Allogeneic transplantation of the radial side of the hand in the rhesus monkey : technical, functional and immunological aspects.

As this is the era of transplantation it is inevitable that the field of allogeneic transplantation for the reconstruction of the upper extremity is explored also. This double-thesis deals with a number of aspects concerning allogeneic transplantation of the radial side of the hand in a rhesus monkey model. In the introduction the reasons for investigating the possibility of hand transplantation from one individual to another are clarified. In particular, the reasons why experiments in a nonhuman primate model were preferred, are explained. Should hand transplantation in man ever be performed, three major questions will always be foremost: is allogeneic transplantation of such a composite tissue allograft technically feasible, can allograft acceptance by the host be established, and if so will sensory and functional recovery occur? These questions inspired the authors to perform the experimental work presented. An attempt was made to integrate the major multi-disciplinary facets, clinically as well as preclinically. S.E.R. Hovius focussed on the technical and functional aspects of transplantation of this composite tissue allograft. H.P.J.D. Stevens examined the immunological aspects of this subject, and new ways to improve the immunosuppressive regimen for transplantation. Prior to the rationale of the experiments an introduction with regard to these aspects is presente

Mesh expansion as the cause of bulging after abdominal wall hernia repair

__Background__ Recurrence is the most important complication of abdominal wall reconstruction. It is pos

Long-term outcome of muscle strength in ulnar and median nerve injury: Comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer

Objective: To compare the outcome of muscle strength with manual muscle strength testing grip and pinch strength measurements and a dynamometer which allows for measurements of the intrinsic muscles of the hand in isolation (the Rotterdam Intrinsic Hand Myometer, RIHM). Methods: Thirty-four patients more than 2 years after ulnar and/or median nerve injury. Muscle strength was evaluated using manual muscle strength testing (MMST), grip, pinch and intrinsic muscle strength measurements. Results: Manual muscle strength testing showed that most muscles recover to grade 3 or 4. Average grip strength recovery, as percentage of the uninjured hand, was 83%. Pinch strength recovery was 75%, 58% and 39% in patients with ulnar, median and combined nerve injuries, respectively. The RIHM measurements revealed a poor recovery of the ulnar nerve innervated muscles in particular (26-37%). No significant correlation (Pearson) was found between the measurements of the RIHM and grip strength. Pinch strength was significantly correlated with strength of the abduction of thumb and opposition of the thumb strength (r 0.55 and 0.72, p = 0.026, 0.002) as measured with the RIHM. Conclusion: While manual muscle strength testing and grip strength measurements show a reasonable to good recovery, measurements of the intrinsic muscles by means of the RIHM showed poor recovery of intrinsic muscle strength after peripheral nerve injury. No correlation was found between the recovery of intrinsic muscle strength and grip strength measurements

Preaxial polydactyly of the foot: Clinical and genetic implications for the orthopedic practice based on a literature review and 76 patients

Background and purpose — Preaxial polydactyly of the foot is a rare malformation and clinicians are often unfamiliar with the associated malformations and syndromes. In order to give guidelines for diagnostics and referral to a clinical geneticist, we provide an overview of the presentation using a literature review and our own patient population. Patients and methods — The literature review was based on the Human Phenotype Ontology (HPO) project. From the HPO dataset, all phenotypes describing preaxial polydactyly were obtained and related diseases were identified and selected. An overview was generated in a heatmap, in which the phenotypic contribution of 12 anatomical groups to each disease is displayed. Clinical cases were obtained from our hospital database a

Characterization of a three-dimensional mucosal equivalent: Similarities and differences with native oral mucosa

The aim of this study was to create and characterize a tissue-engineered mucosal equivalent (TEM) that closely resembles native mucosa. TEM consists of human primary keratinocytes and fibroblasts isolated from biopsies taken from healthy donors and seeded onto a de-epidermized dermis and cultured for 14 days at the air/liquid interface. The structure of TEM was examined and compared with native nonkeratinizing oral mucosa (NNOM). The various components of the newly formed epidermal layer, basement membrane and underlying connective tissue were analyzed using immunohistochemistry. The mucosal substitute presented in this study showed a mature stratified squamous epithelium that was similar to that of native oral mucosa, as demonstrated by K19, desmoglein-3 and involucrin staining. In addition, the expression of basement membrane components collagen type IV, laminin-5 and integrin α6 and β4 in TEM proved to be consistent with native oral mucosa. The expression of PAS, Ki67, K10 and K13, however, appeared to be different in TEM compared to NNOM. Nevertheless, the similarities with native oral mucosa makes TEM a promising tool for studying the biology of mucosal pathologies such as oral mucositis or fibrosis as well as the development of new therapies. Copyrigh

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

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°C

Stronger relation between impairment and manual capacity in the non-dominant hand than the dominant hand in congenital hand differences; Implications for surgical and therapeutic interventions

Objectives To evaluate manual activity capacity (i.e. activity capacity to perform hand activities) and its relation with body functions of the hand and forearm in children with congenital hand differences (CHD) Methods We assessed 10-14 year-old children with CHD (N = 106) using a functional handgrips test. Measurements of body functions included joint mobility and muscle strength. Patient characteristics were hand dominance and severity. Results We found a stronger relation between body functions and manual activity capacity in non-dominant hands than dominant hands. Dominant hands scored significantly higher on manual activity capacity than nondominant hands that were similarly impaired at body functions level. Severity of the CHD and body functions had only small effects on manual activity capacity. Conclusion The relation between body functions and manual activity capacity is stronger in non-dominant hands than dominant hands, indicating that improvement in body functions lead to larger changes in manual activity capacity in the non-dominant hand. This may suggest that in bilaterally-affected children surgery should be done at the non-dominant hand first since this hand would benefit most from surgery-induced body functions improvement