Microsurgical revascularization of ischemic rat femoral heads.

To demonstrate whether revascularization could be surgically induced in avascular bone the femoral heads of female albino rats were excised and drilled through and through. The femoral heads were then placed in the opposite thigh and by use of microvascular techniques the femoral artery was divided and lengthened with a 1 cm artery or vein graft, and reanastomosed after passing one end through the drilled hole in the transplanted femoral head. Arterial blood flowed through the graft within the drilled femoral head on its way to its normal distribution down the leg. Technetium 99m MDP methylene diphosphate, tetracycline labeling, latex injection, and histologic review were used to demonstrate new vessel growth. All grafts patent at the end of the experiment were associated with tetracycline labeling, positive technetium 99m methylene diphosphate counts and latex-filled vessels in the matrix of the femoral heads. Histologically the vascularized femoral heads showed evidence of neovascularization and new bone formation.

Long-term follow-up of metacarpal phalangeal arthroplasty with silicone Dacron prostheses.

Sixteen patients who had eighty-nine metacarpal phalangeal arthroplasties with silicone Dacron prostheses (Niebauer type), were followed for an average of 11 1/2 years. Evaluation for palmar subluxation, ulnar drift, range of motion (ROM), pain relief, and stability showed it was satisfactory for relief of pain and correction of ulnar drift but it was eventually poor for range of motion and stability. If the arthritis was not controlled, the function of the hand decreased progressively, in spite of prosthetic replacements of the joints.

The treatment of mucous cysts: long-term follow-up in sixty-two cases.

To determine the course of the so-called mucous cyst both after various modalities of treatment and without treatment, 56 patients with 62 cysts were contacted to participate in a study with an average follow-up of 6.2 years after initial evaluation. The mucous cysts primarily occurred in elderly women and were most prevalent in the index and long fingers. Longitudinal grooving of the nail was not uncommon and may hve preceded the appearance of the cyst. Degeneration of the distal interphalangeal joint was frequently found. The long-term results after treatment with simple aspiration or decapping, or by excision with skin grafts and flaps as needed or with observation only were similar. However, surgical excision or aspiration may eliminate earlier the cosmetic disfigurement and occasional discomfort that are associated with this lesion.

Entrapment of the posterior interosseous nerve by a fibrous band in the dorsal edge of the supinator muscle and erosion of a groove in the proximal radius.

An unusual case of transient, reversible entrapment of the PIN has been described. The entrapment was due to a fibrous band at the distal edge of the body of the supinator muscle, not at the level of the arcade of Frohse. The transient paralysis was exacerbated by pronation and alleviated by supination. Release at operation alleviated all symptoms. A radiograph showed erosion in the proximal radius, presumably due to the posterior interosseous nerve. One must consider such an entrapment of the PIN when there is weakness of muscles innervated by the radial nerve distal to its course through the supinator muscle.

Recovery of sensibility after suture of digital nerves.

A group of 49 patients with 74 injured digital nerves was studied more than 5 years following epineurial nerve suture. Three tests of return of sensibility were used: von Frey plastic filaments, a modified Weber two-point discrimination device, and a dynamic test--the plastic ridge. The correlation between two-point discrimination and tactilegnosis in the range of 8 to 12 mm was poor. The plastic ridge device detects the presence or absence of tactilegnosis in patients in the intermediate range of two-point discrimination between 8 and 12 mm. Of the factors studied, the patient's age at the time of nerve suture was found to be directly related to the return of sensibility by both two-point discrimination and ridge criteria.

"Tie-in" trapezium prosthesis: Long-term results.

Seventeen of 20 thumbs treated with a silicone-Dacron trapezium replacement arthroplasty for disabling rheumatoid and osteoarthritis at the base of the thumb were reviewed. Patients were uniformly satisfied with the results. Relief of pain was achieved in all but three patients. The latter required excision for tissue reaction to the implant. (Histological findings are reported in these cases.) Motion and stability were satisfactory but not normal. Postoperative subluxation occurred in six cases. Wear and bone erosion were present in two cases after operation.

Recurring digital fibrous tumor of childhood.

A case of digital fibrous tumor of childhood is described. This tumor is multicentric, of possible viral origin, and is characterized histologically by intracytoplasmic inclusion bodies within proliferating fibroblasts. The tumor recurred despite wide local excision and skin grafting.

Epineurial and perineurial fascicular nerve repairs: a critical comparison.

To compare the results of epineurial and intrafascicular perineurial nerve repair techniques, ulnar nerves of 20 domestic cats were severed proximal to the medical humeral epicondyle. One nerve was repaired with No.8-O nylon by standard epineurial technique with the aid of three to five magnifications; the other nerve was repaired with No. 10-O nylon by intrafascicular perineurial technique under higher magnification. Four to five months following neurorrhaphies, the ambulation pattern, fanning of claws, and sensation were evaluated subjectively. Objective measurements included efficiency, absolute strength, and exact weight of the flexor carpi ulnaris muscle. Proximally and distally to each neurorrhaphy, complete axon counts were taken. Histochemically and histologic analyses were made on reinnervated muscles and neuromas. No statistically significant differences were detected between the results of epineurial and intrafascicular perineurial neurorrhaphies. These findings indicate that, following acute nerve laceration in the cat, epineurial neurorrhaphy is as satisfactory as is intrafascicular perineurial neurorrhaphy.

Flexion and extension contracture of the elbow: surgical management.

In those cases in which a contracted capsule at the elbow limits flexion or extension, surgical treatment is warranted. A wide exposure is necessary to identify vital structures and perform an adequate anterior capsulectomy. A direct approach through the triceps is recommended for posterior capsulectomy. In 6 cases, the results were good when the contracture of the capsule was not associated with skin contracture or bony deformity.

Treatment of Dupuytren's contracture. Long-term results after fasciotomy and fascial excision.

Of 359 hands treated surgically for Dupuytren's contracture, 135 were available for study after two years or more, often because of recurrence. Of the sixty-five hands treated by excision of the involved fascia (subtotal fasciectomy), 63 per cent had recurrences in the area operated on but only 15 per cent had sufficient deformity to warrant another operation. Of the forty-one hands treated by palmar fasciotomy, 43 per cent had recurrent deformities severe enough to warrant further surgical treatment. After palmar fasciotomy, improvement at the metacarpohalangeal joint persisted; but, as expected, the deformity at the proximal interphalangeal joint progressed just as it did in an untreated control group. The average postoperative period of disability was fifty-nine days after fasciectomy and twenty-one days after fasciotomy. Stiffness and hematoma occurred after fasciectomy but were not observed after fasciotomy. A digital nerve was severed during one fasciotomy and one fasciectomy. Excision of the involved fascia, therefore, gave the best long-term results but was associated with a higher incidence of postoperative complications.

Results of primary and secondary flexor-tendon repairs in no man's land.

The results of primary and secondary repair of seventy-one flexor-tendon lacerations in Bunnell's no man's land of the hand usually were good when the following principles were adhered to: careful preoperative selection of patients, use of atraumatic technique, avoidance of advancing the flexor digitorum profundus tendon more than one centimeter distally, and caution in performing secondary repairs when both the flexor digitorum superficialis and the profundus were completely severed. Secondary repair resulted in a higher failure rate (loss of extension) only when both tendons were completely severed.