10 days. Blood flow in expanded skin, as measured with laser Doppler flowmetry, dropped with increasing inflation pressure. During the course of expansion, the intraluminal pressure returned to a baseline level within 24 hours after each inflation. It is concluded that an expander placed in the described layer in the rabbit causes considerable skin stretch and interferes with cutaneous blood supply and is therefore an improved model for tissue expansion in the human.

Reconstructive surgery of the post-burn boutonnière deformity.

A retrospective study of fifty-four longstanding post-burn boutonnière deformities was carried out to evaluate the problems associated with the surgical procedures. The aim is to describe the pathophysiological changes of the burned fingers, the primary treatment, the reconstructive principles, the patients and materials and the final post-operative results.

The reversed forearm flap using scarred skin in hand reconstruction.

A reverse forearm flap was used in the reconstruction of the hands of two epileptic patients, who had sustained deep dermal burns of the right hand and forearm. The base of both flaps consisted of scarred, transplanted skin. Furthermore one flap was split. Venous drainage was preserved. A good result was observed in both cases.

Retrospective study of reconstructive surgery of the burned hand.

During the 5 years 1979-1983 915 patients were admitted to the Rode Kruis Ziekenhuis, Beverwijk, for the primary treatment of burns, including 618 cases in which the hands were involved. Subsequently 105 patients required secondary surgery to 180 burned hands. This study assesses the treatment of these burned hands, the aim being to describe the problems of burned hands in relation to post-burn sequelae, in general; and particularly to the reconstructive procedures employed, and to assess the final results.

Cross-finger flaps from scarred skin in burned hands.

An innovation is described in the secondary repair of two types of longstanding post-burn flexion contracture of the little finger. The correction of the PIP joint flexion contractures caused by palmar burns can result in a defect on the palmar side of the finger after incision or excision of the scar. The reconstruction of the post-burn buttonhole flexion deformity of the PIP joint, can result in a defect on the extensor surface of the PIP joint after excision of the dorsal scarred skin. Both acquired defects were covered by two different cross-finger flap techniques, despite extensive scarring of the adjacent finger. It is evident that mature post-burn scarred skin on the dorsum of the finger can be utilised for a cross-finger flap procedure.

Preparation and specificity testing of a rabbit anti-human thymocyte serum (with 1 colour plate).

The preparation of a specific anti-T cell serum, applicable in the indirect immunofluorescence technique on cell suspensions, smears of peripheral blood and bone marrow and on tissue sections is described. Rabbits were immunized with thymocytes; after removal of antibodies against species-specific antigens and antigens common to leucocytes by absorptions with red cells and granulocytes, specificity for thymocytes was obtained by repeated absorptions with CLL cells, used as B cell equivalents. Subsequently, the IgG fraction of the absorbed antiserum was isolated. This antibody preparation was tested with various types of blood cells as well as with cell suspensions depleted or enriched in T cells. For the study of tissue sections it had to be absorbed with liver powder. When studying lymphatic tissue it was found to stain only thymus-dependent areas in the specimens tested.

Identification of T and B lymphocytes in human breast cancer with immunohistochemical techniques.

Cryostat sections of 50 breast cancer specimens and several lymphoid organs were investigated with antisera against human T-lymphocyte antigen, human lymphocytes, and human immunoglobulins using the immunofluorescence technique and the immunoperoxidase technique. These methods proved to make it possible to discriminate between T and B cells in lymphocytic infiltrates in tissue sections. In nearly all mammary carcinomas studied, T cells were found to predominate in and around tumor cell nests. Only the intraductal carcinomas of this series contained a substantial number of B cells in addition to T cells. The presence of T cells indicates that the host-tumor interaction in vivo mall-mediated immune reaction. The role of the B cells found in the lymphocytic infiltrates of the intraductal carcinomas is still a matter of speculation. Moreover, these findings enhance the value of established histologic classifications. These classifications may have to be modified to provide them with a more functional basis.

Cardiac manifestations of Fabry's disease. Report of a case with mitral insufficiency and electrocardiographic evidence of myocardial infarction.

The light and electron microscopic findings in the heart of a patient with Fabry's disease are described. The study revealed that all cardiac tissues, including the conducting tissues and the valves, were involved. The latter finding was of particular interest since the patient was known to have mitral insufficiency. The findings of diffuse ballooning of the mitral valve with localized "overshoot" and massive glycolipid storage in the valve substance suggest that the abnormal storage process was itself responsible for the valvular insufficiency. The widespread involvement of the myocardium and conducting tissues is consistent with the elelctrocardiographic changes indicating infarction, although myocardial necrosis was not observed. The findings in this case suggest that the cardiac manifestations in Fabry's disease can be either primary, that is, directly related to the enzyme deficiency, or secondary, that is, evolving with time as a consequence of the disease.