Biomedical subjects
H Millesi
Publications and source records attributed to H Millesi.
Functional results from replantation surgery: a five year report from the Viennese replantation team.
We present the results of treatment of completely and incompletely severed digits achieved by the Viennese Replantation Team. These results are regarded as comparable with other internationally reported series. Our extended use of vein and nerve grafts has effected an improvement in functional results and has made possible a more radical approach to severe hand injuries. We have also used composite and compound grafts for fingertip restoration, and utilized joint transplantation or transposition when necessary.
[Arthoplasty of the finger joints following posttraumatic conditions (with the exception of the saddle joint)].
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[Reconstructive surgery including Volkmann's contracture (author's transl)].
Restorative measures after mutilating procedures in children are discussed on the basis of an analysis of suitable cases. Modern methods of nerve-transplantation, of bone-transplantation, using microvascular anastomoses, and of microsurgical transplantation of skeletal muscle are described in detail.
[Results of replantation and severe hand injuries in children (author's transl)].
Within the framework of the reimplantation service which has operated in our clinic since June 1974, 23 amputations in children were admitted, out of a total of 184. 17 were complete, 6 were subtotal, and 21 were re-implanted. The healing-quota of 76% is particularly due to the much more generous indications in childhood. The difficulties in post-op. care, and the use of play in physiotherapy are mentioned. Experiences gained in the field of re-implantation, especially through microsurgery, have enabled progress to be made also in the other serious injuries of the hand in childhood.
[Restorative joint operations in childhood (author's transl)].
Restorative measures in children's joints must be planned so that interference with the epiphyses, and consequent cessation of growth, can be avoided. Thus, tried and tested methods in adults, such as arthroplasty or arthrodesis, cannot be applied. The coriumarthroplasty in children has proved rewarding among our cases.
[Long term results following surgical correction of camptodactylia (author's transl)].
The late results of treatment of camptodactylia are reported and 15 patients are presented. It is shown that early surgery can produce good results. Correction in older patients is more problematical and the results are only symptomatic.
Microsurgery of peripheral nerves.
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Collagen types and anticollagen-antibodies in Dupuytren's disease.
The relative proportion of collagen type I and type III in the aponeurosis of twenty-four patients with Dupuytren's disease was determined and compared with the aponeurosis of normal persons. The presence of considerable amounts of type III collagen was found in the Dupuytren's disease patients. The sera of the patients were screened for circulating anti-collagen antibodies using a sensitive radioimmunoassay. In seven out of the twenty-four patients low concentrations of these antibodies were found.
[Restoring the continuity of severed peripheral nerves. Indications and surgical technics].
The detailed literature is critically examined, especially with regard to the questions of the time of the operation, technique of the intervention, use of transplantation, suture under tension, etc. The author recommends the following operating tactics: (I) Smoothly separated nerves without any defects or larger side-injuries are subject to primary care. Mono- to oligofascicular nerves are loosely coapted by epineural sutures; the protruding contents are not excised. For polyfascicular nerves one uses endofascicular guiding sutures and coaptation by epineural sutures. In case of a clear group structure, interfascicular coaption is used. (2) Early secondary care according to plan gets to the stumps from the healthy material and uses interfascicular transplantation for every tension occurring. In case of polyfascicular nerves without group structure, the corresponding sectors are connected with each other. (3) The late secondary care follows the rules for the early secondary care. (4) Re-operations are carried out if regeneration does not set in, testing is mainly carried out by means of the Hoffmann-Tinel sign. Sometimes intraneural neurolysis will be sufficient in these cases; more often than not, parts of the whole cross-section must be resected or bridged again by transplantation.
Nerve suture and grafting to restore the extratemporal facial nerve.
A concept for dealing with extratemporal lesions of the facial nerve is based on cadaver studies performed by Meissl. In spite of plexiform arrangement and fiber exchange, areas and fascicle groups can be differentiated within the cross section of the facial nerve which contain a great percentage of the fibers supplying a certain muscle group. An attempt should be made to unite the corresponding parts by direct coaptation, or, if nerve defect exists, by nerve grafts.
[Microvascular and microneural repair: technique and results (author's transl)].
Microsurgical technique permits repair of arteries and veins of a diameter of 0.5-2 mm. The success rate rose to 80-90% because of the frequent use of vascular grafts. This led to a high success rate in replantation of amputated parts. But repair of digital vessels is indicated even if the basal circulation is present to improve healing of other structures (tendons, nerves) and so to avoid late ischemic complaints. Free transfer of toes to replace digits in cases of multiple digital loss has its place in reconstructive hand surgery. It became possible because of the satisfactory return of sensibility after nerve repair. Microsurgery of peripheral nerves makes it possible to adapt the surgical technique to intraneural structures (mono-, oligo- or polyfascicular pattern with and without grouping). The results of nerve repair have been improved by the widespread use of nerve grafting. This is also true for cases that, in the past, were regarded as prejudicial to a useful recovery.
Replantation and revascularization of amputated parts of extremities: a three-year report from the Viennese replantation team.
A Replantation Team was instituted in Vienna 3 years ago. This team is the oldest in Europe. One hundred and eighty-one complete and incomplete amputated parts of 118 patients were replanted during this period. A survival rate of 86% and a useful functional result ("integrated parts") in 78% of the cases was obtained. Appropriate preparation of the amputated parts, the right timing, a 24 hour service and a clear indication with intensive postoperative physicotherapeutical treatment are the fundamental points for this result.
Nerve grafting.
By avoiding tension and securing anatomical neurorrhaphy, regeneration of nerve is obtainable. When the gap exceeds a certain limit, the only way to avoid tension is the use of grafts. Experience in animal experiments and clinical practice has demonstrated that regenerating axons can cross 2 optimal suture lines much more easily than one sub-standard one. For bridging a gap autografts are used, because in autografts the fascicular pattern is preserved and its Swann cells survive. With the interfascicular technique the dissection of the nerve stumps proceeds from normal to abnormal tissues and the epineurium is resected. The coaptation must be exact so that the grafts cover the whole cross sectional area of the fascicle. All this can be achieved by the use of one 10--0 or 11--0 nylon suture. The clinical results show that in the median nerve 82%, in the ulnar 80% and in the radial nerve 92% of good functional results can be obtained. Also in brachial plexus injuries the interfascicular nerve grafting procedure opened new ways. Therefore interfascicular nerve grafting, using autografts in cases of nerve repair, where a gap may occur, currently is the method of choice.
[Free transplantation of a fibula with epiphysis].
Problems of free bone transplantation, as well as those of bone transplantation by microvascular anastomoses are exemplified by a case of free fibula transplantation--the epiphysis being conserved--by microvascular anastomoses. If revascularisation of the bone transplant is immediately achieved, the chance for survival of bone tissue is improved and there is a chance that the epiphysis will retain the capacity to grow. By multiple surgical interventions the stability of the abnormally mobile forearm was reestablished and considerable lengthening of the shortened skeleton was achieved. By tendon and nerve transplantations simple grasp could be restored to the hand which originally was without function.
[Impairment of the skeletal growth of the hands after electrical burns in childhood].
Fourteen children with electrical burns involving 33 fingers were followed for a period of more than 8 years. Primary treatment was conservative in 17 fingers, of which 11 required surgery at a later date. Adequate function was restored in 12 fingers after completion of this treatment and persisted for 8 years and more. In 5 fingers substantial joint deformities developed. For 16 fingers surgery was required as primary treatment. Bone involvement was present in 10 of these. Secondary surgery proved to be necessary in 2 fingers, on one aseptic necrosis necessitated replacement by a bone graft. All of the 16 fingers showed good function in the period under review. There was no radiological evidence of deformities, but growth was substantially slower than normal. Apparently coverage of exposed bone with well vascularized tissue improved local blood flow so that damage other than that originally produced by the electrical burns was prevented.
Surgical management of brachial plexus injuries.
Exploration of the brachial plexus was done as an elective procedure in 56 patients with complete or partial lesions. The indications were based on clinical findings, a Tinel-Hoffman sign indicating that at least one root was available for direct repair, or a cessation of signs of progressive recovery. In young patients with supraganglionic lesions and evidence of root avulsion, nerve grafts from intercostals to various portions of the plexus were done. Evaluation of the results of motor functions showed that 38 of 54 (70 percent) recovered a useful motor function in at least one important area. There were two postoperative hematomas leading to delayed healing and failure of nerve recovery. Two patients had temporary loss of power in uninvolved muscles but both recovered satisfactory function. Only one patient had a persistent pain syndrome. Two failures were due to the late operation (19 months after injury) and one because of a 15 cm. which was grafted.
[Subcutaneous pedicled flap for the reconstruction of the skin mantle following excision of facial tumors].
A subcutaneous pedicled island flap for closing skin defects in face tumor surgery is presented. Simple design and operative technique of these flaps make them interesting for closing excisional face skin defects especially in the elderly.