Nonsuppurative tenosynovitis secondary to foreign body migration.
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Adolescent↗
Biomedical subjects
E G Zook
Publications and source records attributed to E G Zook.
A scanning electron microscopy evaluation of peripheral nerve regeneration.
Regeneration of a transected peripheral nerve following repair is often impeded by scar formation and misdirection of axon sprouts. This paper describes the use of the scanning electron microscope (SEM) in conjunction with other physiologic tests to evaluate nerve regeneration. A central one centimeter segment was removed from the peroneal branch of both sciatic nerves in 37 white New Zealand rabbits. Sectioned nerves were divided into four experimental groups according to type of repair performed: (A) no repair; (B) mobilization and direct epineural repair; (C) interpositional nerve graft repair; (D) polyglycolic acid (PGA) conduit repair. Each animal was reexplored eight months later and nerves examined by electrophysiologic testing and scanning electron microscopy. Unrepaired nerves viewed by SEM showed impaired axonal regeneration and loss of fascicular morphology with increased scar tissue. Nerve sections of direct epineural and interpositional graft repairs showed the best return of axonal morphology. Nerves regenerated across a one centimeter gap through a PGA conduit demonstrated regrowth of small and large myelinated axons grouped into "mini-fascicles" with increased connective tissue. PGA conduit repairs were electrically inferior to graft and direct repairs as measured by conduction velocity and the amplitude of evoked response. These findings correlated well with anatomy seen on scanning electron micrographs. The scanning electron microscope proved an excellent adjunctive tool for the study of peripheral nerve regeneration.
Animals↗
Nerve regeneration--evidence for early sprout formation.
Following microneurorrhaphy, sharply transected rat sciatic nerves were harvested 2, 5, 12, 16, 21, and 30 days after repair. Transverse sections of these specimens were made 3, 5, 7, 9 and 11 mm distal to the repair and examined with the scanning electron microscope. Myelinated sprouts were found 3 mm distal to the repair on the fifth day. Sprout migration occurred even though old myelin sheaths were present. Sprouts did not appear in old myelin sheath lumens. Many 5 U myelinated sprouts were found 11 mm distally 21 and 30 days after repair. This study demonstrates that nerve regeneration begins early, before degeneration is complete.
Animals↗
Surgical management of familial benign chronic pemphigus by excision and primary closure.
A case describing primary closure after full-thickness excision of long-standing familial benign chronic pemphigus (Hailey-Hailey disease) in a 54-year-old man is presented. The involved axillary, inguinoscrotal, and perineal skin was excised and closed primarily without difficulty. Eradication of the disease in the excised areas was accomplished with minimal hospitalization and morbidity. Familial benign chronic pemphigus and its differential diagnosis are discussed and the literature on surgical management of this rare disease is reviewed.
Axilla↗
Grain auger injuries: the replacement of the corn picker injury?
Corn picker injuries, although more infamous, are less frequent than those produced by the grain auger. The former rarely occurs in other than adult males who are responsible for their carelessness, whereas the grain auger injury frequently involves innocent and uninformed youths. We report 4 arms, 4 forearms, 5 hands, 24 digits, 2 legs, 4 feet, and 4 toes injured by a grain auger in 24 patients. Multiple-level injuries accounted for the larger number of injuries than patients. Twelve amputations or devascularizations were reattached or revascularized successfully. Not all amputations had attempts at reattachment because of the severe crushing of the part and/or stump that was present in all patients to varying degrees. All wounds were heavily contaminated and were treated with voluminous irrigation and adequate debridement. Serial debridements were needed prior to coverage in several patients. Prevention is the best treatment, but given early aggressive care, many injured can regain a high level of function.
Accidents, Occupational↗
Alternative hand flaps for amputations and digital defects.
Traumatic or thermal injury to the hand may result in a composite tissue loss. Exposed tendon, bone, or joint surface is best treated by flap coverage. This paper will discuss four types of alternative hand flaps that can be used to treat difficult areas and/or minimize complications. (1) A thumb flap elevated from the metacarpophalangeal joint flexion crease covers a fingertip injury and the donor site is closed primarily. (2) A proximally based side-finger flap, preferably from the ulnar side of the donor finger, can be used to cover a fingertip defect in a young person or a thumb tip in any age. (3) A deepithelized cross-finger flap, flipped 180 degrees upside-down, can cover a defect on an adjacent finger. The under side of the flap and the donor area are skin grafted. (4) A proximally based arterialized side-finger flap, including the digital artery but sparing the digital nerve, is rotated dorsally to cover a secondarily exposed proximal interphalangeal joint in burn patients where adjacent fingers are not available as donor sites.
Adolescent↗
The perionychium: anatomy, physiology, and care of injuries.
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Humans↗
Anatomy and physiology of the perionychium: a review of the literature and anatomic study.
The perionychium includes the nail and surrounding structures. The anatomy and physiology of the perionychium is presented in detail. Microscopic examination reveals the nail production to take place on the dorsal roof of the nail fold, the ventral floor of the nail fold, and on the nailbed to the free margin of the nail. The arterial supply is by two dorsal terminal branches of the proper digital artery and the nerve innervation by dorsal terminal branches of the proper digital nerve.
Adolescent↗
Successful treatment protocol for canine fang injuries.
The most common bite injury in the United States is that of the dog and is associated with serious social and economic problems. Our series of 61 dog bite patients shows a majority of them to be in children and of the face and neck. Our treatment protocol centers on copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic treatment, and close postoperative monitoring. Two hundred fifteen dog bite wounds in 61 patients were closed with this regimen with only a single wound infection. This is a wound infection rate of 0.47% and a patient infection rate of 1.6%.
Adolescent↗
V-Y advancement flap for facial defects.
We have used 107 V-Y advancement flaps in 76 patients with only loss of one flap and loss of hair growth in a second. The versatility of this method of closure and its superior cosmetic result recommend it to the plastic surgeon who must close defects of the face.
Adult↗
A nerve approximating device.
A nerve approximating clamp designed to approximate and stabilize small nerves during microneurorrhaphy is demonstrated. Negligible injury is induced by the clamp following direct nerve puncture experimentally, and a more accurate and easily performed microneurorrhaphy can be done. Because the nerve can be held in a coapted position without sutures using the clamp, nonsuture techniques of repair using biodegradable adhesives may become possible.
Animals↗
Erythroplasia of Queyrat involving the distal urethra.
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Adult↗
Surgical manpower and practice patterns in a nonmetropolitan area. Nonmetropolitan surgical manpower.
Surgical practice in a nonmetropolitan area was studied with a field survey of 33 general surgeons and family practitioners. Instruments included a physician interview and questionnaire, a nurse-receptionist questionnaire, a sample of 3,733 office patient records, and a sample of hospital operating room logbooks. The general surgeons reported spending an average of 22 hours a week seeing an average of 74 patients in their office practices. Twenty-six percent of the presenting problems and 32% of the principal diagnoses identified in the sample of general surgeons' office patient records were defined as primary care problems. Twenty-two percent of the problems and diagnoses were defined as specialty surgical problems, such as urological problems. An indication of patient referral was found in 2% of the records. In hospital practice the surgeons estimated spending an average of 14 hours a week in the operating room, and performed an average of seven to eight procedures a week. The mean California relative value (CRV) for each procedure was 10.0 CRV. The family physicians managed patients with a broad range of problems, including surgical, in their office practices, and performed an average of three operative procedures each week in the hospital.
Family Practice↗
Transverse volar skin laceration of the finger: Sign of volar plate injury.
Transverse tears of the volar skin of a finger with a hyper-extension injury is associated with frequent volar plate tears or avulsions. Recognition is essential for surgical exploration of the volar plate and supporting joint structures and, if injured, surgical repair should be carried out at the time of skin suturing.
Adolescent↗
Pressure gun injection injuries of the hand.
In the growing number of pressure gun injuries with injection of materials into the hand, the degree of toxicity of the material, the amount injected and early adequate treatment are the three most important factors in determining the final result. Paint is the most toxic agent and causes an extreme amount of tissue inflammation. Early debridement of the injected material gives the best functional result. In spite of early surgical debridement, some of these injuries, most commonly with highly toxic agents, progress to eventual amputation.
Debridement↗
Replantation of the heel in a child.
Complete avulsion of the heel pad and half of the calcaneus constitutes a severe injury. The case presented here emphasizes the need to carefully assess patients with amputated tissue, because even small portions of avulsed tissue that are needed for a specific and important function should have replantation attempted. Failing to consider revascularization as the procedure of choice in some injuries eliminates the potential for primary, ideal reconstruction.
Amputation, Traumatic↗
Microvascular surgery in young children.
We present a series of 8 children, all less than 6 years of age, which demonstrates the feasibility of primary microvascular replantation or reconstruction of amputated or devascularized parts in children. The function and the appearance obtained were excellent, and the potential for growth was maintained. Fortunately, the vessels were larger in these young children than one would expect. It is apparent that in a healthy, stable child, the careful application of microsurgical principles is an excellent method for salvaging devascularized or amputated parts that are vital for function or appearance.
Amputation, Traumatic↗
Examination of peripheral nerves with the scanning electron microscope.
The theoretical applications and advantages of the scanning microscope in peripheral nerve research are presented. The internal anatomy of the peripheral nerve can be distinctly examined, and long segments of axons can be examined without the necessity of tedious study of multiple sections. The SEM should make it possible to more readily study the migration of axon sprouts across a repair site. New concepts in teaching and research may develop from the use of this excellent tool.
Animals↗