Faculty Bibliography

Pedicle skin flaps in dogs were delayed and venous outflow measured at various times following a delay procedure. An initial small but significant decrease in blood flow was noted in the first 48 hours postoperatively in several flaps suggesting that a denervation supersensitivity-arteriovenous shunt mechanism may be active at this time. In all flaps after the second day, total flap blood flow markedly increased compared to the initial measurement. This suggests that the most significant haemodynamic event occurring during the delay period is the development of vascular collaterals

Segments 15 mm in length were excised from the femoral veins of rats and preserved by refrigeration at 4 C in lactated Ringer's solution for periods up to 21 days. The findings show that veins can be preserved for up to seven days and successfully grafted to recipients. Although there was some success in preserving vein segments for more than seven days, a high rate of thrombosis occurred after implantation in the recipients. It is generally accepted that damaged endothelium causes thrombosis. The light and electron microscopic observations in this study, however, suggest that the condition of the endothelium may not be the only important factor in the patency of small vessels. A thickened and prominent elastic lamina may also play a role in keeping the lumen open

Replantation surgery offers a rewarding challenge for one to apply basic biologic and functional concepts to deal with an infinite variety of amputation problems. Although there is an obvious requirement for technical skill, there is no place for stereotype procedures. Often the exact plan of treatment cannot be determined until debridement is completed, so by taking on the responsibility to manage these problems one must have not only fine technical skills but also a thorough knowledge and comprehensive experience in hand surgery, Upper limb amputations are complex and difficult compound hand injuries involving not only the vascular system but the bone, tendon, nerve, muscle, and skin as well. To entertain the concept that upper limb amputations are simply microvascular problems is indicative of a complete lack of comprehension of the realities of the situation. Every hand surgeon must add the ability to perform microsurgical techniques to his or her technical armamentarium, but to endorse the concept of a microsurgeon is bad for medicine and counter to both reality and concerned patient care

It is evident that the independent experiences of these hand surgery units in three completely different parts of the world are remarkable similar. For the most part, one can readily account for the differences reported on the basis of interpretations of such vague terms of evaluation as 'good' or 'poor' and on case selection, which is often dictated by local cultural considerations. For example, a hand with some useful prehension placed on an extremely shortened arm may be most welcome to a Chinese patient, whereas a hand attached to the humerus may be looked upon as grotesque in the Western cultures an so be psychologically devastating. Yet, such differences are minor compared with the common pattern of experience that clearly exists and upon which conclusions can be based for formulating some general guidelines. Indications for upper limb reattachments at this time are neither absolute nor static. They are relative, dynamic, and surely will change as experience increases and techniques become even more refined. Success must not be equated with tissue survival but measured only in terms of what the effort has done for the patient in a global sense. As yet, completely satisfactory system for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not chastem for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not chastem for such evaluation is not available and development of one should be an important goal. Evolution of a treatment plan requires careful consideration and synthesis of the many factors discussed here but always with a view toward what will be of greatest total benefit for our patients. This principle should not change

Single fibres were dissected from the dorsal spinal roots of the nerves serving the brachial plexus in African green monkeys. The dermatomal organization of these spinal nerves was deduced from data concerning the receptive fields of 2834 single afferent fibres. These data were collected in an attempt to reconcile some of the discrepancies that exist in published descriptions of the dermatomes in primates; our results and the literature reviewed suggest that the cutaneous region served by one spinal nerve is actually much wider and much more variable in location than is generally recognized. This makes any summary diagram a misleading indicator of the true complexity of the spinal innervation of the upper limb. In spite of this variability among individuals, within any specific individual there is a regular and orderly progression of innervation which allows prediction of the region served by a particular spinal nerve when information concerning the site of innervation of adjacent nerves is available. The territory of each myotome tended to be larger than the dermatome of the same spinal nerve. Most muscles of the limb received afferent innervation from three to four different spinal nerves. Further, the territory of the myotome did not of necessity coincide with the dermatome of the same spinal nerve. Even those nerves innervating the hand still innervated axial muscles. These observations have important implications for the diagnosis of spinal nerve injuries