First dorsal metacarpal artery adiposofascial flap for venous conduit and soft tissue cover in an avulsed thumb: case report

Skin loss, need for vein grafts, and secondary surgeries are often encountered in avulsion injuries of the thumb. We report a case of successful salvage of an avulsion type of near total amputation of the thumb following a conveyor belt injury in which the first dorsal metacarpal artery adiposofascial flap was used for combined soft tissue cover and venous conduit.     

Internal thoracic artery malperfusion syndrome after bilateral internal thoracic artery grafting: Report of a case

(Received for publication on Sept. 17, 1996; accepted on May 12, 1997)     

The limit of low speed peripheral nerve elongation; neurological and circulatory aspects

We studied peripheral nerve elongation of rabbit sciatic nerves. External fixators developed in our department were applied to 32 rabbit femurs in vivo. The rabbits underwent osteotomy of the femur and were divided into two groups subjected to different sciatic nerve elongation speeds: group I (0.45 mm/day) and group II (1.35 mm/day). The sciatic nerves were elongated 1.5, 3.0, 4.5, 6.0 and 7.0 cm by the external fixators, and the corresponding actual percentage of elongation of the nerves were 8, 16, 24, 30 and 40%. After elongation, nerve electrophysiology, nerve blood flow and pathology were studied. Forty percent elongation decreased nerve blood flow to 69 ± 5.1 % of contralateral controls in group I and to 20 ± 4.8% in group II. Although no decrease in motor conduction velocity (MCV) was observed at any elongation distance, compound muscle action potential (CMAP) amplitude gradually decreased with increasing elongation. In group I, after 40% elongation, specimens showed the following pathologic changes: thinning of myelin sheath, atrophy and detachment of the axon from the myelin sheath. Furthermore, in group II, 40% elongation induced disorganization of the myelin sheath and Wallerian degeneration. Consequently 40% elongation was regarded as critical at speeds of both 0.45 and 1.35 mm/day.