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Biomedical subjects

M Lanzetta

Publications and source records attributed to M Lanzetta.

At least 55 records · Page 3Linked to original sources
PubMed1995

Clinical use of microvascular PTFE grafts.

This paper reports on the first clinical case where a polytetrafluoroethylene (PTFE) graft of less than 3 mm in diameter was implanted in the arterial system of a patient to bridge a vascular defect. A 1.5 cm long, 1.5 mm diameter prosthesis was interposed in the superficial palmar arch of a man who sustained a laceration of the palm of his dominant hand. The graft was implanted by means of the 3M Precise Microvascular Anastomotic System on one end, and by conventional microsurgical technique on the other end. There were no postoperative complications. The patient resumed his pre-injury activities 9 weeks after trauma. Serial Doppler ultrasound examinations showed normal blood flow and complete patency of the graft. An angiogram performed 12 weeks postoperatively confirmed the patency of the prosthesis. Twelve months post-operatively the patient is free from complications. The use of small diameter PTFE prostheses may be considered when planning grafting procedures for microvascular defects.

Adult↗
PubMed1995

A comparison of different surgical techniques in treating degenerative arthrosis of the carpometacarpal joint of the thumb. A retrospective study of 98 cases.

Between March 1977 and December 1991, 98 surgical procedures on 85 patients were performed at SOS Main Strasbourg for osteoarthrosis of the carpometacarpal joint of the thumb. The mean age was 56 and 90% were female; 13 were operated on bilaterally. 40% had Swanson arthroplasties (group 1), 15% Ashworth-Blatt hemiarthroplasties (group 2), and 45% had soft tissue arthroplasties (group 3). 62 cases were reviewed at an average follow-up of 5 years. Normal thumb range of motion was obtained in all cases, regardless of the technique used. Complete pain relief was achieved in 77% of the cases in group 1, 37.5% in group 2 and 71% in group 3. 15% of group 1 and 50% of group 2 required surgical revision, either for displacement or fracture of the implants. No revision was necessary in group 3. One case of silicone synovitis requiring secondary surgery was noted 6 years after surgery, accounting for 2.9% of the total number of silicone implants reviewed, but radiological signs of silicone synovitis were much more common (56%). Proximal metacarpal migration in group 3 averaged 38% of the initial arthroplasty space, and was not related to the type of ligamentoplasty used, or presence or absence of an "anchovy". The migration increased to 68% of the space if an associated MP joint arthrodesis was carried out at the same time. Complications included reflex sympathetic dystrophy (4% in group 1 and 14% in group 3). The Ashworth-Blatt hemiarthroplasty failed to gain satisfactory results, but both silicone arthroplasty and soft tissue arthroplasty proved to be useful procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

Risk and complications in endoscopic carpal tunnel release.

Single portal endoscopic carpal tunnel release was carried out in 107 hands of 88 patients. There were 11 complications. These included incomplete release (2), post operative scarring around the median and ulnar nerves (2), laceration of the superficial palmar arterial arch (1), reflex sympathetic dystrophy (2), palmar fasciitis (1), and wound inflammation (3). In two cases there was no relief of symptoms. In one there was incorrect diagnosis and in another, incorrect indication for endoscopic carpal tunnel release. The follow-up was from 3 to 18 months with an average of 6.8 months. The overall results of the patients in this series are being presented in another paper. Of the 107 procedures, 73 were rated as having an excellent, 25 good, three fair, and six poor results. The case of laceration of the superficial palmar arterial arch is discussed in detail in the paper. The two cases of reflex sympathetic dystrophy and the one case of palmar fasciitis had mild clinical features and resolved within 3 months. The inflammation in three of the wounds at the wrist resolved within 2 days of removal of the percutaneous sutures. These three patients had returned to heavy hand activities within a few days of surgery.

Adult↗
PubMed1995

Versatility of the homodigital triangular neurovascular island flap in fingertip reconstruction.

This paper reports 25 cases of a versatile homodigital triangular neurovascular island flap for fingertip reconstruction. This flap was used to reconstruct traumatic oblique palmar amputations, with loss of fingertip pulp requiring advancement of not more than 2 cm. Good results were obtained in terms of fingertip contour and padding, sensibility, and functional recovery. The tendency for flexion contracture at the PIP joint was prevented by using a dynamic extension splint at night. Cold intolerance must be expected, especially in cold countries.

Adolescent↗
PubMed1995

Use of the 3M precise microvascular anastomotic system in hand surgery.

The results of a two-center clinical study on the use of the 3M Precise Microvascular Anastomotic System in microvascular procedures for hand trauma are presented. Since November 1992, 17 patients (age range, 18-76 years) have received an end-to-end vascular anastomosis using this device. All patients had vascular trauma or amputation requiring replantation or revascularization procedures. The diameter of the anastomosed vessels varied between 1 and 2 mm. Sixteen of the 17 anastomoses were at the level of or distal to the superficial arterial arch of the hand, with 5 anastomoses as distal as the distal interphalangeal joints. No early thromboses were observed in the postoperative period, and all operations were successful with regard to tissue survival and wound healing. Patency and quality of the blood flow at the site of repair were evaluated by means of Doppler ultrasound investigations. In a few cases, angiography was used to confirm patency of the device.

Adolescent↗
PubMed1995

Association of Wartenberg's syndrome and De Quervain's disease: a series of 26 cases.

We report on a series of 25 patients (26 cases) presenting an association of Wartenberg's radial neuritis and De Quervain's tenosynovitis. In all patients the diagnosis was made on clinical grounds. In group 1, conservative treatment of Wartenberg's syndrome was used in 16 patients (associated with surgical release of the first extensor compartment in 5 patients). Of the 14 patients available for follow-up at an average of 15 months, 9 (64 percent) were excellent and good results. In group 2 (11 patients, with 1 failure of conservative treatment), surgical treatment addressed both conditions. Neurolysis has to be performed at the classic proximal site of entrapment (constant excellent and good results), for the 2 cases of neurolysis at the styloid level gave fair results. It is particularly important to identify an associated Wartenberg's syndrome before performing a release of the first dorsal compartment to avoid incomplete relief or even aggravation of neuritis, exposing the surgeon to litigation.

Adult↗
PubMed1994

Idiopathic avascular necrosis of the scaphoid.

Idiopathic avascular necrosis of the scaphoid is a rare condition. A review of the literature shows a variety of conditions labelled as spontaneous avascular necrosis or Preiser's disease. In this paper we report on a study of eight patients with idiopathic avascular necrosis affecting only the proximal pole of the scaphoid. Seven of these patients had positive ulnar variance. The possible aetiology is discussed and the natural history has been studied. A staging system is proposed, as this helps to determine the prognosis and appropriate management. Two of our patients were managed conservatively; the others were treated successfully by partial silastic replacement of the scaphoid.

Adult↗
PubMed1994

Silicone synovitis. A perspective.

Silicone implant arthroplasty is, arguably, the most effective treatment for the majority of patients with symptomatic arthritis in the hand and wrist. In 1985 the problem of silicone synovitis was first brought to our attention. Since that time there have been numerous reports on this condition leading to a worldwide trend against the use of silicone implants. However, the true incidence and effects of silicone synovitis have not been clearly defined. For this reason, we have undertaken a survey of all patients who have undergone silicone implant arthroplasty in the wrist and hand in our Unit between 1975 and 1990. Patients with rheumatoid arthritis and those undergoing MP or IP joint arthroplasty were excluded. Of the 289 implant arthroplasties remaining, we have been able to review personally 229 implants with a mean follow-up of 3.8 years (range 1-15). Although 40% of cases showed significant radiological changes, only 11 patients (4.8%) developed symptoms requiring treatment. Of these, two were managed conservatively whilst the rest underwent revision surgery, all with entirely satisfactory results. We conclude that silicone implant arthroplasty remains the treatment of choice for patients with painful joint disease in the hand and wrist.

Adolescent↗
PubMed1993

Entrapment of the superficial branch of the radial nerve (Wartenberg's syndrome). A report of 52 cases.

We have treated 50 patients (52 cases) of entrapment of the sensory branch of the radial nerve in the forearm (Wartenberg syndrome) between January 1988 and July 1992. Conservative treatment achieved 71% excellent and good results. Operation was followed by 74% excellent and good results. The indications for each type of treatment are discussed. De Quervain's disease was associated in 50% of cases, and it is important to diagnose Wartenberg's syndrome before operating on the tenosynovitis in order to avoid unexpected postoperative complications and medicolegal problems.

Adult↗
PubMed1993

Use of the 3M precise microvascular anastomotic system in grafting 1-mm diameter arteries with polytetrafluoroethylene prostheses: a long-term study.

The 3M Precise Microvascular Anastomotic System has had an experimental long-term testing for the first time in polytetrafluoroethylene (PTFE) 1-mm diameter arterial grafts. The grafts were placed in the infrarenal aorta of 48 rats. At different time intervals (2 weeks, 16 weeks and 1 year), each section containing a graft and its pair of anastomotic devices was removed and processed for light and scanning electron microscopy, with the aid of a newly-designed device. Eighty-three percent of the mechanically anastomosed grafts were found to be patent. Only 14.8 percent of the grafts harvested at 16 weeks or 1 year showed neo-endothelial lining on the inner surface of the graft. A constant finding of this study was the marked atrophy of the aortic media within the devices, that was progressively evident from 2 weeks to 1 year. A network of capillaries within the graft walls was present at 16 weeks. In one case, a large capillary was found to traverse the graft wall and to reach the luminal surface, suggesting that transmural capillaries may contribute to the formation of neo-intima in 1-mm PTFE grafts.

Anastomosis, Surgical↗
PubMed1993

Surgical management of arthritis of the carpo-metacarpal joint of the thumb.

In the years 1970-90, 118 procedures were performed on 100 patients with arthritis (osteoarthritis in all but 13) of the carpo-metacarpal joint of the thumb. The patients were aged 17 to 83 years (mean 54.5 years); 75 were females and 25 males; there were 73 right and 45 left hands; 18 patients had bilateral procedures. The average follow up period was 4.3 years, with a range of 1 to 20 years. Sixteen of the 118 procedures were arthrodeses; all these patients had isolated trapezio-metacarpal joint arthritis. Fifteen procedures were trapeziectomies and soft tissue arthroplasties; they were performed for pan-trapezial arthritis in the older age group, or as a secondary procedure for failed previous operations. Eighty-seven of the 118 procedures were silicone partial or total arthroplasties either for pan-trapezial arthritis or isolated trapezio-metacarpal joint arthritis (53 trapezium, 32 metatarso-phalangeal and 2 condyle implants). The overall results were: arthrodesis (68.7% good, 18.8% fair, 12.5% poor); soft tissue arthroplasty (80% good, 6.7% fair, 13.3% poor); silicone total arthroplasty (73.5% good, 15.1% fair, 11.3% poor); silicone hemiarthroplasty (68.8% good, 15.6% fair, 15.6% poor). No silicone synovitis was found in any of the 87 cases of silicone arthroplasties.

Adolescent↗
PubMed1992

Achieving better patency rates and neoendothelialization in 1-millimeter polytetrafluoroethylene grafts by varying fibril length and wall thickness.

This study evaluates the effects of different fibril lengths and wall thicknesses on patency and neoendothelialization in 1 mm inner diameter polytetrafluoroethylene (PTFE; Gore-Tex) grafts and highlights the importance of longer fibril lengths and matching wall thicknesses. Fibril lengths tested were 30, 60, and 90 microns. The grafts had a wall thickness ranging from 0.18 to 0.34 mm. Ninety-six grafts were implanted in the infrarenal aorta of Wistar rats. Grafts were harvested at various intervals and examined macroscopically, by light microscopy, and by scanning electron microscopy. Both the highest patency rates and the best grades of neoendothelialization were observed in the 90 microns fibril length grafts, while the lowest of both were seen in the 30 microns fibril length grafts. From this study we conclude that 90 microns fibril length PTFE can be considered a valid micrograft for bridging arterial defects in microvascular reconstructive procedures.

Animals↗
PubMed1992

Long-term results of 1 millimeter arterial anastomosis using the 3M precise microvascular anastomotic system.

The 3M Precise Microvascular Anastomotic System has been tested experimentally in long-term studies of arteries of 1 mm in diameter for the first time. The device was placed, using a newly described technique, in the infrarenal aorta of 25 rats. At different intervals (2 weeks, 16 weeks, and 1 year), the section containing the 3M Precise Microvascular Anastomotic System was removed and processed for light microscopy and scanning electron microscopy. All the anastomoses were found to be patent. Using a new device to process the material, both light microscopy and scanning electron microscopy at 2 weeks showed a perfect reparative process at the junction site and the presence of a continuous endothelial layer. Media atrophy was responsible for wall thinning within the device. At 16 weeks, the atrophy of the media was even more marked, reducing the vessel wall thickness within the device to one-third of normal. At 1 year, this atrophy of the media was complete; smooth muscle cells disappeared and were replaced by fibrous tissue. Adventitia was not present over the long term within the device. The continuous endothelial layer, however, was still viable. These long-term results suggest that scar tissue forms within the device, while a continuous endothelial layer remains viable internal to this.

Anastomosis, Surgical↗
PubMed1992

Closed rupture of both flexor tendons in the same digit.

Closed ruptures of both normal flexor tendons in the same finger are extremely rare, only nine cases having been reported in the literature. We describe the case of a patient who sustained a closed rupture of both flexor digitorum profundus and flexor digitorum superficialis of the ring finger, following a forced hyperextension injury. The patient was treated by a two stage reconstruction of the flexor digitorum profundus. He regained full flexion and extension of the finger.

Accidents, Occupational↗
PubMed1992

Aneurysms of the palmar arch and a proper digital artery: case report and literature review.

The first reported case of multiple aneurysms of both the palmar arch and a proper digital artery is described. A palmar arch aneurysm was excised, and two end-to-end anastomoses were necessary to restore the blood flow. Microsurgical repair was the only possible treatment in this case. The authors believe that the vascular anatomy should always be restored as naturally as possible. No treatment was necessary for the more distal aneurysms.

Adult↗
PubMed1992

[Fetal microsurgery. The past and present of a frontier of surgery].

The concept that the fetus may be a patient is very recent. Modern ultrasonography can detect fetal abnormalities early in utero, and lead to prenatal correction of such malformations. At present three anatomic defects can benefit from fetal surgery: diaphragmatic hernia, urethral obstructions and obstructive hydrocephalus. The feasibility of fetal surgery has been proved both experimentally and clinically. Microsurgery can be of great help in this type of surgery. At this stage, fetal surgery should be pursued only in very qualified centers.

Animals↗