Susumu Tamai

Fatty degeneration in the supraspinatus muscle after rotator cuff tear

We studied the relationship between fatty degeneration in the supraspinatus muscle after rotator cuff tear and muscle atrophy and tendon retraction in 41 cadaveric shoulders. Eighteen shoulders had a supraspinatus tendon tear. Transverse sections of the supraspinatus muscle were made at the proximal end of the scapular notch. The tendon fiber areas were stained red and the muscle fiber areas were stained yellow by the van Gieson method. Areas of fatty degeneration were stained orange-red by the Sudan three method. These areas were measured with a computer color image analysis system. There were many areas of the fatty degenerative change in the supraspinatus muscles associated with a cuff tear, mainly around the tendon fibers and the vessels. The fatty degeneration in the supraspinatus muscle after cuff tear was found to have a strong association with the degree of retraction of the tendon fibers rather than the reduction of muscle volume.

The arterialised venous flap: experimental studies and a clinical case

It is accepted that small arterialised venous flaps (AVF) can survive on a recipient bed with poor blood supply but survival of larger flaps is not always satisfactory. Possible reasons for this include the flap anatomy, particularly the pattern of the venous network, or factors at the recipient site. To investigate the possible factors in the flap design and the recipient site of an arterialised venous flap, we studied the relationship between (1) size of the artery used to arterialise the flap at the recipient site and the survival rate and (2) the number of draining veins and the survival rate, using rabbit ear skin flap models. Our results suggest that AVFs may become necrotic in the presence of a relative excess of arterial blood inflow, and that two exit veins are more effective than one. We also report a case where a 10 x 15 cm sized free AVF harvested from the lower extremity survived on the forearm.

Arteriovenous shunt in digit replantation

From May 1958 to May 1987, 331 digits were replanted successfully with an overall survival rate of 86.2%. Complete success in replantation of amputated fingers requires an accurate anastomoses of both arteries and veins. However, anastomosis between arteries may not be possible in some patients. Since reports that a thumb amputated at the interphalangeal joint area could be successfully replanted by an arteriovenous shunt on the palmar side, we did arteriovenous shunts in four such cases. Two replantations were successful; necrosis developed in the other two patients.

Innervated radial thernar flap for sensory reconstruction of fingers

A radial thenar flap, which is supplied by the superficial palmar branch of the radial artery and innervated by the superficial branch of the radial nerve, was used in four patients for sensory reconstruction of the fingers. Two patients had degloving injuries of the hand and two had amputation injuries of the thumb. Three of the cases underwent free-flap transfers, and one case underwent a reverse-flow island flap. The size of these flaps was about 3 x 5 cm except in one case, where a 15 x 5 cm flap combined with a radial forearm flap was used. Sensory reinnervation was excellent and donor site morbidity was minimal in all four cases. An innervated radial thenar flap from the ipsilateral hand offers an alternative choice to reconstruct large palmar defects of the fingers.

Long-term follow-up of periarterial sympathectomy for chronic digital ischaemia

This study investigates long-term clinical results (> 10 years) of periarterial sympathectomy in chronic ischaemic digits compared with intermediate-term results (3 years). Periarterial sympathectomy via the palm and volar wrist was carried out on 11 hands of seven patients with digital ischaemia but no gangrene or severe ulceration. The aetiology of ischaemia was Buerger’s disease in four hands, collagen disease in three hands, and repetitive digital trauma in four hands. Subjective symptoms were evaluated at a mean follow-up period of 12 years. The efficacy of surgery was assessed objectively using thermography and plethysmography. Although five of seven patients continued on oral vasodilators and antiplatelet agents until the final follow-up, improvement of symptoms was maintained in all patients between intermediate- and long-term evaluations. Our results suggest that periarterial sympathectomy via the palm and wrist could prevent long-term aggravation of symptoms of chronic digital ischaemia when combined with adequate postoperative drug therapy.

Surgical treatment for posterior ossifications of the glenoid in baseball players.

Seven baseball pitchers with symptomatic posterior glenoid osteophytes were operated on between 1982 and 1988 and were followed for an average of 5.2 years. Five and two patients had ossifications on the posteroinferior glenoid rim and on the infraglenoid tubercle, respectively. Ossifications on the posteroinferior glenoid rim were associated with posterior glenohumeral impingement, posterior glenoid labrum tears, and axillary neuropathy. Ossifications on the infraglenoid tubercle were associated with axillary nerve entrapment by the osteophytes and the thickened long head of the triceps muscle. Histologic study showed the coexistence of reactive new bone formation and bone necrosis. Preoperative and postoperative pain, sensory loss, muscle strength, and throwing distance were assessed. After surgical resection of the osteophytes and release of the axillary nerve entrapment, improvement in all parameters was observed in all patients.

Blood flow through prefabricated flaps—an experimental study in rabbits

Prefabricated flaps were created by femoral vessel implantation beneath the abdominal skin in rabbits. The area of survival and blood flow through the prefabricated flap were measured after 1, 2, 4, 6, 8, and 12-week intervals. The parameters at 6, 8 and 12-week intervals were significantly larger than those for random pattern flaps (p < 0.01), but were significantly smaller than those for axial pattern flaps (p < 0.01). The minimum interval at which the prefabricated flap could be transferred successfully was between 6 and 8 weeks in this model. Microangiography demonstrated that neovascularisation began at the distal end of the implanted vascular bundle and spread throughout the flap by 8 weeks.

Reconstruction of the triangular fibrocartilage complex after surgery for treatment of synovial osteochondromatosis of the distal radioulnar joint

Synovial osteochondromatosis of the hand is uncommon, except for tenosynovial chondromatosis of the digits. It is even more rare in the wrist joint. A patient with synovial osteochondromatosis of the distal radioulnar joint that involved the triangular fibrocartilage complex is described. At operation, synovectomy, excision of osteochondral bodies, and removal of the entire triangular fibrocartilage complex was done. The triangular fibrocartilage complex was reconstructed using part of the extensor carpi ulnaris tendon. One year after operation, the patient had regained almost full range of motion and is without pain.

Fifth digit sesamoid fracture with tenosynovitis

of the sesamoid articular surface and synovitis at its condylar articulation. The bone was removed. The IP joint was normal. Pathologic examination of the specimen was positive only for degenerative changes. The patient had immediate postoperative relief of pain and was able to resume all activities she had performed before the onset of symptoms. This symptomfree state has persisted for 18 months.

Metastatic potential of malignant fibrous histiocytoma of myxoid or giant-cell subtype in rats

We have previously reported on the induction of rat malignant fibrous histiocytomas by 4-hydroxiaminoquinoline 1-oxide. The present study describes cell number- and time-related formation of metastatic lung nodules after i.v. injection of cell suspensions containing various numbers (10(3) to 10(5)/ml) of myxoid or giant-cell subtype malignant fibrous histiocytoma cells. The metastatic potential of the myxoid subtype of rat malignant fibrous histiocytoma was significantly enhanced by i.v. injection of tumor cells selected from metastatic lung nodules and was further increased by repeating the selection procedure more than 7 times. In contrast, the growth activity of subcutaneous transplants of tumor fragments obtained from metastatic lung nodules derived from myxoid subtype did not differ from that of parent malignant fibrous histiocytomas.