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Biomedical subjects

S E Hovius

Publications and source records attributed to S E Hovius.

At least 37 records · Page 2Linked to original sources

Evaluation of five different incisions for correction of radial dysplasia.

The complications of the five different incisions used for centralization from 1970 to 1996 were evaluated. In five cases access was by an S- shaped incision, in one with a transposition flap. Sixteen centralizations were done using a radial Z-plasty in combination with an ulnar excision and four by using two opposite Z- plasties, preserving wrist mobility as much as possible. In 1995 and 1996 a bilobed flap was used in seven cases. No complications occurred with the primary procedures prior to 1995. In all seven cases where the bilobed flap was used venous congestion was seen. In four out of these seven superficial necrosis of parts of the flaps occurred. In all cases though wound healing occurred spontaneously by delayed primary healing after the standard 8 weeks of cast immobilization.

Abnormalities, Multiple↗

Genetics of limb development and congenital hand malformations.

The vertebrate limb bud develops along three different axes: proximodistal, anteroposterior, and dorsoventral. Several genetic factors responsible for control of each of the three limb axes have been identified. The genes involved interact in complex feedback loops to achieve proper arrangement and differentiation of tissues. Most of the available information on limb development and patterning has come from studies carried out in the lower vertebrates. In recent years, an increasing number of studies have been unraveling the genetic basis of human hand malformation phenotypes. At present, genes responsible for preaxial polydactyly, split hand/split foot malformation, and brachydactyly type C have been localized, and the gene responsible for synpolydactyly has been identified. In this paper, we present an overview of the genetic factors involved in limb development, followed by summarized discoveries in the genetics of human congenital hand malformations.

Arm↗

[The value of a hand injury chart].

OBJECTIVE: To assess practicality, clinical merit and usefulness for scientific purposes of a hand injury chart in a hand surgery unit. DESIGN: Descriptive. SETTING: Academic Hospital Rotterdam-Dijkzigt, the Netherlands. METHODS: The records were examined of patients who within the period of one ear required acute surgical therapy for serious hand injuries (n = 148). Data concerning cause and extent of the damage to anatomical structures were recorded to evaluate accuracy in describing a hand injury with and without the chart. Time needed to study the patient record to ascertain sufficient details of the injury was noted in each case. RESULTS: The accuracy in describing a hand injury increased significantly for all anatomical structures except vascular lesions in patient records containing the hand injury chart compared with records without the chart. Using the chart saved one minute of time at the first aid station and the outpatient department. CONCLUSION: The use of a hand injury chart allowed a more accurate and uniform description. The computerized data could be easily used for scientific and audit purposes.

Emergency Service, Hospital↗

The role of metacarpophalangeal pattern (MCPP) profile analysis in the treatment of triphalangeal thumbs. Description of a method and a case report.

The metacarpophalangeal pattern (MCPP) profile analysis is a method of comparing the length of each of the 19 tubular bones of the hand on the X-ray with the standard length in the normal population according to age and sex. An MCPP plot is a graphic illustration of the MCPP analysis. It is not the exact height of the curve on the MCPP plot which is most important, but the profile which occurs because of the individual lengthening or shortening of the bones. This pattern profile appears to be specific for several congenital malformation syndromes. We have recently used MCPP analysis in planning surgery for triphalangeal thumbs. The percentage of excessive or reduced length of each individual bone of the hand can be read from the MCPP plot and is helpful in calculating a more accurate length for the newly created thumb. MCPP analysis can be used as a diagnostic tool in a number of congenital hand malformations, but may also be helpful in planning surgical treatment of congenital hand malformations when abnormal bone length is involved.

Fingers↗

Metacarpophalangeal pattern (MCPP) profile analysis in a family with triphalangeal thumb.

Triphalangeal thumb (TPT) is a rare congenital disorder characterised by a long, finger-like thumb with three phalanges instead of two. It can occur as an isolated defect, in association with other abnormalities of the hands and feet, or as a part of a syndrome. Sporadic cases have been described, but it is usually inherited as an autosomal dominant trait. In order to examine skeletal morphology in different phenotypic variations of this disorder, we performed metacarpophalangeal pattern profile analysis in one kindred with this disorder. A characteristic profile occurred in all affected people, based on the individual lengthening or shortening of the thumb bones. Comparison of the affected and unaffected people from this family with people with a different genetic background suggests that the described profile is specific for TPT and could be used as a helpful diagnostic tool in syndromes which include TPT.

Chromosome Aberrations↗

Connections between the tendons of the musculus flexor digitorum profundus involving the synovial sheaths in the carpal tunnel.

In the carpal tunnel anatomical interconnections between the tendons of the musculus flexor digitorum profundus are systematically present. These interconnections limit the mutual tendon displacements, which decreases finger independence and may be problematic in a musician's hand. The present study investigates a possible role of the synovial sheaths in the formation of these intertendinous connections in the carpal tunnel. To this end a morphological model is provided which correlates the often distinctly fibrous structure of the deep flexor tendons in the carpal tunnel and the frequent exchange of tendon fibres between the tendons to the different fingers, with the tendency of the synovial membranes to strongly adhere to the tendons. This model is validated by gross dissection results, and by cross sections of the flexor tendons in the carpal tunnel. In agreement with the model, the anatomic data show that the synovial membranes tend to invade and become trapped in tendons made up from individualised tendon strands, and also strongly adhere to the substantial amounts of tendon fibres which may be exchanged between the flexor tendons proximal to the lumbrical origins. These fibres and the synovial membranes may form a strong fabric able to withstand substantial stretching forces of interconnected oppositely pulled flexor tendons.

Adult↗

Is the pectoralis myocutaneous flap in intraoral and oropharyngeal reconstruction outdated?

METHODS: Our experience with 224 immediate pectoralis major myocutaneous flap reconstructions in patients with carcinomas of the oral and oropharyngeal cavities is presented. RESULTS: Although flap-related complications developed in 53% of the patients, all flaps survived, and we had no major skin paddle loss. The incidence of reoperation due to flap-related complications was 2%. All other complications were minor and did not affect the length of hospitalization. Analysis showed no significant risk factors for the development of complications. Because of fistula formation, infection, or metal exposure, plate removal was necessary in 10% of the AO fixation plates used in cases of mandibular swing. This occurred in 68% of the anterior and 22% of the lateral mandibular reconstructions performed with a reconstruction plate (P < 0.05). CONCLUSIONS: We conclude that a reconstruction plate is unsatisfactory for anterior mandibular continuity reconstruction and debatable for lateral mandibular reconstruction. At present, anterior defects are reconstructed with free vascularized osteocutaneous flaps that should probably also be used for lateral mandibular reconstruction. Furthermore, in a large number of series, it is reported that free flaps also have high complication rates and 5-10% flap loss. As all pectoralis major flaps survived in our series, it still remains a good choice in intraoral and oropharyngeal reconstruction when there is no necessity to reconstruct bone.

Adult↗

The diagnostic value of magnetic resonance imaging in combination with angiography in patients with vascular malformations: a prospective study.

Vascular birthmarks are common lesions that can be divided into hemangiomas and vascular malformations (arterial, venous, capillary, and lymphatic malformations or a combination of these, according to Mulliken. Thirty-four patients with a vascular malformation were evaluated prospectively with magnetic resonance imaging (MRI) during a 6-year period in a combined study of the departments of radiology and plastic and reconstructive surgery. Hemangiomas were not part of this study, as they regress spontaneously in childhood. MRI and angiographic findings are described and the value of MRI is investigated for its usefulness in conjunction with angiography. MRI turns out to be superior as the initial diagnostic test for vascular malformations. Further investigations are not necessary in low-flow lesions. In case of high-flow and combined-flow lesions, angiography is indicated following MRI to show the exact angioarchitecture, which is essential for therapy planning. A flowchart, based on radiodiagnostic features, is proposed for diagnostic evaluation of patients with vascular birthmarks.

Adolescent↗

The effect of cigarette smoking on the survival of free vascularized and pedicled epigastric flaps in the rat.

Microsurgeons suspect that cigarette smoking reduces the survival of free vascularized flaps and replantations, but this has never been proven. This experimental study investigates the effect of smoking on free-flap survival. A fasciocutaneous epigastric flap was used in 30 rats as a free flap and in 30 rats as a pedicled flap. Of each group, 10 rats were smoked 6 weeks before and 2 weeks after surgery, 10 rats were smoked only 6 weeks before surgery, and 10 rats underwent the sham smoking procedure. Also, a distally based dorsal skin flap was cut in all rats, representing a random vascularized flap. Vitality and size of both flaps and patency of the vascular anastomoses were assessed 14 days after surgery. The epigastric flaps were monitored by laser Doppler flowmetry and thermometry during the experiment. Survival of the free vascularized epigastric flaps was significantly lower in smoking rats. All pedicled flaps except one survived. The epigastric flaps only necrosed or survived completely, exactly correlating to the patency of the vascular anastomoses. The mean surviving area of the dorsal flaps was best for nonsmoking rats, worse for only preoperatively smoking rats, and worst for preoperatively and postoperatively smoking rats. The differences were statistically significant. Postoperative laser Doppler flow differed significantly between surviving and dying flaps, affirming the value of laser Doppler flow monitoring in microvascular surgery. In conclusion, this study proves that smoking of cigarettes is detrimental to the survival of free vascularized flaps.

Anastomosis, Surgical↗

Genetic aspects of polydactyly.

The early limb development follows the similar pattern in all vertebrates since different species develop using the same regulatory genes in the formation of the body plan. Some of these genes remained well conserved during evolution and can be traced back as far as Drosophila--while some others changed their structure or developed new functions. This is why the limbs from different animals still look different from one another. However, all existing tetrapods have, like Homo Sapiens, limbs with five, or fewer digits. It has been argued that the interplay of the factors controlling the patterning and differentiation during the embryonal limb development can provide five distinct "genotypes" allowing development of only five different digits. This would imply that the Greek definition of polydactyly, namely "duplication of the finger or a part of it", is correct, not only in morphological but also in a genetical sense. Genes involved in the determination of the outline of the limb are candidates for disorders like polydactyly and syndactyly. Recently, we have localised the gene for triphalangeal thumb (TPT) on chromosome 7q. As almost 50% of our patient population also had rudimentary postaxial polydactyly and/or syndactyly, the interesting question arose whether the TPT gene also was responsible for isolated post-axial polydactyly. Our preliminary evidence suggests, however, that different gene(s) are involved in the pathomorphogenesis of postaxial polydactyly. Studies of human congenital hand malformations--combined with genetic studies in lower vertebrates--will help us to understand not only the molecular basis of these disorders, but also to get insight into the fascinating mechanisms involved in the normal development of the human hand.

Animals↗

Axillary plexus blockade in microvascular surgery, a steal phenomenon?

A case report is presented of an axillary plexus blockade following a second toe-to-hand transfer. After completion of the microvascular anastomoses and restoration of blood flow to the transplanted toe, the axillary plexus blockade was started. Together with the vasodilation of the hand and forearm there was a marked drop in blood flow in the transplanted toe. Possible explanations for this phenomenon are considered. We suggest starting axillary plexus blockade before completion of microvascular anastomoses and maintaining a continuous postoperative blockade.

Adolescent↗

Loss of viable neuronal units in the proximal stump as possible cause for poor function recovery following nerve reconstructions.

Function recovery after nerve reconstructions is often poor. Could this be caused by a loss of viable neuronal units proximal to the nerve reconstruction? The number of neuronal units (i.e., a motor or sensory neuron, including its axon and axonal branches) in the proximal segments of reconstructed peripheral nerves were studied using a novel magnetic recording technique. In five rabbits a common personal nerve was transected and microsurgically reconstructed. After 8 weeks regeneration time the nerve compound action signals were recorded magnetically from the reconstructed as well as from the healthy contralateral peroneal nerve and from peroneal nerves of five unoperated control animals. The amplitudes of the recorded signals were compared and the diameter distribution histograms were calculated. These calculations were based on the conduction distance between the stimulator and the sensor and the conduction velocities of 30 different axon diameter classes ranging from 3 to 18 microns. Our results indicate that there is a reduction of approximately 50% in the number of viable neuronal units at 10 mm proximal to a simple nerve reconstruction after 8 weeks regeneration time. The number of neuronal units innervating a hand is strongly correlated with clinical function in a healthy hand. The reduction in viable neuronal units after a reconstruction, demonstrated in our experiments, corresponds with a frequently clinically observed decrease in function after nerve reconstructions. Therefore, we suggest that the number of viable neuronal units may be a good indicator of final functional recovery.

Action Potentials↗

Comparison of laser Doppler flowmetry and thermometry in the postoperative monitoring of replantations.

Reliable postoperative monitoring in microvascular surgery is necessary to improve the success rate of reexplorations following vascular compromise. Surface thermometry is known as an easy and inexpensive objective postoperative monitor and therefore is used by many microsurgeons. Reliability, however, is not satisfactory, and therefore several other instrumental methods have been tested of which laser Doppler flowmetry shows the most promising results. This study compared laser Doppler flowmetry to thermometry in the postoperative monitoring after replantation surgery. In 34 patients, 45 replantations and revascularizations were monitored by laser Doppler flowmetry and thermometry. A reliable alarm value of 10 PU was defined for replantations and revascularizations, with a sensitivity of 93% and a specificity of 94%. Thermometry showed a sensitivity of 84% and a specificity of 86% at 29 degrees C.

Adolescent↗

Clinical evaluation of techniques used in the surgical treatment of progressive hemifacial atrophy.

We critically review 13 patients with progressive hemifacial atrophy treated with three basic surgical procedures (free flap transplantation, alloplastic implants, micro-fat injections 'lipofilling') and further ancillary techniques. In spite of the satisfactory results achieved with the procedures, with the exception of alloplasts, we feel that lipofilling may be considered an interesting solution for soft tissue augmentation of the face especially for moderate adipose defects, due to its repeatability, no donor site morbidity, no complications at the recipient site such as lesions resulting from dissection, bleeding, necrosis, etc. This technique can be performed in a day-hospital with short surgery time, at low cost and without a highly skilled team. For severe grades of adipose atrophy, because of the low blood supply to these tissues which interferes with take of any type of autograft, we think that free flaps actually represent one of the best solutions for soft tissue augmentation.

Adipose Tissue↗

The gene for triphalangeal thumb maps to the subtelomeric region of chromosome 7q.

Triphalangeal thumb is a developmental anomaly, sometimes dominantly transmitted, characterized by a long, finger-like thumb with three phalanges instead of two. The underlying genetic defect is unknown, but presumably involves genes that regulate the differentiation of the developing forelimb. In two large kindreds with triphalangeal thumb, evidence for linkage to the long arm of chromosome 7 was obtained with a maximum lod score of 12.61. Multipoint linkage and haplotype analysis placed the gene close to the telomere of the long arm. To our knowledge this is the first time that a human gene involved solely in the pathologic morphogenesis of the hand and feet has been localized.

Chromosome Mapping↗

Phenotypic analysis of triphalangeal thumb and associated hand malformations.

Triphalangeal thumb (TPT), a long, finger-like thumb with three phalanges instead of two, is regarded as a subtype of preaxial polydactyly. It can occur as a sporadic disorder, but is more often seen as a dominant familial trait. We describe four white Dutch families in which triphalangeal thumb has variable expression and is sometimes associated with preaxial extra rays, rudimentary postaxial polydactyly, cutaneous syndactyly of the hands, and, rarely, postaxial polydactyly and syndactyly of the feet. A comparison with similar familial conditions reported during the past 10 years is provided. The potential significance of linkage and molecular genetic analysis for better insight into the pathogenesis of complex hand malformations is discussed.

Adult↗

Dermatography--a new discipline with a wide range of applications.

Dermatography is the application of tattooing techniques in medicine. In the past, several techniques were tried but none led to reproducible results. Dermatography has been developed over the last 10 years into a technique which is both generally applicable and reproducible. It is a suitable treatment modality for disturbing discolorations and scars of the skin which can be permanently camouflaged.

Dermatology↗