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Biomedical subjects

A Vigasio

Publications and source records attributed to A Vigasio.

18 recordsLinked to original sources
PubMed1999

Arterial anatomy and clinical application of the dorsoulnar flap of the thumb.

After injection of stained latex at the brachial artery, the arterial supply of the dorsal aspect of the thumb was studied by light microscopy in 25 cadavers. An artery, located on the dorsoulnar side and connecting the head of the first metacarpal with the dorsal arcade of the proximal nail fold, was found in all dissections. We report the results of the anatomic study and the clinical applications of a dorsoulnar skin flap that can be raised on its artery with a distal pedicle. Clinical experience is based on 32 flaps. In 25 cases this flap was used for distal skin loss coverage (palmar or dorsal) of the thumb as an island flap. In 7 cases it was used for reconstruction of the finger pulp (5 index and 2 middle fingers) in the form of a cross-finger flap.

Cadaver↗
PubMed1996

[Dorso-cubital flap of the thumb. An anatomical study with clinical applications. Apropos of 22 cases].

The arterial supply of the dorsal surface of 25 thumbs was studied by light microscopy. An artery, located on the dorso-ulnar side and connecting the head of the first metacarpal bone with the dorsal arcade of the nail matrix, was constantly found in all dissections. The authors report the results of the anatomical study and the clinical applications of a skin flap which can be raised on the dorso-ulnar surface of the M.P. joint with a distal pedicle. Clinical experience is based on 22 flaps. In 18 cases this flap was used for distal skin loss coverage (palmar or dorsal) of the thumb as an island flap. In 4 cases it was used for reconstruction of the finger pulp in the form of a cross finger flap.

Amputation, Traumatic↗
PubMed1995

Modified Steindler procedure for elbow flexion restoration.

The results of modified Steindler procedures for elbow flexion performed during the past 20 years were reviewed retrospectively. The modifications were designed to avoid the phenomenon of the patient having to make a fist in order to obtain elbow flexion (Steindler's effect). The flexor carpi ulnaris, the flexor carpi radialis, and the palmaris longus, along with a bone fragment, are transferred to the anterior aspect of the humerus. The muscles are carefully separated from the flexor digitorum superficialis, which is left in place. This avoids both flexion of the fingers and pronation. Indications are discussed, especially in brachial plexus reconstructive surgery. Steindler's procedure is indicated in upper plexus lesions (C5-C6); other transfers are more appropriate for lower plexus palsies. Results were assessed according to elbow flexion against resistance. Flexion over 120 degrees when lifting 3 kg was rated very good. Of 32 modified Steindler procedures reviewed, 18 were rated very good, 8 good, 4 fair, and 2 poor.

Bone Transplantation↗
PubMed1995

Microvascular fibular grafts in skeleton reconstruction.

Extensive bone defects from any cause require large bone grafts. Such large defects usually cannot be repaired by conventional, nonvascularized cancellous grafts. Before the advent of microsurgery, many of these lesions could not be cured, and amputation was often the only solution. The bone may be transferred alone or in combination with skin or muscle or both. Idiopathic femoral head necrosis is 1 of the main indications for free microvascular (fibular) transfer. The authors propose a new classification for idiopathic femoral head necrosis. A technique that has been used for the past 14 years, on providing mechanical support and improved blood supply to the femoral head, is described. The fibula is favored for its mechanical properties and its vascular pedicle, and because it is easier to harvest.

Adult↗
PubMed1994

Different conduits in peripheral nerve surgery.

A considerable amount of research is being undertaken regarding the possibility of bridging loss of nerve substance with different guiding tubes, in order to improve functional outcome, reduce the surgical time, and reduce damage at donor nerve sites. A review of the literature and personal research allows us to state that: for short gaps, biological tubes (autologous veins) may give good results and also allow chemotactic attraction with selective arrangements of motor and sensory axons. Gaps longer than 1 cm do not allow tropism and are associated with failure to support axonal regrowth. Artificial biodegradable conduits still show results that are controversial; they may give good results provided that the material of which they are made is perfectly tolerated. Empty tubes, longer than 8-10 mm, besides being deprived of the chemotactic attraction, may collapse or be partially reabsorbed and replaced by scar. Probably in the near future biological or biodegradable tubes, containing laminin-like substances or muscle scaffold, will allow us to bridge increasingly large defects in nerves.

Humans↗
PubMed1993

Bridging nerve defects with combined skeletal muscle and vein conduits.

The use of vein or muscle grafts to bridge nerve defects longer than 1-1.5 cm gives poor results. Veins collapse and in muscle grafts axons may regrow outside the graft. We used veins (to guide regeneration) filled with muscle (to avoid vein collapse). Nerve regeneration through 1 and 2 cm grafts made of vein plus muscle was compared with similarly long traditional nerve grafts, free fresh muscle grafts, and empty vein grafts. Regeneration was assessed clinically and histologically (qualitative and quantitative evaluation) in the graft and distal nerve stumps. Vein plus muscle grafts were superior to vein and fresh muscle grafts both functionally and histologically. Functional results were similar to those found in traditional nerve grafts, but axon number was superior in the veins filled with muscle. This suggests that vein filled with muscle might serve as a grafting conduit for the repair of peripheral nerve injuries and could give better results than traditional nerve grafting.

Animals↗
PubMed1992

The effects of lengthening on nerves.

Use of external fixators in limb lengthening and skin expanders in plastic surgery are well-known operative techniques. In some cases neurologic complications arise due to distraction which is either excessive or too fast. What happens to the nerve in these cases has not yet been thoroughly investigated. We therefore conducted an experiment on the sciatic nerve of rats. In one group of animals the nerve was studied after lengthening the femur, and in the other group after lengthening the nerve itself with a skin expander. Electrophysiologic and histologic studies (optic microscopy and axon teasing) were used to examine the effects of tension on the sciatic nerve. The results suggest that if distraction is performed gradually, the nerve does not undergo any electrophysiologic functional changes. It does, however, undergo some morphologic changes, such as a decrease in both the areas of the axons and the myelin sheaths, an increase in the distances between the nodes, and proliferation of Schwann cells.

Animals↗
PubMed1991

Compartmental syndrome due to viper bite.

The case is reported of a young girl who was bitten on the hand by a viper and developed compartment syndrome of the intrinsic muscles more than 24 h later. Multiple dorsal and volar fasciotomies resolved the acute episode with complete restitutio ad integrum. The clinical case is discussed in detail and the literature on these rare complications of snake bites in European countries reviewed.

Acute Disease↗
PubMed1990

Experimental investigation of cross-nerve transfers relating to repair of brachial plexus avulsion injuries.

There is a lack of agreement regarding the potential for peripheral nerve cells with short axons to regenerate and innervate the terminal end organs of nerve cells with long axons. We designed a study to evaluate experimentally the possibility of neurons to reconstitute much longer axonal segments. Twenty Wistar rats were used. The brachial plexus was isolated and the radial nerve transected immediately after its origin. The proximal end of the axillary nerve (previously cut) then was coapted tot he distal stump of the radial nerve. In 10 other rats, the cut radial nerve was simply recoapted to itself without involvement of the axillary nerve; these animals served as controls. Finally, in 10 rats, nerves were cut without repair to evaluate the degenerative changes. After 90 days, the distal part of the radial nerve was examined by light microscopy, calculating the number and area of regenerated axons. We also checked the motor end-plates of reinnervated muscles. In the nerve-transferred group, good axonal regeneration with good reinnervation of the muscles was seen. In this way, we have experimentally demonstrated a plasticity of regeneration in peripheral nerves. This suggests that the surgeon may use nerves connected to proximal muscles to neurotize avulsed nerves of distal muscles.

Animals↗
PubMed1990

[Arthrodesis of the wrist in cases of hand paralysis (personal technique)].

Arthrodesis of the wrist in cases of paralysis of the upper limb, although rejected by certain authors, is a valid operation provided it is confined to certain indications such as paralyses requiring minimal muscle transfers. Arthrodesis of the wrist is particularly useful in the sequelae of brachial plexus lesions with dissociated paralysis and in total paralysis of the radial nerve with hand drop and preservation of the wrist flexors. Numerous techniques of arthrodesis have been proposed. Over the last 27 years, the authors use a technique with a direct dorsal incision. The first row of carpal bones and the radius are roughened with chisel. A cortico-cancellus graft is then raised from the dorsal surface of the radius, leaving a distal cortical bridge. The graft is slid under this bridge, placed onto the roughened surface of the carpus and pushed under the operculum raised at the base of the 2nd and 3rd metacarpals. The arthrodesis is fixed with two Kirschner pins and a plaster for 3 months. We have used this technique in 31 patients with nerve paralyses since 1971 and have obtained complete consolidation with total patient satisfaction in all but one case.

Activities of Daily Living↗
PubMed1988

Traumatic aneurysms of two proper digital arteries in the same patient: a case report.

Aneurysms in the hand are infrequent and aneurysms of the proper digital arteries are particularly rare, only 11 cases having been reported in the literature. The authors describe the case of a patient operated on for two traumatic false aneurysms of the ulnar digital arteries of the middle and ring fingers. Arterial aneurysms should be carefully evaluated to exclude other lesions such as cysts, abscesses, neuromas. The choice between ligation and resection or reconstruction of the vessel should be based on pre-operative and intra-operative evaluation of circulation.

Adult↗
PubMed1987

A comparison of vascularized and nonvascularized bone transfer in rabbits: a roentgenographic, scintigraphic, and histologic evaluation.

Extensive bone defects caused by bone tumor resection, osteomyelitis, congenital pseudoarthrosis, post-traumatic bone loss, or femoral head necrosis, require large bone grafts. Such large defects usually are not amenable to conventional, nonvascularized cancellous grafts. By using vascularized bone grafts that do not undergo creeping substitution, that heal rapidly and are not depending on the surrounding tissue, better, safer, and faster results can be obtained. To compare recoveries after vascularized grafts with those after conventional, nonvascularized grafts, experiments were carried out in a rabbit model. They demonstrated good viability and better and faster healing of the microvascular grafts, using radiography, scintigraphy, light microscopy of bone osteocytes and vessels, and tetracycline double-labeling evaluation techniques.

Animals↗
PubMed1985

[Muscular elementarization in the "borderline" replantation and revascularization of the forearm].

In order to avoid the risks of local and general complications encountered in replantations after long ("critical") periods of ischemia, or in cases of severe open fractures with crushed muscles, a so-called "muscle elementarization" technique has been devised. This technique consists of removing the muscular masses which have undergone prolonged ischemia with a priority for the least important muscles. In this manner, we believe that edema and the consequent risks of compartment syndromes as well as of life threatening complications can be reduced. Functional impairment is limited as well. Eleven cases of severe crushing or critical time limit ischemia replantation have been treated in this manner without any complications.

Forearm↗
PubMed1983

Slip-knot flexor tendon suture in Zone II allowing immediate mobilisation.

Immediate mobilisation after flexor tendon suture produces a conflict between the muscle force and resistance of the sutures. Sutures within the tendon after repair are weak and need contrived measures (e.g. wrist and metacarpophalangeal flexion, rubber bands etc.) to prevent dehiscence, while pull-out sutures do not allow mobilisation because of their anchorage. A new technique is presented which consists of a simple slip-knot suture which transmits the tension generated by the muscle to the distal tendon stump and its bony insertion, allowing immediate mobilisation. Results in ninety eight cases repaired by this technique during nine years are presented.

Adult↗
PubMedDate not supplied

Free microvascular fibular versus conventional bone grafts.

Free microvascular grafts have many advantages over conventional bone grafts. Above all they do not undergo creeping substitution and live on their own vessels, thus being able to heal quickly and fight infection. Research in rabbits has been done with radiographic, scintigraphic and light and fluorescence histologic examination which demonstrated the high superiority of quality, reliability and rapidity in healing of the microvascular bone transfer as related to avascular ones. Eighty-five cases of free microvascular fibular transfers starting in 1975 are presented including six congenital cases, 12 non-unions, eight osteitis, seven tumors, seven large losses of bone and 45 femoral head necrosis. The failure ratio is very low. Six primary failures were cured by plaster or additional cancellous bone grafts. Four failures (in femoral head necrosis) did not cure due to recession of the graft, its reabsorption or progression of avascular necrosis in two corticosteroid cases.

Animals↗
PubMedDate not supplied

Electromicroscopic observations on small vessels in animals treated with sulfinpyrazone and placebo following vascular microsurgery.

To evaluate the antithrombotic effect of sulfinpyrazone on blood vessels (1-2 mm diameter) injured by microsurgical procedures, twenty male rabbits were chosen at random to receive sulfinpyrazone (10 mg/kg/die) or placebo three days prior to and on the morning of vascular microsurgery, which consisted of a complete transverse section, or a longitudinal section 1 cm long, of the femoral artery and vein, followed by interrupted suture. Scanning electron microscopy revealed consistently less fibrin and blood cell adhesion to the endothelial areas adjacent to the surgical trauma in the animals treated with sulfinpyrazone than in those treated with placebo. Our results agree with those reported in the literature, demonstrating the antithrombotic effects of sulfinpyrazone at the level of the vascular endothelium injured by various kinds of trauma and are sufficiently encouraging to justify testing this drug in the prevention of vascular thrombosis following microsurgical procedures in man.

Animals↗
PubMedDate not supplied

[Epidemics of musculotendinous pathologies of the upper limbs (cumulative trauma disorders) in a group of assembly line workers].

The study was prompted by a report concerning a group of assembly line workers in a factory producing prams who had developed various muscular and tendinous disorders of the upper limbs that can be classified under the larger category of Cumulative Trauma Disorders (CTD). The study first concentrated on the working conditions with analysis of the main factors responsible for overloading of the upper limbs during work. This analysis revealed high frequency and repetitiveness of upper limb movements together with a marked inadequacy of the length and distribution of pauses. In a significant part of the operations the workers also performed movements in positions that over loaded the wrist and hand. A parallel clinical and instrumental study carried out in collaboration with specialists in orthopedics, brain surgery and neurophysiology on all 40 workers in the shop showed that 90% of the subjects suffered from a form of CTD of the upper limbs: in particular, 40% were affected with carpal tunnel syndrome (12.5% bilateral), and there were high prevalence of tenosynovitis (32% Trigger Finger, 17% De Quervain's syndrome) and epicondylitis (20% medial or lateral). The results of the study once again emphasize the need for greater attention of occupational health practitioners in Italy for muscular and tendinous disorders of the upper limbs due to repeated strain, which Italian law defines, albeit controversially, as occupational.

Adult↗