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Biomedical subjects

H Millesi

Publications and source records attributed to H Millesi.

At least 19 recordsLinked to original sources
PubMed1992

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 76 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference in the retroauricular angle between the surgical group and controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

Adult↗
PubMed1992

Are growth alterations a consequence of surgery for prominent ears?

This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the retroauricular angle in the surgical group and in controls. The morphologic ear length in the surgical group was significantly smaller than in controls. Maximum ear length was significantly greater in men. Our measurements in the control group were significant below the reference values reported in the literature. Comparing the ear index of both groups with published data, we found a harmony between the width and the length of the ear. We could demonstrate that prominent ears were significantly larger in all other dimensions and that auricular growth does not stop following surgery for prominent ears with the cartilage excision method. We also evaluated subjective criteria such as tolerance to cold, scar formation, and patient satisfaction.

Child↗
PubMed1991

Biomechanical properties of elastase treated palmar aponeuroses.

Human palmar aponeurosis was treated with elastase in the presence or absence of soybean trypsin inhibitor. The removal of elastic fibers was complete as proved by electron microscopy. Cyclic loading was performed at a constant strain rate. Residual strain was measured and the stiffness and the fraction of dissipated energy of strain energy was calculated and compared to that of untreated samples of palmar aponeurosis. Residual strain and dissipated energy showed a dramatic increase after enzyme treatment, both in presence and absence of soybean trypsin inhibitor. Stiffness, on the other hand was reduced. The remaining collagen fibers show a more viscous behavior. Our results support the hypothesis that the elastin fibers are responsible for the elastic recovery, observed on specimens of untreated palmar aponeurosis.

Adult↗
PubMed1990

The gliding apparatus of peripheral nerve and its clinical significance.

Every nerve must have the capacity to adapt to different positions by passive movement relative to the surrounding tissue. This capacity is provided by a gliding apparatus around the nerve trunk. There is another level of gliding provided by the interfascicular epineurium which allows the fascicles to glide against one another. The clinical significance of the gliding apparatus in the context of external and internal neurolysis and nerve repair is discussed. An explanation is offered for the occurrence of the so-called meander-like deformity of fascicles, seen in nerve entrapment syndromes.

Elasticity↗
PubMed1990

[Results of decompression of the ulnar nerve in Guyon's canal].

Between January 1980 and March 1988 twenty-two patients with compression neuropathies of the ulnar nerve in the Guyon's canal were treated. In seven patients the ulnar nerve was simultaneously decompressed at the elbow. Nine patients suffered from disorders of the sensibility and thirteen patients had sensory and motor symptoms. The ulnar nerve compressions were caused by a ganglion, a thrombosed aneurysm of the ulnar artery, or an aberrant branch of the ulnar artery; in ten cases by the fibrotic arch of the origin of the hypothenar muscles and in eight cases by the roof of the Guyon's canal. In one case no abnormality could be found. The follow-up of twenty-one patients showed, that the sensibility was improved or normalized. The motor function was normalized or improved in three patients and remained unchanged in four patients. No correlation could be found between the postoperative results, the intraoperative findings, the patients' age and the period of symptoms.

Adult↗
PubMed1990

[The gliding tissue of the median nerve in the carpal tunnel].

Passive movement of nerves is possible because the epifascicular epineurium is connected to the surrounding tissue by a loose connective tissue. In the carpal tunnel tendon sheaths have been developed to facilitate gliding of tendons produced by muscle contraction. By cadaveric dissection and by intraoperative examination of the carpal tunnel, a special gliding tissue of the median nerve could be demonstrated. Injection of fluid into the tissue revealed a sheath-like structure with a space between the layers limited both proximally and distally. Intraoperatively a parietal layer of loose connective tissue and several layers surrounding the median nerve could be demonstrated.

Connective Tissue↗
PubMed1989

[Is intraneural neurolysis in ulnar nerve sulcus syndrome justified?].

A follow-up of thirty-seven patients with ulnar nerve entrapment at the elbow is presented. External neurolysis was performed in fourteen cases, whereas internal neurolysis involving interfascicular dissection was performed in twenty-three cases. When indicated, internal neurolysis can lead to very good results. However, unnecessary interfascicular dissection may result in unwarranted impairment of hand function.

Elbow↗
PubMed1989

[Elastic behavior of the median nerve and ulnar nerve in situ and in vitro].

This study was performed to investigate the mechanical properties of the median and the ulnar nerve in ten fresh cadaver extremities in situ and in a second series in vitro in a strain controlled testing equipment. In situ the nerves were fixed in the equipment at the level of the insertion of the pectoral muscle. The extensions of the nerves were tested in the undissected bed of the nerve with loads from 2 to 25 Newtons. The extension rate of three sections was measured: A: Axilla-wrist, B: Axilla-forearm, C: Axilla-elbow. On the contralateral arm the section D: Axilla-wrist was measured after cutting the nerve's branches without destroying the nerve's bed. The values of the section A, B, and C were significantly different. The nerves were less extensible the more distal the load was fixed. The values of the two sections with equal length A, without, and D, after cutting the nerve's branches also were significantly different (p less than 0.001). The in vitro series showed that the nerves were more extensible after removal of the connective tissue of the nerve's bed.

Biomechanical Phenomena↗
PubMed1988

Sonoanatomy of the muscles of facial expression.

Primary anatomic studies served for identification and differentiation of the individual mimetic muscles. As a second step, we investigated the clinical potential of ultrasound imaging to visualize the mimetic musculature in 15 volunteers. This examination technique was used to diagnose pathological alterations, especially associated with facial palsy. The excellent sonographic visualization of the mimetic musculature indicates that this technique may be a valuable adjunct in the diagnosis and differentiation of facial palsy, as well as in planning plastic surgery and reconstructive procedures, and in follow-up care.

Adolescent↗
PubMed1988

Photogrammetry of the muscles of facial expression.

The present study has attempted to determine the volume, square measure as well as length, width and thickness of the individual muscles of facial expression by photogrammetry. 15 fresh male head specimens were employed for a careful dissection of muscle layers. The volume was measured using the immersion procedure. The mean values of each parameter together with the standard deviation were summarized. The results suggest that this novelty in the representation of the mimetic muscles will facilitate the planning of corrective interventions in plastic surgery. Moreover, photogrammetry offers additional information on the required size and measurements of donor muscles.

Aged↗
PubMed1988

Brachial plexus injuries. Nerve grafting.

Brachial plexus lesions with complete or partial palsy of the dependent musculature are a severe handicap for the patient. By microsurgery of lesions in continuity and nerve grafting in cases with complete interruption, some recovery can be achieved. Comparing the present-day results with the ones of earlier years, a significant increase of the percentage of useful recoveries has been observed. The quality of the results of the two groups does not differ very much.

Adolescent↗
PubMed1987

[Primary measures in facial nerve injuries].

Anterior to a vertical line across the lateral angle of the eyelids it is not mandatory to restore the continuity of a single transected branch of the facial nerve. The marginal branch of a facial nerve has always to be restored and a repair has to be performed if several neighbouring facial nerves are involved. A primary repair is indicated because only at the day of injury and a few days after, before Wallerian degeneration occurs, the localization of the peripheral stump by electrostimulation is possible. In the middle third of the extratemporal course of the facial nerve each branch has to be repaired and primary repair is advocated. If the main trunk of the facial nerve is involved, early secondary repair by a surgeon experienced with facial nerve surgery is the treatment of choice.

Facial Nerve Injuries↗
PubMed1987

[Surgical treatment of traumatic brachial plexus lesions].

The introduction of a reliable technique for nerve transplantation and the development of microsurgical neurolysis have made it possible to improve the degree of functional restoration that can be achieved following post-traumatic lesions of the brachial plexus. Although the functional recovery achieved still leaves a great deal to be desired, it is possible to reach a level of functioning that is beneficial for the patient. It is essential for the initial treatment plan to take account of both surgical reconstruction in the region of the brachial plexus itself and subsequent improvement of function by means of appropriate palliation.

Brachial Plexus↗
PubMed1986

The nerve gap. Theory and clinical practice.

In peripheral nerve surgery, the term "gap" means the distance between the two stumps of a transected peripheral nerve without further specification. The factors that contribute to the formation of a gap are analyzed in this paper. It becomes clear that the gap formed by a true nerve defect has a different meaning than a gap formed by elastic retraction. The final length of a particular nerve gap in an extremity is decisively influenced by the joint position. Therefore, the question arises regarding how a nerve adapts to the length difference during limb motion, which can be estimated for the median nerve during flexion and extension of the elbow joint with approximately 10 cm in an adult patient. Three mechanisms play an important role: true elongation of the length of the nerve in the relaxed state against elastic forces; movement of the nerve trunk in the longitudinal direction; and increase and decrease of the tissue relaxation at the level of the nerve trunk (relaxed course) and the nerve fibers (change in the undulated course). The efficiency of this mechanism partially depends on the ability of the nerve to move against the surrounding tissue. This ability is provided by the loose connective tissue around the nerve (adventitia, conjunctiva nervorum, perineurium). Only if this movement is possible, traction forces to elongate the nerve are distributed over the whole length of the nerve and are kept minimal for each particular segment. Adhesions of the nerve trunk at the site of repair prevent an equal distribution of forces and cause an unfavorable rise of traction forces at certain segments, according to the anatomic site. True elongation of the nerve, therefore, has only a limited application in overcoming a gap. Alternatives are rerouting, limb-shortening, and nerve-grafting. Today, the most reliable technique is the use of autologous cutaneous nerve segments as free nerve grafts. Advantages and disadvantages of "vascularized" nerve grafts are discussed. The use of neuromatous neurotization to overcome a gap is still in an experimental state.

Elasticity↗
PubMed1985

Peripheral nerve repair: terminology, questions, and facts.

The most important single technical factor in peripheral nerve repair is the coaptation of fascicular tissue. Only an exact description of how coaptation is achieved according to fascicular patterns, can provide the basis for a comparison of results. The problem of preparation of the stumps was discussed, and a method was suggested for defining conditions at different stump levels, in order to indicate to which level the resection should be carried. Demonstrations of the advantages of resecting the epifascicular epineurium, relating to various types of fascicular patterns, were provided. Different factors which contribute to the formation of gaps between nerve stumps were analyzed. Problems related to the sliding capacity of peripheral nerves were discussed, as well as the relationship between sliding capacity and tension distribution along the nerve. A schematic overview of different possibilities for overcoming gaps at the coaptation site was provided. Suggestions were offered for defining the term "neurotization," and different neurolysis procedures were described.

Humans↗