Treatment of leprous neuritis by neurolysis combined with perineural corticosteroid injection.

A study on leprous neuritis, involving the ulnar nerve, was carried out on 39 patients. The evaluation of nerve function was done before and after treatment by a score chart. Patients were divided into two groups. Group A (21 patients) was subjected to neurolysis only, and group B (18 patients) were given the combined treatment of neurolysis and perineural corticosteroid injection at the same time as neurolysis and subsequently at the end of the second and third weeks. In group B, 83.3% of patients showed 10% or more increase in the posttreatment score in comparison with 57.1% in group A. Improvement was more marked in paucibacillary cases and when the duration of nerve involvement was less than 3 months. Patients with short segments of nerve involvement with minimal thickening had better recovery. This procedure was observed to be simple, easy and well accepted by the patients, with a marked beneficial effect.

Bilateral elbow flexion reconstruction with functioning free muscle transfer for obstetric brachial plexus palsy.

A child suffered a bilateral obstetric brachial plexus palsy involving the C5 and C6 nerve roots. Abduction of the shoulder joints had recovered by 1 year, but elbow flexion did not recover on either side. Free gracilis muscle transfers were performed on both sides, at an interval of 6 months, to achieve elbow flexion. The spinal accessory nerve was used as the donor nerve.

Replantation of very thumb distal amputations with pre-osteosynthesis interpositional vein graft.

Replantation of distal thumb amputations is difficult because of the anatomic orientation of the thumb and the location and size of vessels. A simplified technique is presented, in which interposition vein grafts are anastomosed to a terminal branch of the digital artery and a subcutaneous vein in the amputated thumb tip. This technique is convenient, relatively easy and reliable.

Surgical approach to the spinal accessory nerve for brachial plexus reconstruction.

An easy, safe, and less invasive surgical approach to the spinal accessory nerve for brachial plexus reconstruction is described. The technique avoids a longitudinal unsightly scar over the neck and preserves the branches innervating the upper part of the trapezius.

Clinical application of intraoperative measurement of choline acetyltransferase activity during functioning free muscle transfer.

Intraoperative measurement of choline acetyltransferase (CAT) activity was used for evaluation of the functional status of donor nerves during functioning free muscle transfer (FFMT). Twelve patients underwent the procedure. Seven patients had a brachial plexus injury, 3 Volkmann's contracture, 1 chronic peroneal nerve injury, and 1 forearm extensor muscle loss after wide resection of soft tissue sarcoma. The purpose of reconstruction using FFMT was to achieve wrist extension in 4 patients, simultaneous elbow flexion and finger extension in 3, elbow flexion in 2, finger extension in 1, finger flexion in 1, and ankle extension in 1 patient. The gracilis muscle was transferred in all cases. The donor nerves for FFMT that were evaluated by CAT activity included 5 spinal accessory nerves, 4 posterior interosseous nerves, 2 anterior interosseous nerves, and 1 deep peroneal nerve. Fascicles with greater than 2,000 cpm CAT activity were considered to reliable and used as donor motor nerves. All muscles had reinnervation by 3.2 months (range, 2-5 months) and obtained useful recovery. Intraoperative measurement of CAT activity can provide direct and quantitative information about the functional status of donor nerves during FFMT.

An unusual case of orbital trauma with a large foreign body in the maxilla.

A case in which a broken handle of a scooter was found lodged in the right maxillary sinus and infratemporal fossa with an unusual route of entry through the orbital floor without any injury to the globe is reported.

A microneurovascular study of the great saphenous vein in man and the possible implications for survival of venous flaps.

Cross sections (n = 372) of human long saphenous veins (n = 12) from unsalvageable fresh above knee amputation specimens brought to a trauma centre in a large metropolitan hospital were studied. The veins were harvested longitudinally with an amount of soft tissue equivalent to the diameter of the vein and sectioned at intervals of 5 mm. The sections were stained with haematoxylin and eosin for general study, Van Gieson for better delineation of different coats of the vessel wall and reticulin stain to differentiate between venules and arterioles. The vascular structures within the vein wall and its surrounds were analysed by using analySISpro via a CCD camera attached to a light microscope, with the help of a frame grabber card and image analysis software. Results show that the vein has vasa vasorum within its wall, a capillary network around it, arterioles, venules and the saphenous nerve and its branches with their vascular network a further distance apart. The relevance of the microsurgical anatomy of the saphenous vein and its soft tissue envelope in the survival of venous flaps is discussed.

Changes in the local morphology of the rectus abdominis muscle following the DIEP flap: an ultrasonographic study.

This study was undertaken to assess the changes in the local morphology of the rectus abdominis muscle following intramuscular dissection of the deep inferior epigastric artery perforators after harvesting of the deep inferior epigastric perforator (DIEP) flap. While the DIEP provides the well-known advantage of use of the lower abdominal tissue with preservation of the integrity of the abdominal wall musculature, postoperative problems such as abdominal asymmetry, bulges and reduced flexion capacity have been found. These changes may be due to rectus abdominis muscle damage from ischemia or denervation. We used ultrasonography to assess the changes in rectus abdominis muscle thickness and contractility, preoperatively, 1-month and 1-year postoperatively. The study group consisted of 17 rectus abdominis muscles in 14 patients subjected to intramuscular dissection of perforators. The control group consisted of 11 intact rectus abdominis muscles in 11 patients who had undergone unilateral DIEP flap elevation, the dissected muscles being part of the study group. We found that the resting muscle thickness in the study group was, significantly increased at 1-month postoperatively, resolving by 1-year follow-up. As these changes were not seen in the control group, the increased muscle thickness is attributed to postoperative oedema that resolves with time. All muscles in the study and control groups retained contractility showing no evidence of muscle denervation. Our date demonstrates that intramuscular dissection of perforator vessels in the DIEP flap leads to minimal changes in the local morphology and contractility of the rectus abdominis muscle.