PubMed · 3126419
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R F Bellamy. 1988. A triple amputation.. https://pubmed.ncbi.nlm.nih.gov/3126419/
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Does transneuronal degeneration occur in the neurons of the spinal intermediate zone following degeneration of the anterior horn cells in man? To investigate this possibility, we carried out a quantitative examination of neurons in the cervical intermediate zone of a 56-year-old man who had suffered accidental amputation of the right upper arm 38 years prior to death. Recently, we reported that the cervical anterior horn cells of this patient were reduced in number not only on the amputation side but also on the spared side. The present study revealed that medium-sized neurons in the cervical intermediate zone, which were considered to be internuncial neurons, were decreased in number on both the amputation and the spared sides, but less so on the spared side. These findings indicate that retrograde transneuronal degeneration occurs in the internuncial neurons following degeneration of the anterior horn cells caused by amputation. Sequentially to this, degeneration of the commissural neurons in the intermediate zone secondary to that of the internuncial neurons may induce degeneration of the neurons in the intermediate zone and the anterior horn cells on the spared side.
Based on the anatomic data obtained from earlier studies on the vascular anatomy of the hand, the vascular architecture in the palm of the hand was studied on 60 sides of unembalmed adult upper extremities. Each palm was divided into 64 squares by 8 sagittal and 8 transverse sections. The vascular architecture in these squares and the arterial relations between them were observed and measured by angiography, operative microscopic dissection and computerised three-dimensional reconstruction. According to the pattern of the blood-vessels, the amputated palms can be classified into 4 types. The anatomic basis for the vascular anastomosis in each type is defined. There are three key-areas for the blood-supply of the palm and their significance is discussed. Apart from the 4 types of transversely amputated palms, the repair program of the blood-vessels in 4 types of common obliquely amputated palms are also discussed.