Biomedical subjects
Publications and source records attributed to Giorgio A Brunelli.
Various types of sensory nerve transfer in the hand are presented. They were all performed after brachial plexus injury to restore sensation, mainly to the adjacent borders of the thumb and index finger or to the ulnar aspect of the little finger. Twenty one cases were assessed. Their outcomes according to the Highet-Zachary system were: S2 in nine cases, S2 in four cases, S1 in four cases and S0 in four cases.
Permanent palsies of the median nerve cause severe impairment of hand functions. This chapter reviews both the various surgical methods able to restore functions and complex mechanisms necessary for brain adaptation to the new functions of the cortical areas. Different methods of reconstructive surgery, according to both the severity of palsy and patients' needs, are presented. The contemporary restoration of sensory function of the paralysed digits is recommended, as sensation is a prerequisite for good motor function. The various mechanisms and methods useful to obtain good gliding and strength of the transferred tendons are stressed. Reconstructive surgery for permanent palsy of the median nerve can supply improved function, provided that all the recommendations for a meticulous balance of the number of functions to be restored and available motors to be transferred, as well as of their strength and course, are addressed.
After having hinted to the various component of the malformity caused by malunions of the distal radius fracture, the various possibilities of correcting this deformity are described. The difficulty to correct all the components of the deformity are considered. Then a Dome-shaped osteotomy of the distal radius is described that allows to correct all the deformities in all the directions as the gliding plane of the osteotomy is spherical. The ulnar plus and the DRUJ alterations are corrected by means of an added Sauvé-Kapandji procedure that guarantees against any painful movement of the DRUJ preserving effective prono-supination.
Surgery of the spinal cord is still experimental, and outcomes must be confirmed by more cases. In this field, knowledge and research are still figuratively in the Stone Age. Nevertheless, the author is confident that in the future, with the improvement of surgical and resuscitation techniques and with the introduction of new biotechnologic drugs and molecules that favor axon regeneration and inhibitor blocking, CNS-peripheral nerve connections can be performed with some functional improvement, even in tetraplegia.
Sural nerve withdrawal in peripheral nerve surgery is commonly performed for grafting nerve lesions with gap. Notwithstanding its popular use, this procedure is not entirely without fault as painful neuromas can occur after the withdrawal. We have treated 24 cases of painful neuromas of sural nerve after withdrawal; 11 of which were treated surgically. A safe procedure to cure and to prevent such neuromas is described - the electrical coagulation of the stump of the nerve by slowly increasing the intensity of the current. This procedure has been devised based on the fact that electrically burnt patients do not produce painful neuromas. An experimental histological study performed on rats demonstrated that slow electrical burning of the stump of a severed nerve prevents the formation of intraneural fibrosis which, on the contrary, forms abundantly when the cut nerve is not coagulated.
Arthritis of the trapezio metacarpal joint (TMJ) is a very frequent condition, which affects women more than men, especially in the fifth or sixth decade of life. It can be very painful and disabling and the patient will need surgery for relief even if it can result in painless stiffening (in adduction of the metacarpal and hypertension of the metacarpal, which in turn is very disabling). TMJ arthritis is rarely primary or idiopathic; in general, it is secondary to instability of the joint, which, in turn, may be primary or secondary.