Journal of reconstructive microsurgery
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J Reconstr Microsurg · Apr 2000
Biography Historical ArticleJames R. Learmonth: the first peripheral nerve surgeon.
The life and education of James R. Learmonth are reviewed. His experimental and clinical activities place him historically as the first surgeon to devote himself to peripheral nerve surgery.
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J Reconstr Microsurg · Aug 1999
Comparative StudyCholine acetyltransferase activity in collateral sprouting of peripheral nerve after surgical intervention: experimental study in rats.
The purpose of this study was to establish an assay of choline acetyltransferase (ChAT) activity to investigate the regeneration of injured peripheral nerve, repaired by end-to-end or end-to-side neurorrhaphy. Murine sciatic and peroneal nerves were exposed, and the peroneal nerve was transected at a site 5 mm from its ramification. For end-to-side neurorrhaphy, an epineurotomy producing a 5-x5-mm window was carried out on the tibial nerve, just above the level of gastrocnemius muscle ramification. ⋯ ChAT activity in the end-to-side neurorrhaphy yielded approximately two-thirds the value of the end-to-end neurorrhaphy, and more than half the value of positive controls at 3 months postoperatively. Histologic sections of the end-to-side and end-to-end sutured peroneal nerve demonstrated large numbers of myelinated axons and Schwann cells at the third postoperative month. All the results demonstrated that end-to-side neurorrhaphy is comparable to well-performed end-to-end neurorrhaphy, thus providing another option for surgical treatment of avulsion nerve injury and massive nerve defect.
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J Reconstr Microsurg · Apr 1999
Peripheral nerve revascularization: histomorphometric study of small- and large-caliber grafts.
The revascularization of nerve grafts was investigated using histologic and morphometric techniques. Small-diameter nerve grafts (sciatic in the rat and sural in adult ewes) were studied, as was a large-diameter peroneal nerve graft in the ewe. Ninety-six hours after sciatic nerve engraftment, rats were injected with an intravascular fluorescent tracer. ⋯ The finding suggests that small-diameter nerve grafts spontaneously revascularize, and revascularization using microvascular techniques is not necessary. In contrast, the larger-diameter nerve graft did not revascularize well. Such a large-diameter nerve graft would provide a suitable model to investigate the potential merits of a vascularized nerve graft.
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J Reconstr Microsurg · Feb 1999
Case ReportsMicrosurgical repair of Stensen's duct using an interposition vein graft.
Facial wounds are frequently associated with bone fractures and multiple trauma; however, disruption of the parotid gland or Stensen's duct is rare and is often associated with facial nerve palsy. Lesions are often undiagnosed on first assessment of the multiple trauma patient. ⋯ Although simple ligation of Stensen's duct has been reported to give satisfactory results, the authors prefer a more anatomic reconstruction of this structure whenever possible. A case of Stensen's duct microsurgical repair using a vein graft are reported.
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J Reconstr Microsurg · Jul 1998
Comparative StudyFlap flow and cardiac output as functions of pulmonary artery wedge pressure: experimental study in the pig.
Cardiac output (CO) is redistributed during hypovolemia, but it has not been clearly documented how this influences flap perfusion. Simultaneous changes in perfusion of a muscle flap and CO as modulated by reductions in cardiac filling pressure were compared in a pig model. The hypothesis was that flap flow (FF) would remain relatively constant as CO was reduced, according to the Frank-Starling curve. ⋯ Changes in FF paralleled changes in CO as the PAWP was reduced. Inhalation anesthesia and local sympathectomy may influence flap perfusion during hypovolemia. These results underscore the importance of avoiding hypovolemia during flap surgery, in order to maintain flap perfusion.