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Biomedical subjects

M E Jabaley

Publications and source records attributed to M E Jabaley.

At least 19 recordsLinked to original sources
PubMed2000

A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans.

This article reports the first randomized prospective multicenter evaluation of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjects with 136 nerve transections in the hand and prospectively randomized the repair to two groups: standard repair, either end-to-end or with a nerve graft, or repair using a polyglycolic acid conduit. Two-point discrimination was measured by a blinded observer at 3, 6, 9, and 12 months after repair. There were 56 nerves repaired in the control group and 46 nerves repaired with a conduit available for follow-up. Three patients had a partial conduit extrusion as a result of loss of the initially crushed skin flap. The overall results showed no significant difference between the two groups as a whole. In the control group, excellent results were obtained in 43 percent of repairs, good results in 43 percent, and poor results in 14 percent. In those nerves repaired with a conduit, excellent results were obtained in 44 percent, good results in 30 percent, and poor results in 26 percent (p = 0.46). When the sensory recovery was examined with regard to length of nerve gap, however, nerves with gaps of 4 mm or less had better sensation when repaired with a conduit; the mean moving two-point discrimination was 3.7 +/- 1.4 mm for polyglycolic acid tube repair and 6.1 +/- 3.3 mm for end-to-end repairs (p = 0.03). All injured nerves with deficits of 8 mm or greater were reconstructed with either a nerve graft or a conduit. This subgroup also demonstrated a significant difference in favor of the polyglycolic acid tube. The mean moving two-point discrimination for the conduit was 6.8 +/- 3.8 mm, with excellent results obtained in 7 of 17 nerves, whereas the mean moving two-point discrimination for the graft repair was 12.9 +/- 2.4 mm, with excellent results obtained in none of the eight nerves (p < 0.001 and p = 0.06, respectively). This investigation demonstrates improved sensation when a conduit repair is used for nerve gaps of 4 mm or less, compared with end-to-end repair of digital nerves. Polyglycolic acid conduit repair also produces results superior to those of a nerve graft for larger nerve gaps and eliminates the donor-site morbidity associated with nerve-graft harvesting.

Absorbable Implants↗
PubMed1999

Surgical treatment of Dupuytren's disease.

A surgical approach is described that has been used in nearly 200 primary cases of Dupuytren's disease treated by one surgeon. Special attention and comments are directed to the proximal interphalangeal joint, a notoriously difficult area to correct. Observations suggest that the pathologic anatomy of this area is more variable and complex than generally described. The importance of postoperative therapy is stressed.

Dissection↗
PubMed1993

Open hand fractures: an analysis of the recovery of active motion and of complications.

Seventy-five of 104 patients who underwent operative fixation of open hand fractures were reviewed between 6 months and 7 years after injury (average, 17 months). There were 140 fractures involving 125 fingers. Results, evaluated on the basis of total active range of digital motion achieved at final follow-up, correlated highly with severity of soft tissue injury. When open fractures of comparable severity were contrasted between groups that did and did not require additional extension by incision to achieve acceptable reduction and stabilization, there was some additional loss of active range of motion in the surgically treated group. Metacarpal fractures had significantly better outcomes than phalangeal fractures. Fractures involving the proximal phalanx or the proximal interphalangeal joint had the poorest prognosis, especially when they were associated with tendon injury. There were significant complications in 13 fingers. Infection and late amputation were related to wound severity.

Adolescent↗
PubMed1988

Acquired rotational digital deformity in children as a result of finger sucking.

Although most attention to the harmful effects of finger sucking by infants has been on the potential dental deformities, finger deformities also occur. The three cases presented in this article describe radial rotation of the index finger as a result of persistent finger sucking. In the majority of cases rotational deformities spontaneously resolve once finger sucking ceases. In a few cases, particularly when the habit is unduly prolonged, deformities may persist and cause functional impairment. In these patients surgical intervention is indicated. In our cases the rotational digital deformities were treated successfully by rotational osteotomy of either the metacarpal or the proximal phalanx.

Adolescent↗
PubMed1988

Stabilization of fractures in the hand and wrist with traumatic soft tissue and bone loss.

Open type III fractures of the hand or wrist with severe bone and soft tissue loss justify aggressive treatment to restore anatomy, assure healing, and maximize functional recovery. The techniques of modern wound excision used at initial surgery predictably result in a decompressed and surgically clean wound within a few days from injury in the vast majority of cases. This allows a safe application of delayed primary internal fixation and bone grafting for fracture restoration or joint arthrodesis as well as early wound closure or coverage. The immediate or early application of stable external devices, internal fixation, or combinations of the two along with early bone grafting restores the structural integrity of the skeleton, reduces pain, protects other repaired and reconstructed tissues, promotes the healing, and supports early and intensive functional rehabilitation of the hand and wrist. Early wound closure or coverage minimizes scar formation. Together, the early sequencing of effective wound debridement with skeletal stabilization and bone grafting and early wound closure or coverage provide the most favorable circumstances for healing and functional recovery of the seriously damaged hand and wrist.

Adult↗
PubMed1986

Rigid internal fixation in the hand: 104 cases.

One-hundred and four patients with fractures of the metacarpals and phalanges have been treated with rigid internal fixation over a 6-year period. Patients with both open and closed injuries had their fractures fixed by tension band wires, interosseous compression screws (lag screws), or plates and screws. The concepts of primary bone healing and its variations, methods of fixation, and the importance of interfragmentary compression are defined and stressed. Illustrative cases of each technique are described and the applicable principles are enunciated.

Accidents, Occupational↗
PubMed1986

Late breast pain following reconstruction with polyurethane-covered implants.

Two patients of 56 who were reconstructed with polyurethane-coated implants developed breast pain as a late complication and eventually required implant removal for relief. Although the cause of pain was not proven, it may have been due to contracture of the fibrous capsule which formed between the polyurethane and the shell of the implant. The complication of late pain has not been stressed previously in the literature on reconstruction.

Adult↗
PubMed1986

The importance of internal anatomy of the peripheral nerves to nerve repair in the forearm and hand.

We have completed and analyzed recent studies on the internal topography of the median and ulnar nerves of the forearm and hand. These findings have been compared with the classic studies of Sir Sydney Sunderland and more recent work by other authors has been included. Our studies confirm that there is a complex interfascicular relationship between the various components of the median and ulnar nerves in the forearm and hand, but, with careful dissection, several anatomic relationships can be defined. Individual branches and bundles can be traced within the main nerve trunks for considerable distances without significant trauma to the conducting fibers. These include the recurrent branch of the median nerve, the branches to the lumbrical muscles, the motor and sensory components of the ulnar nerve, and the dorsal sensory branch of the ulnar nerve. These findings have a direct relationship to the clinical repair of fresh nerve injuries as well as those injuries that require nerve grafting for significant gaps in the neural tissue. Intraneural neurolysis can be safely performed if detailed knowledge of the internal topography of the peripheral nerves is understood. This knowledge may also be applied to the dissection and management of neuromas in continuity. The increased awareness of the interfascicular relationships of the peripheral nerves may well influence a more favorable outlook in the care of patients with nerve injuries.

Dissection↗
PubMed1986

Evolving concepts of median nerve decompression in the carpal tunnel.

Carpal tunnel syndrome is the most common and best known of the compression neuropathies in the upper extremity. The authors review their clinical experiences in the diagnosis and management of this entity and survey the extensive literature on the subject. An operative approach for decompression of the median nerve in the carpal canal is described that has proved to be most efficacious and safe.

Anesthesia↗
PubMed1984

Technical aspects of peripheral nerve repair.

This essay describes the internal topographical anatomy of peripheral nerves and outlines the use of this information in the specific steps of nerve suture. Repair is detailed in the context of overall wound management and those factors are emphasized which can be controlled by the surgeon and which have a definite effect on the functional outcome.

Humans↗
PubMed1984

Delayed primary bone grafting in the hand and wrist after traumatic bone loss.

Seventeen patients had 21 bone graft operations as part of the overall delayed primary management of hand and wrist wounds. All bone graftings were performed within 10 days of injury. Internal or external fixation was used in all cases, and all wounds healed without infection. Complications included a fibrous union at one bone graft juncture and one malunion. Follow-up was from 3 months to 7 years. Successful delayed primary bone grafting requires a well-decompressed and surgically-clean wound, good blood supply, adequate fixation, and secure soft-tissue cover. If these conditions cannot be met, bone grafting should be deferred and performed in the conventional manner. The advantages of delayed primary bone grafting are: primary bone healing, a shorter rehabilitation period, fewer operations, avoidance of wound contracture, and bone grafting in a well-vascularized scar-free bed.

Adolescent↗
PubMed1982

Reeducation of sensation in the hand following nerve suture.

In the past decade, sensory reeducation has been widely accepted and applied in patients recovering from nerve injury. The results available for analysis in the few published studies suggest that it is a useful adjunct in patients following nerve repair. The percent of patients achieving the highest level of recovery (S4) and the savings in time (two years instead of five) required to reach this level, are strong testimony to the usefulness of sensory reeducation.

Adult↗
PubMed1980

Cellular immune deficiency in black patients with basal cell carcinoma.

Skin cancer, the most common malignancy in white patients, is rare in black populations. Seventeen black patients have been diagnosed and treated for basal cell carcinoma in the past 20 years at the University of Mississippi Medical Center. Ten of them have died, six of various types of cancer. Of the seven living patients, one had two cancers at the time of study: a new basal cell carcinoma and generalized lymphoma. The majority of patients had some degree of mixed racial ancestry, with medium to light brown skin, a history of heavy sun exposure, and lesions appearing on the head or neck. Highly significant depression of cellular immunity was demonstrated in these patients by T-cell assay. Altered tumor surveillance is implied as an etiological factor in basal cell carcinogenesis in black patients.

Adult↗