Michael E. Jabaley

A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans.

This article reports the first randomized prospective multicenter evaluation of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjects with 136 nerve transections in the hand and prospectively randomized the repair to two groups: standard repair, either end-to-end or with a nerve graft, or repair using a polyglycolic acid conduit. Two-point discrimination was measured by a blinded observer at 3, 6, 9, and 12 months after repair. There were 56 nerves repaired in the control group and 46 nerves repaired with a conduit available for follow-up. Three patients had a partial conduit extrusion as a result of loss of the initially crushed skin flap. The overall results showed no significant difference between the two groups as a whole. In the control group, excellent results were obtained in 43 percent of repairs, good results in 43 percent, and poor results in 14 percent. In those nerves repaired with a conduit, excellent results were obtained in 44 percent, good results in 30 percent, and poor results in 26 percent (p = 0.46). When the sensory recovery was examined with regard to length of nerve gap, however, nerves with gaps of 4 mm or less had better sensation when repaired with a conduit; the mean moving two-point discrimination was 3.7 ± 1.4 mm for polyglycolic acid tube repair and 6.1 ± 3.3 mm for end-to-end repairs (p = 0.03). All injured nerves with deficits of 8 mm or greater were reconstructed with either a nerve graft or a conduit. This subgroup also demonstrated a significant difference in favor of the polyglycolic acid tube. The mean moving two-point discrimination for the conduit was 6.8 ± 3.8 mm, with excellent results obtained in 7 of 17 nerves, whereas the mean moving two-point discrimination for the graft repair was 12.9 ± 2.4 mm, with excellent results obtained in none of the eight nerves (p < 0.001 and p = 0.06, respectively). This investigation demonstrates improved sensation when a conduit repair is used for nerve gaps of 4 mm or less, compared with end-to-end repair of digital nerves. Polyglycolic acid conduit repair also produces results superior to those of a nerve graft for larger nerve gaps and eliminates the donor-site morbidity associated with nerve-graft harvesting.

Late breast pain following reconstruction with polyurethane-covered implants.

Two patients of 56 who were reconstructed with polyurethane-coated implants developed breast pain as a late complication and eventually required implant removal for relief. Although the cause of pain was not proven, it may have been due to contracture of the fibrous capsule which formed between the polyurethane and the shell of the implant. The complication of late pain has not been stressed previously in the literature on reconstruction.

Myocutaneous flaps in lip reconstruction. Applications of the Karapandzic principle.

Our experiences with the reconstruction of lips by the use of innervated myocutaneous flaps is described. We present the technique and some illustrative cases.

Basal cell carcinoma of the medial canthal region.

Summary One hundred sixteen cases of basal cell carcinoma of the medial canthal region are reviewed. Radiation therapy and surgical excision offer similar results in terms of recurrence, complications, function, and cosmesis. Preservation or reconstruction of the lacrimal drainage system or both should be attempted whenever possible without compromising adequate tumor removal.

A simple technic for laryngeal suspension after partial or complete resection of the hyomandibular complex

Abstract Ptosis of the larynx and/or base of the tongue resulting from extirpation on the hyomandibular complex is a major factor in the production of chronic aspiration. A simple technic of laryngeal suspension, equally applicable in primary reconstruction or as a secondary procedure, is described. A modification of the method can be adapted for glossoptosis.

Muscle Flaps and Musculocutaneous Flaps in the Repair of Urinary Fistulas

Techniques for including muscle flaps and musculocutaneous flaps in the repair of difficult vesicocutaneous, urethrocutaneous, and vesicovaginal fistulas are described. These methods have been uniformly successful in 10 consecutive patients. The incorporation of such healthy, well-vascularized tissue into the standard techniques of urologic repair can be a major factor in the successful management of these problems.

Rigid internal fixation in the hand: 104 cases.

One-hundred and four patients with fractures of the metacarpals and phalanges have been treated with rigid internal fixation over a 6-year period. Patients with both open and closed injuries had their fractures fixed by tension band wires, interosseous compression screws (lag screws), or plates and screws. The concepts of primary bone healing and its variations, methods of fixation, and the importance of interfragmentary compression are defined and stressed. Illustrative cases of each technique are described and the applicable principles are enunciated.