Maurice Rousso

Extent of fiber regeneration after peripheral nerve repair: Silicone splint vs. suture, gap repair vs. graft

The degree of regeneration in surgically repaired sciatic nerves in rats was measured using a simple new electrophysiologic method: comparison of the size of nerve responses evoked by stimulation distal and proximal to the anastomosis. Five different repair procedures were evaluated. After simple end-to-end suture anastomosis, about 40% of the severed parent fibers regenerated past the suture line. The result was substantially improved when the anastomosis was covered with a newly designed thinwall silicone sheath which incorporated a narrow longitudinal slit. The presence of suture material at the point of anastomosis had no effect. Finally, regeneration across a 5-mm gap ensheathed in silicone (67%) was better than regeneration through a 5-mm autograft (45%).

Hemangioma of the median nerve

Intrinsic hemangiomas of peripheral nerves are extremely rare. Eight cases have been reported in the literature and only two of them involved the median nerve. An extensive cavernous hemangioma with carpal tunnel symptomatology is reported.

Healing and tensile strength of CO2 laser incisions and scalpel wounds in rabbits.

An experimental model was designed in order to compare the results of wound healing after skin incision by CO2 laser and scalpel. The skin of 36 rabbits was incised by a CO2 laser with a 15-W current output and by scalpel. The wounds were tested for tensile strength and histology after healing up to 4 weeks to determine if scalpel wounds differed from those made by the laser beam. Tensile strength tests showed that the wound incised by the laser beam was initially stronger up to 3 weeks; thereafter, the strength of both types of wounds was equal. Histologic preparations showed partial necrosis of the wound edges and a more extensive inflammation response in laser beam incisions which disappeared gradually from 2 weeks after incision. Because of initial stronger scar following laser beam incision as compared with scalpel incision, early mobilization of the operated limb is possible.

Arthrodesis of finger joints by dynamic external compression using dorsoventral Kirschner wires and rubber bands.

A new method is presented for arthrodesis of small joints in the hand. In this method Kirschner wires are inserted dorsoventrally through the phalanges on either side of the joint, and the external ends bent into hooks. Longitudinal compression is achieved by connecting these hooks with rubber bands. This technique gives a solid and painless immobilization in a proper position, and the latter can be corrected easily when necessary. We arthrodesed 46 joints in 39 patients by this method in 1975 and 1976. The fusion time was 4 to 6 weeks, and the method produced a good bony arthrodesis in 42 of the 46 fingers.

Prevention of peripheral nerve entrapment following extensive soft tissue injury, using silicone cuffing: an experimental study.

Abstract A semirigid silicone cuff was investigated in rats to prevent scar entrapment of the sciatic nerve. Scar was induced by crushing or burning the surrounding muscles. On one side, the nerve was covered by a longitudinally split semirigid silicone tube. On the other side, the same procedure was done without silicone coverage of the nerve. At different time periods the animals were sacrificed and the nerve with surrounding tissues examined. The protected nerve was found gliding freely during mobilization of the limb. The blood supply to the nerve was maintained through the split in the silastic cuff by formation of new mesoneurium. On the control side, the nerve was surrounded by a fibrous tissue in various stages of maturation depending upon the time postinjury. The nerve structure showed reduced vascularity and progressive degenerative changes of the axons. Clinical tests on the silicone cuff method are proposed fo selected patients with extensive soft tissue injury around nerves.

Anesthesia in a hand surgery unit

Impressions of two different regional anesthetic techniques used in the management of 670 cases in a hand surgery unit are described. For operations at or below the wrist, subcutaneous ring anesthesia for the forearm tourniquet, together with local nerve block or local infiltrative anesthesia using Lignocaine, is very satisfactory. It is effective, simple, and safe, and it permits patient cooperation with the surgeon, who can readily evaluate motor activity because the flexor and extensor extrinsic muscles of the hand are then not paralyzed. For more extensive upper limb surgery, intravenous regional anesthesia with Bupivacaine is very effective, though toxicity might result if the tourniquet is unreliable or is released too rapidly. These effects are minimized by the intravenous infection of diazepam (5 to 10 mg) immediately prior to release the tourniquet.

Multifocal hemangioendothelioma of bones in the hand—A case report

The authors present a 4-year follow-up of a case of a multifocal hemangioendothelioma of the hand in a l7-year-old girl. The patient refused amputation and was treated solely by radiation.

Electrical stimulation in the treatment of the painful hand.

Fifty patients with painful hands due to inflammation, trauma, or surgery were treated by means of a Neurogar nerve stimulator. In 82% of the cases the results were satisfactory. Early physiotherapy was possible, and yielded best recovery and healing.