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Biomedical subjects

G Freilinger

Publications and source records attributed to G Freilinger.

At least 37 records · Page 2Linked to original sources
PubMed1990

Histochemical mapping and fiber size analysis of mimic muscles.

Fourteen functionally relevant mimic muscles of nine human bodies were analyzed with respect to their muscle fiber sizes and their histochemical fiber type composition. In cryostat sections stained for actomyosin ATPase, type 1 and type 2 fibers were evaluated separately by means of computer-assisted image analysis. The fiber diameters varied between 20.24 and 41.45 microns. According to the proportions of the fiber types, the mimic muscles could be classified into three groups: (1) phasic muscles, with 14 to 15 percent type 1 fibers, (2) intermediate muscles, with 28 to 37 percent type 1 fibers, and (3) tonic muscles, containing 41 to 67 percent type 1 fibers. It is concluded that one has to consider this diversity of mimic muscles when planning the surgical reconstruction of facial paralysis.

Adult↗
PubMed1989

[Reconstruction of deformities of the external ear].

Microtia is a rare malformation. Reconstruction of microtia is not a routine operation because of its rarity of occurrence and the complex deformity. In this paper the indication for surgical treatment, technique, results and complications are discussed. Two different operation methods were used in our patients. A multiple-stage and a single-stage reconstruction procedure. We used autogenous rib cartilage. Five of the seven treated patients came to the follow-up examination. Reconstruction was performed 2 years ago in two cases and between 4 and 12 years ago in three cases. Our patients were content with the result in so far as they would be prepared to undergo treatment again. Carefully built rib framework is an essential prerequisite for a successful postoperative result. Microtia represents a greater psychological problem than a cosmetically imperfect result after reconstruction.

Adolescent↗
PubMed1989

[Late results following surgical correction of syndactyly and symbrachydactyly].

Growth and the type of surgical treatment of the hand play an important role in the results of surgery in children. 29 patients have been operated on because of syndactyly and symbrachydactyly and were controlled. The following parameters were assessed: kind of incision and skin graft, functional results, x-ray to examine the skeleton and the depth of the commissure, colour of the skin graft and use of the hand. After operation of syndactyly all patients were able to use their hands normally, although full extend of flexion and extension was achieved only in 20 of 22 hands. In 5 divided pairs of fingers there was recurrence of syndactyly. In all cases except one, a split thickness skin graft has been used. After operative treatment of symbrachydactyly and complex syndactyly, full extent of flexion was achieved in 13 of 19 hands, in 6 hands the range of flexion was incomplete because of skeleton abnormalities. Recurrence occurred in 9 divided pairs of fingers; in 7 cases, a split thickness skin graft had been used. Despite this, all patients were able to use their hands normally. The use of split thickness skin grafts resulted in a 60% recurrence rate, whereas the use of full thickness skin graft led merely to 7.5% recurrence rate. Our results show the advantage of the full thickness skin graft. As a consequence, full thickness skin graft should be used in all cases. Furthermore, the operation should be performed at an early age, if fingers of unequal length have to be separated. Zig-zag incision should be used in all cases.

Child↗
PubMed1989

[Hemodynamic and clinical studies following injury of the arteries of the forearm].

Forearm arterial injury usually does not lead to acute ischemia, but a functional deficit may develop. We tried to evaluate the need for two patent forearm arteries using rheological, Doppler sonographical and clinical parameters. Twenty-seven patients were examined after arterial and/or nerve injury in the forearm as well as six patients in whom a forearm flap was harvested. In seventeen patients both arteries were patent after primary reconstruction. Nine patients showed only one patent artery, while in the six patients with a forearm flap the radial artery was reconstructed in only one case. We found a decreased skin temperature in cases with artery and nerve injury. If both structures were reconstructed, the difference was not significant. The pressure of the finger collateral arteries and of the forearm arteries as well as the rheological investigation did not show any difference. The two-point discrimination, reflecting the nerve regeneration, was not affected, if one or two arteries had been reconstructed. Pain following exercise rarely occurred if both arteries of the forearm were patent. Because of the positive effect on skin temperature and of the reduced pain following exercise, reconstruction of both forearm arteries should be considered. Furthermore, the possibility of a subsequent arterial injury has to be taken into account.

Adolescent↗
PubMed1987

Surgical anatomy of the mimic muscle system and the facial nerve: importance for reconstructive and aesthetic surgery.

Mimic muscles are arranged in four layers regarding their origins, and these four layers should be considered when muscle tissue is added or lifted. All mimic muscles are built up by parallel fibers. Mean values of length, width, and thickness of the three lip elevators have been determined. These data might be of importance when dealing with this muscle system, which appears rather different from all other muscles in the human. The individual muscles receive their innervating facial nerve branches from their deeper surface when they belong to the superficial (first, second, or third) layer and from outside when they lie in the deepest (fourth) layer. Nerve branches communicate at least four times before innervating their respective muscles.

Aged↗
PubMed1987

[Clinical and electroneurographic results following surgery of carpal tunnel syndrome].

The surgical treatment of carpal tunnel syndrome is successful in most cases. Sometimes, however, it is not possible to reach a satisfying result. In order to find out the reasons for failure, we examined 80 surgically treated patients. Clinical and electroneurographical parameters were observed. We could show, that the time of intervention and the age of the patient are responsible for the results. The skin incision has to be planned carefully in order to avoid transection of the palmar cutaneous nerve. In cases of systemic diseases the patient has to be informed preoperatively about the possibility of incomplete recovery.

Carpal Tunnel Syndrome↗
PubMed1987

[Comparative study of primary and secondary management of flexor tendon injuries].

In 1974 a replantation service started at the authors' department. Before that time the treatment of flexor tendon injuries was mainly performed secondarily. Therefore, the authors had the opportunity to compare patients after primary and secondary surgery. In 52 primarily and 22 secondarily treated patients the technique of Kleinert was used. Following issues were investigated: functional results, decrease of grip strength, influence of early mobilization on sensibility restoration in cases of nerve injury, relation between sensitivity to cold and vessel and nerve injuries, duration of physiotherapy and disability. The damage of only one finger might lead to decrease of grip strength. Primary surgery was superior to secondary surgery. Early mobilization in cases of additional nerve injuries did not affect sensibility restoration. Poor sensibility increased the chance of cold sensitivity. The duration of physiotherapy and of disability depended on the need for second procedures such as tenolysis which was more common in the group of secondarily treated patients.

Adolescent↗
PubMed1986

[Gynecomastia: attempt at a classification and surgical results].

Gynecomastia may appear at any age of life. We divided the cases we treated into three groups depending on the size of the gynecomastia. The patients were surgically corrected and then re-examined in order to find the most suitable incision. We consider a semicircumareolar incision on the inferior areolar margin the best. This kind of incision can also be used in cases of massive gynecomastia and results in almost invisible scars.

Adolescent↗
PubMed1985

[Free muscle transplantation].

To survey the current use of free muscle transplantation in the German speaking part of Europe, a questionnaire was sent to all Replantation Centres in 1982/1983. The answers revealed that micro-neurovascular muscle transplantation for functional use is still an uncommon procedure. Its use in facial palsy, in the sphincter region and in reconstructive procedures in extremities is emphasized and postoperative healing and functional improvement is shown in a diagram. The follow-up period is too short to discuss functional improvement in detail. Regarding our own cases, we are quite impressed by the result of free microneurovascular muscle transplantation in unilateral irreversible facial palsy patients, but are unable to prove the final result in extremities because of short observation time.

Adult↗
PubMed1984

Epithelioid sarcoma.

The first appearance, the 12-year follow-up, and the autopsy of a patient with a strange soft-tissue tumor in the lower leg region are described. Although it was originally taken for a malignant synovial tumor, its peculiar distribution pattern, together with its histologic picture, confirmed the final diagnosis as an epithelioid sarcoma.

Adult↗
PubMed1984

[Operative technic in muscle transplantation with microneurovascular anastomoses based on animal experiment studies].

The influence of the transient ischemia during free muscle transplantation with microneurovascular repair was studied in the rectus femoris muscle of the rabbit, as well as the effect of denervation and reinnervation by nerve suture. Both factors, ischemia and nerve suture, were taken together in a separate series. The functional results of the different kinds of reinnervation by nerve suture, by nerve implantation and by muscular neurotisation were compared. The possibility to use a motor nerve elongated to the contralateral side by nerve grafting was tested. In a further series the effect of changes of the initial tension of the muscle during the transplantation was clarified. These isolated factors were compared with the real transplantation from the left to the right side. As the most representative parameter for function the maximal tetanic tension was chosen for evaluation. Our results show that the following considerations in the operative technique are significant. To shorten the time of ischemia the donor and recipient area should be prepared for transplantation at the same time, the recipient vessels should be elongated before the muscle transplant is taken off, and the arterial anastomoses should be performed before the venous. For reinnervation of the muscle transplant nerve suture is more successful than nerve implantation. Both methods can be combined to make good use of all the potential of reinnervation. The muscular neurotisation should be used only in the face and for sphincter reconstruction. A contralateral source of reinnervation is useful in the face, but it is not in the extremities. The restitution of the original initial tension of the muscle after transplantation is of great importance.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

[Reconstruction of grip function in cases of a fingerless or missing hand].

In two cases a grip reconstruction by double toe-to-hand transfer is demonstrated. In the first patient all fingers of the left hand were amputated at the metacarpo-phalangeal joint level. The second and the third finger were reconstructed by transplantation of the second toe from the left foot and the third toe from the right foot. The distal and middle phalanx of the transplanted third toe had to be re-amputated because of mummification two weeks after the transplantation and was covered with a groin flap. Good function of the newly formed grip could be demonstrated. The second patient was a 21-year old man with amputation of both hands. Grip reconstruction in the right lower arm was performed by transplantation of the second toe of each foot together with a metatarsal bone and a dorsalis pedis flap. One year after the operation the follow-up study demonstrated good function of the newly formed hand. The patient is able to use his two new fingers during daily life mainly to hold small objects. The sensation and the range of movement of the newly formed right hand are demonstrated and discussed.

Adult↗
PubMed1984

Improvement of continence by myoplasty of the pelvic floor.

The authors report their experiences with sphincter reconstructions by free muscle transplant using a denervated muscle with its blood supply intact. The transplanted muscle is fixed to the remaining functioning sphincter musculature. New muscle fibres grow from this muscle into the transplanted muscle, allowing the reconstructed sphincter to contract voluntarily as well as reflexively. The operative technique depends on the existing sphincter defect. Free muscle transplantation is preferred if the external sphincter is still partially existing. Eight patients were examined 2 years after the reconstruction operation and the result was very satisfactory. Solid and semi-solid stool could be controlled by all patients. Large muscle transplantations carried out after the method reported by Thompson (1971) are followed by an increased intramuscular scar formation, as was shown by our experiments. A denervated muscle transposition with its own blood supply is therefore preferable. The change of innervation allows the transplanted muscle to perform its new function. In the treatment of congenital sphincter malformations, a larger muscle, i.e. transposition of the denervated gracilis muscle, should be used. This operation was performed in 7 cases of incontinence following operations for rectal atresia and in 1 case of extensive posttraumatic destruction of the sphincter apparatus. In only 1 case was continence for solid stool achieved. In 6 patients there was a temporary control of fluid stools, but under stress all patients with complex sphincter malformations soiled.

Adolescent↗
PubMed1983

Is a crossover to the contralateral side by nerve transplants a satisfactory source for reinnervation of a muscle transplant? An experimental study in the rectus femoris muscle of the rabbit.

In ten rabbits the nerve branch to the left rectus femoris muscle was prolonged to the contralateral side by a nerve graft. Three months later the distal end of the transplant was connected to the transsected nerve branch to the right rectus femoris muscle. Nerve biopsies were taken from the muscle nerve, the nerve graft at the time of grafting and from the distal end of the nerve graft immediately before nerve suture in the second operation. Six months after the second operation the final assessment of muscle function and of the histology of the muscle and of the muscle nerve was performed. The functional results of the rectus femoris muscle reinnervated by a crossover nerve graft ranged between 6% and 56% of a normal standard muscle and seemed to be insufficient to justify a clinical use for muscle transplant reinnervation in the extremities. The histological findings also confirmed the basic possibility of elongating a motor nerve by nerve grafts, but the second nerve suture, the interposition of a long nerve graft, and the obviously changed reflex system probably caused a moderate and unpredictable muscle function.

Animals↗
PubMed1983

The importance of the correct resting tension in muscle transplantation: experimental and clinical aspects.

The influence of a reduction of resting tension by elongation of the tendon on muscle function and morphology is investigated in the rectus femoris muscle of the rabbit. An elongation of the patellar tendon of 5 mm causes a reduction of the twitch tension to 73.5 percent of the contralateral control side and a reduction of the tetanic tension to 78.3 percent 6 months after surgery. The histologic, histochemical, and planimetric changes are similar to those reported by other authors for tenotomy, but they are less marked. The clinical relevance of these experimental results for free muscle transplantation with microneurovascular anastomoses and some technical details are discussed.

Animals↗
PubMed1983

Experimental free-muscle transplantation with microneurovascular anastomoses.

In 13 rabbits the rectus femoris muscle was freely transplanted from the left to the right side using microneurovascular anastomoses. About 7 months after surgery the muscle transplants were assessed functionally by force measurements. On the average, the transplanted muscles regained 55 percent of the maximal tetanic tension of unoperated, normal rectus femoris muscles, expressed as force per gram of muscle weight even 68 percent. After functional assessment, the muscles were weighed and then used for histologic, histochemical, planimetric, and biochemical evaluation. H&E-stained cross sections showed a high content of healthy muscle fibers; only some small atrophic and single fat cells were scattered over the cross sections. Good reinnervation over the sutured muscle nerve was confirmed by the type-grouping of muscle fibers in the NADH and myofibrillar ATPase staining. There was an excellent correlation between the functional results and the histologic picture as well as the content of choline acetyltransferase (CAT). A certain parallelism was found between the function of the transplants and the content of hexokinase, but none for the other estimated muscle enzymes, such as malate dehydrogenase (MDH), creatine kinase (CK), and lactic dehydrogenase (LDH). All enzyme levels were lower than in normal muscles. The results of this experimental series underline the utility of muscle transplantation with microneurovascular anastomoses to restore lost muscle function, even in the extremities, when strong forces are needed.

Animals↗