Kenya Tsuge

Repair of flexor tendons by intratendinous tendon suture.

In a three year period, severed flexor tendons in the fingers and palm of 50 patients were repaired using an intratendinous suture method. The majority were secondary repairs, and 21 of 50 were in children less than 15 years of age. Results were satisfactory, with 79% being rated as good or excellent. The technique apparently causes little disturbance in the circulation, and if adhesions develop, they are limited and good results can be expected from tenolysis.

Free muscle transplantation by microsurgical technique to treat severe Volkmann's contracture.

In a free muscle transfer, great care must be taken in selecting the muscle to be grafted. We have found the pectoralis major to be a good donor muscle. Although most muscles are not nourished by a single artery and a few veins, the vessels which enter the pectoralis major muscle with the nerves are the main nutrient vessels, and these vessels alone can adequately nourish this muscle. Neurorrhaphy should be performed at a site as close as possible to the muscle. Good indications for free muscle transfer are cases in which a flexor muscle has become necrotic, while the extensor muscle is viable--for example, if the flexor muscle has sustained traumatic crushing injury or if there is a Volkmanns contracture.

Reconstruction of the heel pad by flexor digitorum brevis musculocutaneous flap transfer.

We strongly believe that rotational transfer of a musculocutaneous island flap composed of the flexor digitorum brevis muscle is the best procedure currently available for covering and reconstructing the weight-bearing area of the heel and its posterior area from the histologic and functional points of view. Further, since it requires only one operation, we are confident that it is the ideal method.

Free flap transfers by end-to-side arterial anastomosis

Abstract Five cases of free flap transfer by end-to-side arterial anastomosis are reported.

Experimental studies on the effects of tension on intraneural microcirculation in sutured peripheral nerves.

Tension on an end-to-end nerve suture causes injury to the intraneural vessels. Impairment of the transverse anastomoses occurs first, followed by degeneration of the intrafascicular vessels. The the transverse anastomoses undergo complete degeneration, and the extrafascicular vessels also sustain severe damage. This series of circulatory disturbances is an important factor to consider when determining the advisability of an end-to-end nerve suture.

Postoperative results of looped nylon suture used in injuries of the digital flexor tendons

Primary or delayed suture was performed on 174 patients involving 234 digits with flexor tendon injury on the day of injury to a maximum of 486 days after injury during the past eight years from 1974. In the treatment a 4-0 or 5-0 looped nylon suture was used. Follow-up study was made on 121 patients involving 164 digits in whom at least six months had elapsed since the operation. The evaluation showed the results in 53.0% excellent, 15.3% good, 18.9% fair and 12.8% poor. Discussion is made of a number of factors which have effects upon the results of treatment of flexor tendon injury of the hand.

Aetiology of Kienböck’s Disease Based on a Study of the Condition among Patients with Cerebral Palsy

Examination of 110 patients with cerebral palsy revealed a diagnosis of Kienböck’s disease in six wrists in five cases. All had cerebral palsy of the mixed type with athetosis and high muscle tone. It is considered that the increased prevalence of Kienböck’s disease in these cases was attributable to repeated minor trauma to the lunate from childhood due to high muscle tone across the wrist joint, together with negative ulnar variance. The high prevalence of Kienböck’s disease observed in patients with cerebral palsy strongly suggests that repeated minor trauma together with negative ulnar variance is also the cause of Kienböck’s disease in normal individuals.

Vascular pedicle fibular transplantation as treatment for bone tumor.

In 4 cases of bone tumor in which extensive bone defects resulted from removal of the tumorous focus, vascular pedicle free fibular transplantation was performed using microsurgical techniques together with filling the defects with iliac bone. Early bone union was achieved. Atrophy and fracture were avoided. Early postoperative physical therapy was possible. The vessels selected in the recipient site are dependent upon the location of the graft bed, but the anastomosed site of the vessels should be kept outside of the graft bed. It is important to plan the operation so as to avoid motion at the site of callus formation and tension at the anastomosis site.

Further technical considerations of the sleeve microanastomosis.

In sleeve anastomoses, stenoses at the suture site have been the main concern. Mechanical dilatation is one way to prevent the stenosis, as suggested by Lauritzen. In the present study, 50 vessels (femoral and carotid) and 10 veins were used for sleeve anastomoses and the same numbers of vessels were used for conventional anastomoses (as control) to evaluate the effect of mechanical dilatation using resin corrosion cast (Mercox) because the Mercox cast facilitates three-dimensional stereoscopic views. Gradual dilatations around the suture sites were observed in seven carotid arteries, and three of seven resulted into aneurysm formation due to weakening of the inner vascular wall in the sleeve anastomosis. No dilatation or aneurysm was observed in the femoral arteries. Newly proliferating capillaries formed on the endothelial surfaces of the inner vascular walls around the suture sites after 4 weeks in the sleeve anastomoses. Operative time and endothelial trauma were markedly reduced with sleeve anastomoses. The gradual dilatation and aneurysm formation in the carotid arteries show that sleeve anastomoses should be used carefully for high-pressure arteries in clinical practice if mechanical dilatation is performed.

The smallest digital replant yet

TAMAI (1974) reported the successful replantation in a ao-month-old child of a little finger amputated at the proximal interphalangeal joint. Our patient was only 13 months old and the amputation was through the base of the distal phalanx of the ring finger. The injury was caused by a broken milk bottle which also lacerated the little finger and the palm; the amputation was clean cut without crushing or tearing (Fig. I). Under general anaesthesia the amputated portion was held in place with a Kirschner wire while the digital nerves and one of the digital arteries, whose outside diameter was about 0.4 mm, were anastomosed. When the tourniquet was released the finger tip turned pink and blood oozed from the cut end. Unfortunately the only veins present were only about 0.1 to 0.2 mm in diameter and attempts to anastomose them were abandoned. The palmar part of the wound was sutured accurately but the dorsal part only loosely to allow the escape of venous blood. The circulation had been interrupted for about 5 hours (Fig. 2). The colour of the finger tip slowly darkened but pressure to expel blood from the dorsal suture line turned it pink again. The mother was therefore instructed to milk