John M. Markley

The preservation of close two-point discrimination in the interdigital transfer of neurovascular island flaps.

Some possible reasons for the reported failures of digital neurovascular island flaps to provide normal (or near normal) tactile sensibility are discussed. Some technical variations which may improve the results are proposed. An illustrative case is reported in which there was transfer of intact two-point discrimination.

Regeneration of skeletal muscle after grafting in monkeys

Twenty-five palmaris longus muscles were transplanted into the forearm (orthotopic autografts) or into the face (heterotopic autografts) in 15 Rhesus monkeys. These muscles were transplanted with or without anastomosis to a motor nerve. No significant difference was observed long-term between the grafts done with or without prior denervation of the muscle. The forearm muscle grafts without neurorrhaphies formed a static, fibrous sling which did not contract. The forearm autografts with neurorrhaphy and the grafts to the face, with or without neurorrhaphy, all developed regenerating skeletal muscle fibers and showed contractile activity.

Characteristics of Cat Skeletal Muscles Grafted with Intact Nerves or with Anastomosed Nerves

Grafting of 3-g extensor digitorum longus (EDL) muscles of cats may be made with (i) severence of the nerve with spontaneous reinnervation, termed standard grafts (ii) severence of the nerve with reinnervation facilitated by anastomosis of the nerve, termed nerve-anastomosed grafts; and (iii) preservation of the nerve, termed nerve-intact grafts. In previous studies, standard grafts developed a maximum isometric tetanic tension (P0) that was 22% of the value for control EDL muscles. We hypothesized that the low values of P0 resulted from incomplete reinnervation of muscle fibers. To test this hypothesis, EDL muscles were grafted in cats with nerves intact and with nerves anastomosed. In standard grafts differences were observed in both structure and function at 120 compared with 240 days after grafting. Characteristics of the nerve-intact and nerve-anastomosed grafts did not change significantly between 120 and 240 days and the data were pooled for comparisons with control EDL muscles. Nerve-anastomosed and nerve-intact grafts developed P0 values that were 34 and 64% of the control values, respectively. Nerve-intact grafts had a mass and fiber cross-sectional area not different from control EDL muscles. Compared with control values, all grafts had fewer fibers, more connective tissue, lower absolute and normalized P0, reduced capillary density, and increased fatigability. The greater P0 of nerve-intact compared with standard and nerve-anastomosed grafts supported our hypothesis that the degree of reinnervation is a factor that limits graft development. The presence of a necrotic core and the low tension development of even the nerve-intact grafts suggested that revascularization is a significant limitation as well.

Skeletal Muscle Transplantation in Cats With and Without Nerve Repair

The regeneration of skeletal muscle fibers following free, whole muscle auto-transplantation has been well documented in rats (Carlson and Gutmann, 1975a und b). Neither vascular nor nerve repair was made, so revascularization and reinnervation occurred spontaneously or not at all. The time course of regeneration and the degree to which control values are restored have been described (Carlson et al., 1979). A limited number of studies have focused on the regeneration of skeletal muscle fibers following transplantation of skeletal muscles in larger species. Successful transplantations have been reported in cats (Hakelius et al., 1975; Faulkner et al., 1976; Maxwell et al., 1978; Faulkner et al., 1980) and monkeys (Markley et al., 1978; Markley and Faulkner, 1980; Maxwell et al., 1979). In dogs, Thompson (1971) has reported successful grafts whereas Lavine and Cochran (1976) and Watson and Muir (1976) described unsuccessful transplantations.

Transplantation and transposition of skeletal muscles into the faces of monkeys

Restoration of normal facial movement after long-term facial paralysis with muscle atrophy has not yet been achieved reliably by either free grafts, in which fibers degenerate and regenerate, or by grafts made with microneurovascular repair, in which most fibers survive. Our purpose was to compare the structural and functional properties of free muscle grafts and continuously perfused muscle flaps transplanted into the faces of monkeys. In adult monkeys, the facial muscles were replaced by either a free graft of a donor muscle from the lower limb or a denervated flap of ipsilateral temporalis muscle. Each graft or flap was reinnervated with the preserved buccal branch of the facial nerve. The control muscles, grafts, and flaps were examined 90 days later for gross appearance, contractile properties, and fiber areas. Compared with muscle flaps, free grafts showed greater adaptability to the new location and innervation and a closer approximation to the structural and functional properties of the original facial musculature.

Functional properties of palmaris longus muscles of rhesus monkeys transplanted as index finger flexors

This experiment with skeletal muscle autografts in monkeys was designed to retest previous findings that transplanted skeletal muscle can regenerate to a functional degree in primates without predenervation and to test a new hypothesis that increased functional demands on regenerated muscle grafts in monkeys may result in improved functional capacity of the grafts. Rhesus monkey index flexors were replaced with free palmaris longus muscle autografts with microneural anastomoses between the graft motor nerve and the severed profundus motor nerve. One monkey was taught selective index flexion before grafting and continued with this program after grafting to test the effect of training on the graft. Mature grafts were evaluated for in vivo contractile properties and by histology and histochemistry and were compared with a group of normal Rhesus palmaris longus muscles. The results reconfirm the capacity of nonpredenervated monkey skeletal muscle grafts to regenerate and to achieve some contractile ability and suggest that training of free muscle grafts may enhance recovery of their functional and structural properties.