W F Kolkman | PubMed Health

PubMed1997

Adventitial stripping does not strip the adventitia.

This study investigates the process of stripping the adventitia off a blood vessel, which is a normal procedure prior to performing a microvascular anastomosis. In five rats, the common carotid and the superficial femoral arteries of one side were stripped sharply, whereas the arteries of the other side were left unstripped to serve as controls. In a further set of five rats, the arteries were stripped bluntly. Immediately following stripping, experimental and control arterial segments were removed. Histology of cross sections of the segments was studied. In no case was there complete removal of the adventitia. When stripped and control arterial sections were compared, no significant difference between cross-sectional adventitial areas could be demonstrated. Morphologic study revealed that stripping mainly removes large collagen fibers from the adventitia. The small collagen fibrils that are still in place fan out in such a way that although considerable tissue is removed, the volume that the adventitia occupies remains the same. Stripping the adventitia does not cause complete removal of the adventitia, and in this study no significant reduction in the adventitial volume could be found. Stripping does, however, allow a better view of the cut edge of the vessel wall under an operating microscope. Since blunt stripping could cause damage to other vessel wall layers, sharp stripping is to be preferred.

Anastomosis, Surgical↗

PubMed1996

Changes in the carpal tunnel due to action of the flexor tendons: visualization with magnetic resonance imaging.

Successive cross-sectional areas (CSA) of the carpal tunnel were measured with the fingers in both extension and full flexion in 12 healthy volunteers using magnetic resonance imaging. During flexion, lumbrical muscles could be observed to move into the carpal tunnel up to different levels in all volunteers. For each of the volunteers, the level of the hook of hamate was used as the reference level. The mean CSA measured at this level was considerably larger in flexion than in extension: 191 mm2 (SD, +/- 26) and 169 mm2 (SD, +/- 15), respectively (p = .004). In three volunteers, no difference in CSA between extension and flexion was measured at the hamate level, despite the presence of lumbrical muscles, whereas in these same volunteers at levels more distal, the CSA clearly increased during flexion. The mean CSA for extension and flexion distal and just proximal to the smallest level differed significantly, but the absence of expansion was noticed only at the smallest level. Other changes that were frequently observed during flexion were fat compression, flattening and displacement of the median nerve, and pressure on the superficial and deep flexor tendons.

Adult↗