Protective coverage of the median nerve using fascial, fasciocutaneous or island flaps.

PURPOSE: The aim of the study is to present our experience with fascial or fasciocutaneous pedicle and island flaps in the treatment of recurrences of CTS with and without median nerve lesions. MATERIAL AND METHODS: From 1987 to 2006 we have operated on 25 patients (17 women and 8 men, ages ranging from 38 to 76 years with a mean age of 55 years) due to a recurrence of CTS. All the patients required nerve coverage using a local or distant flap. There were 19 hypothenar fat flaps; two forearm radial artery flaps, a forearm ulnar artery flap, an ulnar fascial-fat flap and a posterior interosseous flap. Patients were clinically and instrumentally evaluated before the operation. Assessments of the evaluation parameters were classified in excellent, good, fair and poor according to clinical and return to work criteria. RESULTS: Patients were evaluated after a mean follow-up of 51 months (12 to 168 months). The pain evaluation showed an improvement passing from a mean value of 9 to 4. The best results were for those patients in whom the median nerve was undamaged (mean value of 1). Eleven patients obtained excellent results; good results were obtained in twelve cases; two patients demonstrated fair results due to partial median nerve injury. In these cases, a hypothenar fat flap and an ulnar fascial-fat flap were used, respectively. CONCLUSION: Protective coverage of the median nerve by using fascial or fasciocutaneous flaps after failure of CTR and/or unsuccessful re-operations is a good solution to furnish to the median nerve a gliding tissue to avoid adherences with the surrounding tissue of previous surgery. The protection of the nerve can reduce painful symptoms even if it does not permit a return to a painless condition. However, the clinical results in terms of median nerve functional recovery cannot be predicted: if the median nerve is damaged, protective coverage of it by flaps cannot give a favourable result in terms of recovery of both sensory and motor deficits.

[Arthroscopic wrist arthrolysis]. / Arthrolyse arthroscopique du poignet.

Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3 to 6 months. From 1988 to 2003, 47 cases (45 patients: 35 males and 10 females), with a mean age of 36 years were operated on. All the radiocarpal, midcarpal and DRUJ portals were used in relationship with the site of rigidity. At a mean follow up of 58 months (range from 3 to 176 months) no complications were documented. Pain was almost absent in all the cases, mean flexion-extension ROM increased from 92 degrees preop to 106 degrees postop, mean pronation/supination increased from 145 degrees preop to 155 degrees postop, and mean grip strength increased from 25 to 31 kg postop. The average modified Mayo Wrist Score improved from 39 to 87, and the postop DASH Questionnaire obtained an average of 21 points.

Nervous lesions as neurologic complications in regional anaesthesiologic block: an experimental model.

The purpose of the study was to evaluate the lesions produced by direct trauma of injection needles in the peripheral nervous trunks. Two types of needles were compared: one with a tip with a 45 degrees inclination, and one with a tip with a 14 degrees in clination. Sprague Dawley rats were used, the sciatic nerve of which had been subjected to repeated injections under direct vision; the results were collected 7, 14, and 21 days after surgery. Both macroscopic and histological observation revealed that the greatest injury was produced using needles that had a tip with a 14 degrees inclination, that was longer, while needles that had a tip with a 45 degrees inclination had a greater tendency to slip and rotate at every attempt at penetration.

Mitotic activity in chondrocyte transplantation from the in vitro phase to the in vivo phase.

The transplantation of devitalized allogenic matrices vehiculating autologous chondrocytes, previously isoled and seeded on them could be a solution to the problem of repairing lesions of the joint cartilage. For the matrix/cell "composite" to be "graftable" the cells must continue to duplicate and produce cartilaginous matrix even after transport in vivo. The present study analyzes the mitotic activity of chondrocytes planted on devitalized allogenic cartilage and grafted in living animals. Chondrocytes of joint cartilage of lambs were isolated enzymatically and then seeded in vitro on devitalized allogenic cartilaginous matrices for 3 weeks. At the end of the co-culture period, these matrix/chondrocyte composites were transplanted in subcutaneous pockets of athymic mice. The experimental and control samples were evaluated subsequent to explantation by histological study and incorporation of tritiated thymidine. The results obtained revealed an important decrease in the values for the incorporation of thymidine beginning from experimental time 0 (pre-implant evaluation) up to day 28 after implantation, followed by a mild increase at the experimental time of 42 days. This study demonstrated the tendency of articular chondrocytes cultivated in vitro and subsequently transplanted in vivo on a support of devitalized allogenic cartilaginous matrix to modify mitotic activity from very high values for the first experimental times, typical of the in vitro phases of cellular expansion, to very low values, more similar to the behavior of articular chondrocytes in vivo.

[Arthroscopic wrist arthrolysis.] / Arthrolyse arthroscopique du poignet.

Wrist stiffness is a complication of wrist trauma or surgery. Rehabilitation is the treatment of choice to improve the wrist range of motion. Since 1988 we used the arthroscopic wrist arthrolysis. Criteria for patient inclusion in our preop and postop study were wrist stiffness with or without pain, unsuccessful results from rehabilitation after 3 to 6 months. From 1988 to 2003, 47 cases (45 patients: 35 males and 10 females), with a mean age of 36 years were operated on. All the radiocarpal, midcarpal and DRUJ portals were used in relationship with the site of rigidity. At a mean follow up of 58 months (range from 3 to 176 months) no complications were documented. Pain was almost absent in all the cases, mean flexion-extension ROM increased from 92 degrees preop to 106 degrees postop, mean pronation/supination increased from 145 degrees preop to 155 degrees postop, and mean grip strength increased from 25 to 31 kg postop. The average modified Mayo Wrist Score improved from 39 to 87, and the postop DASH Questionnaire obtained an average of 21 points.