Twenty-one patients with revascularized/replanted amputated parts of the upper limb were studied for an evaluation of hand function. Two patients had been injured at the lower arm to wrist level, four between the wrist and MCP joint, three distal to the MCP joints in thumbs and/or fingers, and twelve in the thumb only. Hand function was measured as grip and pinch strength, range of movement (ROM), sensibility (two point discrimination), and Sollerman test score. Cold sensitivity as related to circulatory changes in the replanted limb was evaluated in six patients using the critical opening test (COP). Twelve of 17 initiated replantations (71%), and 11 of 12 revascularizations (92%), were successful. Hand function was restricted in patients with amputations at the lower arm to wrist level, fair in replanted midhands, good, but with wide variations after replantations at the MCP or distal II-V fingers, and best of all in replanted thumbs. Sensibility was poor in a majority of the patients. Three out of six of the patients who were COP-tested had significantly reduced blood pressure in the replanted part. The test results (grip, ROM, Sollerman score) in three patients with amputated thumbs were not found to differ greatly from those with replanted thumbs. These results raise the question of whether the Sollerman test underestimates the importance of the thumb or whether the thumb is overestimated in hand function.
One hundred and sixty-five patients with localized cancer of the lower lip were excised and reconstructed over a 25-year period using Bengt Johanson's step technique. Eight-eight percent of the tumors were less than 2 cm in size and 65% were of high histopathological differentiation. Fifty-six percent were reconstructed with bilateral step flaps. Nine local recurrences appeared in 5 patients, none of whom died of lip cancer. Eight patients later developed regional metastases and 3 of these patients died of lip cancer. The 5-year survival rate was 98%. The step technique is recommended for reconstruction of lip defects of up to 2/3 of the lower lip and may, in larger resections, be combined with either a fan flap or an Estlander flap. The outstanding functional results are due to the use of adjacent tissue for the reconstruction which preserves the normal arrangement of muscles, vessels and nerves.
Fifty-five eyelids operated on for congenital blepharoptosis over a 10-year period were followed up, with a mean observation time of seven years. Ptosis was on the right side in 12 patients, the left side in 20, and bilateral in 12. Ptosis was regarded as being slight in 32 eyelids, moderate in 10 and severe in 14. The operative procedure was resection of the levator muscle and its aponeurosis through an anterior approach. Fifty-five percent of the patients with slight ptosis were improved, with the eyelid having a normal position. All the patients with moderate ptosis were improved--half to a normal eyelid position, and half with a residual slight ptosis. All but one patient with severe ptosis were improved, and half of these to a normal eyelid position. It is concluded that this operation can be used for all types of congenital ptosis, and especially in severe cases, where it produces better results than e.g. the frontalis sling procedure.
In one group (a) one ear of NMRI hairy mice was scalded in water at 36 degrees C, 39 degrees C, 42 degrees C, 45 degrees C, 48 degrees C, 51 degrees C, 52 degrees C, 53 degrees C, 54 degrees C, 57 degrees C, and 60 degrees C for 20 s, using a new dip burn model, for evaluation of edema formation 2 h postburn. In another group of mice (b) one ear was scalded in the 45 degrees C-60 degrees C interval and the ear studied in a vital microscope repeatedly for 4 days. In a third group (c), one ear was scalded in the 36 degrees C-60 degrees C interval and the microcirculatory flow was recorded by a laser Doppler flowmeter (1Df) for a period of 2 h postburn. In a fourth group of animals (d) one ear was scalded at 53 degrees C or 54 degrees C. In some animals the ear was then cooled in 8 degrees C water or saline for 30 min. Others were treated preburn with cimetidine, Ketanserin, indomethacin or methylprednisolone. Edema was determined in group (a) by wet-dry weight measurements of punch biopsies from both the burned and the contralateral unburned ear and expressed as an increase in tissue water content. The long-term effect was determined by observing the survival of the ears (groups b and d); the area of necrosis was expressed as a percentage of the total area of the ear. Significant edema was formed in ears immersed in 48 degrees C to 60 degrees C water with a maximum after 53 degrees C burns.(ABSTRACT TRUNCATED AT 250 WORDS)
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