Tord Skoog

Perichondrial Potential for Cartilagenous Regeneration

This preliminay investigation was conducted in 2-month-old rabbits. The perichondirum was stripped away from the ear cartilage, and raised as a flap. A segment of the exposed cartilage was then removed and the perichondrial flap was sutured back over the created defect. The other ear served as a control, but there the resection of cartilage included the covering perichondrium. In the first group there was a progressive regeneration of cartilage originating from the perichondrium; in the control study, no new cartilage developed. The chondrogenic activity of the perichondrium of the aural cartilage is thus demonstrated and will be further verified in succeeding experiments.

The Use of Periosteum and Surgicel® For Bone Restoration in Congenital Clefts of the Maxilla: A Clinical Report and Experimental Investigation

New principles are introduced for the primary repair of the maxilla in congenital cleft deformities, founded on the assumption that periosteum and bone bordering the cleft possesses normal growth potential. By periosteum to periosteum apposition all around the cleft new bone was formed. In complete clefts continuity between the segments was achieved, the premaxilla became firmly consolidated into the arch, maxillary collapse was prevented, and there was a favourable approximation within the alveolar region. Over denuded bone complete periosteal regeneration took place and appositional growth of the lateral segment was promoted.To obtain a larger volume of bone by periostealplasty it proved necessary to keep the flaps suitably separated. In maintaining the periosteal membranes in the desired position Surgicel® provided a useful scaffolding. Animal experiments demonstrated that this hemostatic material can be safely used for subperiosteal implantation. This procedure will lead to the formation of cancellous...

The Pathogenesis of Cauliflower Ear: An Experimental Study in Rabbits

Appreciating an imcomplete understanding of the pathogenesis of cauliflower ear, an experimental study was designed to demonstrate the pathophysiology of this deformity. The investigation was conducted in 2-month-old rabbits. In one ear a collection of blood was placed under the raised perichondrium which was then sutured back in place and the skin closed. In the other ear an equal amount of blood was deposited between the intact perichondrium and skin. In the first study new cartilage developed under the perichondrium, but in the ear in which the blood was left above the surface of the perichondrium-covered cartilage, complete resorption of the clot occurred. The cauliflower ear was thus shown to be generating cartilage, arising from a layer of raised perichondrium which was further stimulated by a sero-sanguinous medium. The subperichondrial hematoma was extensively invaded by chondroblasts within 2 weeks, and over a period of 4 weeks the new tissue gradually changed into more mature cartilage. It was a consistent finding that the separated perichondrium retracted, thus causing the original cartilage to rise and buckle over the hamatoma, similar to the picture observed in the human pathology.

Repair of Unilateral Cleft Lip Depormity: Maxilla, Nose and Lip

The congenital cleft lip deformity is defined as a tripartite reconstructive problem: restoration of the cleft maxilla, correction of the nasal deformity, and repair of the lip. Procedures extensively based on new principles for the surgical management of these malformations are described and shown in detail. They allow consideration of the entire reconstructive task in the primary operation.For maxillary reconstruction the osteogenic capacity of tissues bordering the cleft is utilized. The operation involves subperiosteal exposure of the bone and the establishment of periosteal continuity between the maxillary segments, using local flaps of the periosteal membranes. Surgicel® is used as a scaffolding between the periosteal surfaces to bring about deposition of a mass of bone. In complete clefts a two-stage procedure is recommended for periosteal repair and for the implantation of Surgicel. Observations on the effect of periosteo-plasty confirmed previous reports: the procedure will lead to the formation ...

Reconstruction of articular cartilage using autologous perichondrial grafts. A preliminary report.

In a pilot study of grown-up rabbits perichondrium from the ear was grafted to the joint surface of cavitas glenoidalis from which the normal articular cartilage had been resected. in all cases regeneration of new cartilage occurred. Five clinical cases of arthritis are reported in which, following removal of the degenerated cartilage and grafting of rib perichondrium, articular cartilage regeneration took place

The pharyngeal flap operation in cleft palate: A clinical study of eighty-two cases

Summary A report is made of eighty-two cleft palate patients treated by the posterior pharyngeal flap operation during a twelve-year period. Indications for this surgical procedure are considered and a detailed description is given of a surgical technique to prevent scar contracture and late displacement of the pharyngeal flap when it is based superiorly. A method for reconstruction of the soft palate utilising buccal and pharyngeal flaps is also reported. Post-operative complications are mentioned. The velopharyngeal anatomy was studied on clinical examination and by means of cinefluorography on an average four years and ten months post-operatively. The results were compared with detailed analyses of speech, hearing and nasal function. Patients operated upon before the age of 10 years all demonstrated normal speech; of those below the age of 20 years 97 per cent. were rated as having acceptable intelligibility compared with 77 per cent. when the operation had been performed after that age. No adverse effects on hearing or nasal function were found following operation, and some observations indicated improved hearing. No significant differences in any respect were revealed between the two groups of patients with superiorly and inferiorly based pharyngeal flaps. On the basis of the observations provided by this follow-up study conclusions are formed on the prognosis of the pharyngeal flap operation in various conditions of cleft palate deficiency.

The chondrogenic potential of the perichondrium

SummaryThe chondrogenic capacity of the perichondrium was first demonstrated by Skoog, Ohlsén and Sohn in 1972. To further elucidate this finding large series of experiments have been carried out in 2-month-old rabbits. In surgically created defects in ear cartilage, 10×15 mm and 18×18 mm, a proliferation of new cartilage was seen in all cases where a perichondrial flap had been used to bridge the defect. No growth of cartilage was found in the control groups. The formation of new cartilage originated from the deep surface of the perichondrial flap, i.e. from cell layers adjacent to the cartilage before separation of the flap. The effect of hematoma as a matrix for this growth was evident. Some experiments were devised to confirm that the perichondrium is the source of the formation of new cartilage, excluding the possibility of the cartilage edges participating in the chondrogenesis.These series of experiments have demonstrated the perichondrium to be an active tissue with a remarkable potential for cartilage generation opening promising possibilities in reconstructive surgery.

Dupuytren's Contracture:Pathogenesis and Surgical Treatment

In order to understand the pathogenesis and symptomatology of Dupuytrens contracture it is essential to have a thorough acquaintance with the anatomy of the palmar aponeurosis. Such knowledge is also indispensable to the performance of suitable surgical treatment of afflicted hands. Since Dupuytren (1832) demonstrated that changes localized to the aponeurosis are the cause of this deformity there has been a marked interest in the fascial framework of the palm, and the cure obtained by removal of the palmar aponeurosis still justifies an interest in the aponeurosis per se. The purpose of this paper is to report on some original observations on the arrangement of the transverse palmar ligament, and the behaviour of the transverse elements of the palmar aponeurosis in Dupuytrens contracture. From these findings conclusions are made with regard to the pathogenesis of the disease and a technique for selective aponeurosectomy is recommended for the surgical treatment of contracted hands.

The Influence of Primary Periosteoplasty on Maxillary Growth and Deciduous Occlusion in Cases of Complete Unilateral Cleft Lip and Palate: A Longitudinal Study from Infancy to the Age of 5

The influence of infant periosteoplasty upon the growth of the maxilla, its form and size, and the prevalence of malocclusion in the deciduous dentition was investigated. The material consisted of 66 patients with total unilateral clefts of the primary and secondary palate. Thirty-six had periosteoplasty performed in conjunction with cleft-lip and/or palate repair. Thirty patients were operated upon without periosteoplasty and served as controls. Repair of the lip had a notable effect upon the width of the alveolar cleft and palatal cleft, both in the periosteoplasty cases and in the controls, with no certain difference between the groups. Following lip repair, the anterior width of the alveolar arch was slightly reduced. After palatal repair a further reduction was noted in the deciduous dentition, both in the cases treated with periosteoplasty and in the controls, while the posterior width of the palate across the tuberosities increased during growth. In the deciduous dentition, no differences were found in intercanine and intermolar dimensions between the periosteoplasty cases and the controls. Thus, the new bone formed in the cleft area after periosteoplasty does not seem to withstand the contracting forces introduced by palate surgery. An increased length of the buccal alveolar arch on the cleft side, compared with that on the non-cleft side, was found at both the lip repair and the palate repair in the periosteoplasty cases, as well as in the controls. In the deciduous dentition, this difference was negligible. In the deciduous dentition an anterior position of the lateral maxillary segment proved more common in the periosteoplasty cases than in the controls. On the non-cleft side, there was an increased frequency of mesial occlusion and a corresponding decrease of neutral and distal occlusion in the periosteoplasty cases. No increased frequency of anterior crossbite was found even after repeated periosteoplasty, nor was the maxillary dental-arch length unfavourably influenced. Descriptive analysis of occlusion revealed an increase of buccal crossbite in the periosteoplasty cases of a select group of the widest clefts, treated by repeated periosteoplasty. These cases also had the highest total occlusal score according to the numerical classification, while the total occlusal score after one periosteoplasty in patients with less wider clefts was smaller than in the controls. In all patients who had undergone periosteoplasty new bone formed within the alveolar cleft. A good amount of new bone developed in about half the number of cases.(ABSTRACT TRUNCATED AT 400 WORDS)

An operation for inverted nipples

Summary An operation for inverted nipples is described, and the results in six operated cases are reported. In one case the deformity was traced through four generations, and there was a familial occurrence in two other cases.