Journal of reconstructive microsurgery
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J Reconstr Microsurg · Feb 2006
Decompression of the lateral femoral cutaneous nerve in the treatment of meralgia paresthetica.
Meralgia paresthetica (MP) is a painful mononeuropathy of the lateral femoral cutaneous nerve (LFCN). Neurolysis is reserved for patients with MP who respond poorly to medical management. This study retrospectively evaluated the outcomes of 41 patients who underwent either unilateral or bilateral neurolysis of the LFCN for a total of 48 procedures. ⋯ Overall, surgical outcome was considered by patients to be successful in 77 percent of cases. LFCN neurolysis alone had better results, compared to combined LFCN neurolysis and nerve resection. The conclusion is that neurolysis of the LFCN is an effective treatment for MP in properly selected patients.
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J Reconstr Microsurg · Jan 2006
ReviewRecipient vessels for microsurgical flaps to the groin and pelvis: a review.
Reconstruction of large defects of the pelvis and groin sometimes requires microsurgical flaps when the otherwise rich supply of local options fails to be sufficient in difficult and complicated cases. Recipient vessels for microsurgical flaps to the groin and pelvis are important elements in planning such procedures. Seven groups have reported pelvis and groin microsurgical flap cases, and their recipient vessels have included the superior and inferior gluteal vessels, the femoral vessels, the deep perforators of the femoral system, the inferior epigastric vessels, intra-abdominal vessels, and interpositional vein grafts to distant recipient vessels. This review summarizes their experience and describes the recipient vessel options in the pelvic and groin region.
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J Reconstr Microsurg · Aug 2005
Early effect of gene therapy on a direct muscle neurotization model.
Direct nerve-to-muscle neurotization has been the subject of both clinical and experimental studies. In this study, the authors report a new animal model to test the regenerative properties of a nerve (musculocutaneous) implanted in a muscle (biceps). They also report the early effects of the application at the implantation site of exogenously administered Brain Derived Nerve Factor (BDNF) and of endogenously produced BDNF, via the administration of an adenoviral construct with a tissue-specific promotor for muscle cells (AdRSV), and containing the BDNF gene. ⋯ There was also no difference in the histologic appearance and number of the motor end-plates at the implantation site, compared to the controls. The electrical stimulation of the MC nerve did not produce statistically significant results among the experimental groups. In this direct nerve to muscle neurotization model, the application of AdRSV-BDNF at 3 x 10 (9) pfu/ul did not show enhanced production of BDNF at 1 week.
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The authors describe a reverse end-to-side neurorrhaphy model in which the proximal end of a donor nerve is sutured to an epineurial window in the side of a recipient nerve. If effective, this technique would have useful applications in nerve reconstructive surgery. Female Sprague-Dawley rats were divided into three groups (n = 9). ⋯ Group B animals did not demonstrate any measurable contractions. No statistically significant differences were found between Groups A and C. This demonstrated the successful neurotization of a denervated muscle using a reverse end-to-side neurorrhaphy model.
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The medicinal leech, Hirudo medicinalis, has been widely used in the salvage of microvascular free flaps. Numerous publications have detailed the biology, use, benefits, and risks of leech therapy. ⋯ The authors report a simple method of limiting the movement of medicinal leeches from the surgical site, namely, affixing one end of a surgical suture to the leech and tying the free end to a firm object or dressing. This simple method limits the potential range of movement of the leech and reduces the risk of leech migration to unwanted areas.