A comparison of peripheral nerve repair using an absorbable tubulization device and conventional suture in primates.

Median nerve regeneration was studied in 30 adult primates after repair by microsurgical suture or tubulization with a nonwoven, bioabsorbable, polyglycolic acid device. The two methods were compared electrophysiologically and histologically 6 and 12 months after repair. The electrophysiology included recording of electrically evoked compound action potentials and subsequent determination of threshold, conduction velocity, amplitude, and area above the baseline for each component. Measurements were obtained before nerve transection and at the time of biopsy by stimulating both proximal and distal to the transection site. Analysis of all electrophysiological parameters revealed no statistically significant differences (p less than 0.05) between the two repair techniques. Histopathology included examination of cross sections proximal and distal to the repair sites and longitudinal sections through the coaptation site. End organs (Meissner's and Pacinian corpuscles and muscle) were sectioned to determine the degree of reinnervation. No significant differences between the repair techniques were observed by histological analysis of these sections. These evaluations indicated that the tubulization repair technique produced results comparable to that of the suture technique.

Exertional compartment syndrome in covert mild hemophilia. A case report.

A 37-year-old white male experienced unexpected postoperative bleeding after fasciotomy and decompression for left pronator and compartment syndromes of the forearm. He was subsequently diagnosed with a mild form of hemophilia A. One year later, surgery was required for right pronator and compartment syndromes. Pre- and postoperative cryoprecipitate infusions controlled bleeding following the second operation until the patient discontinued his infusions, resulting in a wound hematoma. Covert mild hemophilia is implicated in the pathogenesis of his compartment syndromes.

Variations of the median nerve in the carpal canal.

Eight hundred twenty-one median nerves were retrospectively and prospectively reviewed for variations during operations to treat carpal tunnel syndrome. Ninety-two cadaver median nerves were also dissected to document the incidence of variations within the carpal canal. The combined incidence of anomalies at operation (Lanz groups 1 to 4) was 9.8% and in the cadaver series 18%. The discrepancy reported by Poisel, 54% in the Lanz group 1 series, versus ours of 1.42% cannot be explained.

Partial flexor tendon laceration: a cause of trigger finger.

This paper reports four cases of trigger finger that resulted from partial laceration of the flexor tendons. Of the four cases, there were one profundus and three superficialis tendons in three males and one female, ranging from 13 to 36 years of age. They were all treated surgically by excision of the "tag" with full functional recovery.

Tourniquet ischemia: ultrastructural and histochemical observations of ischemic human muscle and of monkey muscle and nerve.

Biopsies of muscle from ten patients and of muscle and nerve from three monkeys were obtained during periods of continuous ischemia and studied by light and electron microscopy and by histochemical means. Between the third and fourth hours of ischemia, swelling of the mitochondria was noted in monkey muscle. One week later the appearance was normal. In the monkey nerves degenerated myelin was seen one week later but appeared to be normal at 2 weeks. If after 3 hours the tourniquet was deflated for 30 minutes and then reapplied for 2 additional hours, no changes were found. Succinic dehyrogenase analysis was used to identify swelling of the mitochondria. No mitochondrial changes were seen in human muscle made ischemic by a tourniquet for 2 hours.

An anomalous flexor digitorum sublimis muscle. A case report.

A report of an anomalous flexor digitorum superficialis muscle in a 14-year-old presenting as a painful, enlarging palmar mass was explored and found to lie on the ulnar side of the flexor, separate from the lumbrical. The anomalous flexor digitorum superficialis muscle was found attached to a normal flexor digitorum superficialis tendon supplied by a branch of the median nerve, and resected. The muscle represents a rare lesion to consider in diagnosis of hand masses. A phylogenetic anatomic explanation for the anomaly is feasible.