| 1. |
- Kalbermatten, Daniel F, 1969-, et al.
(författare)
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Schwann cell strip for peripheral nerve repair
- 2008
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Ingår i: Journal of Hand Surgery - British and European Volume. - : SAGE Publications. - 0266-7681 .- 1532-2211. ; 33:5, s. 587-594
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Tidskriftsartikel (refereegranskat)abstract
- Many strategies have been investigated to provide an ideal substitute to treat a nerve gap injury. Initially, silicone conduits were used and more recently conduits fabricated from natural materials such as poly-3-hydroxybutyrate (PHB) showed good results but still have their limitations. Surgically, a new concept optimising harvested autologous nerve graft has been introduced as the single fascicle method. It has been shown that a single fascicle repair of nerve grafting is successful. We investigated a new approach using a PHB strip seeded with Schwann cells to mimic a small nerve fascicle. Schwann cells were attached to the PHB strip using diluted fibrin glue and used to bridge a 10-mm sciatic nerve gap in rats. Comparison was made with a group using conventional PHB conduit tubes filled with Schwann cells and fibrin glue. After 2 weeks, the nerve samples were harvested and investigated for axonal and Schwann cell markers. PGP9.5 immunohistochemistry showed a superior nerve regeneration distance in the PHB strip group versus the PHB tube group (> 10 mm, crossed versus 3.17+/- 0.32 mm respectively, P<0.05) as well as superior Schwann cell intrusion (S100 staining) from proximal (> 10 mm, crossed versus 3.40+/- 0.36 mm, P<0.01) and distal (> 10 mm, crossed versus 2.91+/- 0.31 mm, P<0.001) ends. These findings suggest a significant advantage of a strip in rapidly connecting a nerve gap lesion and imply that single fascicle nerve grafting is advantageous for nerve repair in rats.
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| 2. |
- Atroshi, I, et al.
(författare)
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The SF-6D health utility index in carpal tunnel syndrome.
- 2007
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Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32:2, s. 198-202
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Tidskriftsartikel (refereegranskat)abstract
- Cost effectiveness is an important factor to consider when choosing between various hand surgical interventions. Health utility measures can be used to determine cost effectiveness. The SF-6D is a health utility index derived from 11 items of the SF-36 quality of life questionnaire; values range from 0.296 to 1.0 (“perfect” health). We evaluated the validity of the SF-6D in patients with carpal tunnel syndrome (CTS) who completed the SF-36 and the CTS symptom severity and functional status questionnaire before and 3 months after carpal tunnel release. Complete responses to the SF-6D items were available for 100 patients at baseline and 95 patients at baseline and follow-up. The mean SF-6D health utility index was 0.69 (SD 0.13) before surgery and 0.77 (SD 0.13) after surgery (moderate effect size). The SF-6D could discriminate between patient groups differing in self-rated global health and in whether, or not, they had a minimal clinically important improvement in CTS symptom severity after surgery. The SF-6D appears to be a valid measure of health utilities in patients with CTS and can be used in cost effectiveness studies.
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| 3. |
- Berglund, Maria, 1975-, et al.
(författare)
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The inflammatory response and hyaluronan synthases in the rabbit flexor tendon and tendon sheath following injury
- 2007
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 32:5, s. 581-587
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Tidskriftsartikel (refereegranskat)abstract
- Using a rabbit model of flexor tendon injury, mRNA levels for a subset of relevant molecules involved in inflammatory and fibrotic processes were assessed by reverse transcriptase-polymerase chain reaction 3, 6, 12 and 24 days after injury. Increased levels of COX-2, IL-1beta, MMP-13 and TIMP-1 mRNA were detected in both tendon and tendon sheath following injury, with each molecule exhibiting tissue and time-dependent changes. MMP-13 and TIMP-1 mRNA levels were markedly upregulated in both tissues, whereas COX-2 and IL-1beta predominantly increased in tendon. Both hyaluronan synthase (HAS) 2 and 3 exhibited increases in mRNA levels in tendon tissue after injury, HAS 2 being more pronounced. These findings support the concept that healing in the flexor tendon and the sheath involve different molecular events and that each tissue may require unique modifications if healing is to be enhanced and adhesions reduced.
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| 4. |
- Einarsson, Fredrik, 1968, et al.
(författare)
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Subscapularis muscle mechanics in children with obstetric brachial plexus palsy
- 2008
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Ingår i: The Journal of Hand Surgery (European Volume). - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 33:4, s. 507-12
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates the passive mechanical properties of the subscapularis muscle in children with a contracture as a result of obstetrical brachial plexus palsy. Muscle biopsies were harvested from nine children undergoing open surgery for shoulder contracture. Passive mechanical testing of single cells and muscle bundles was performed. Corresponding comparisons were made using muscle biopsies from seven healthy controls. Single muscle fibres from patients with obstetric brachial plexus palsy displayed a shorter slack sarcomere length, linear deformation of the fibre within a wider zone of sarcomere length and a greater relative increase in stiffness compared with muscle bundles. We conclude that secondary changes in muscle fibre properties will occur as a result of a longstanding lack of sufficient passive stretch, leading to compensatory changes in the extracellular matrix. These results suggest the presence of a dynamic feedback system constituting a muscle-to-extracellular matrix communication interface.
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| 5. |
- Rosén, Birgitta, et al.
(författare)
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Enhanced sensory recovery after median nerve repair using cortical audio-tactile interaction. A randomised multicentre study.
- 2007
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Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32:1, s. 31-37
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Tidskriftsartikel (refereegranskat)abstract
- The "Sensor Glove System" offers an alternate afferent inflow from the hand early after nerve repair in the forearm, mediated through the hearing sense, implying that deprivation of one sense can be compensated by another sense. This sensory "by-pass" was used early after repair of the median nerve with the intention of improving recovery of functional sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. In a prospective multicentre clinical study, one group (n = 14) started early after surgery with sensory re-education using the Sensor Glove System and the control group (n = 12) received conventional sensory re-education, starting 3 months postoperatively. The patients were checked regularly during a 1-year period, with focus on recovery of tactile gnosis. After 12, months, tactile gnosis was significantly better in the Sensor Glove System group. This highlights the timing for introduction of training after nerve repair, focusing on the importance of immediate sensory re-learning.
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| 6. |
- Svernlov, Birgitta, et al.
(författare)
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Conservative treatment of the cubital tunnel syndrome
- 2009
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 1753-1934 .- 2043-6289. ; 34:2, s. 201-207
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Tidskriftsartikel (refereegranskat)abstract
- Conservative treatment of the cubital tunnel syndrome was evaluated in a randomised study of 70 patients with mild or moderate symptoms (Dellon, 1989). All patients were informed about the cause of symptoms and allocated to three groups: night splinting, nerve gliding and control. Evaluation consisted of Canadian Occupational Performance Measure, visual analogue pain scales, strength measurements and neurophysiological examination, before treatment and after six months. Fifty-seven patients were followed for six months. Fifty-one (89.5%) were improved at the follow-up. There were no significant differences between the groups in any of the recorded variables. Night splints and nerve gliding exercises did not add favourably. Routine neurophysiological examination seems unnecessary since 76% of the patients with typical symptoms had normal findings and 75% with pathological findings improved. Patients with mild or moderate symptoms have a good prognosis if they are informed of the causes of the condition and how to avoid provocation.
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| 7. |
- Tägil, Magnus, et al.
(författare)
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Correlation Between Range of Motion and Implant Fracture: A 5 Year Follow-Up of 72 Joints in 18 Patients in a Randomized Study Comparing Swanson and Avanta/Sutter Mcp Silicone Prosthesis
- 2009
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Ingår i: Journal of Hand Surgery: European Volume. - : SAGE Publications. - 2043-6289 .- 1753-1934. ; 34E:6, s. 743-747
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Tidskriftsartikel (refereegranskat)abstract
- Eighteen out of 18 rheumatoid patients (at one centre of a two-centre 30 patient study previously reported) with a mean age of 56 years, and 72/72 operated joints were randomized to Avanta/Sutter or Swanson MCP prostheses and followed for 5 years. Both ulnar deviation and extension lag were improved already at 6 weeks and remained improved at 5 years. The Avanta prosthesis had a better range of motion (ROM) than the Swanson. Six of nine patients with Avanta/Sutter implants had at least one implant fracture compared to 1/9 patients with the Swanson implant (P=0.05) but fracture did not change the outcome subjectively. The ROM at 3 months correlated with the occurrence of an implant fracture at 5 years and a greater early ROM may be related to implant fracture. At 5 years patients remained satisfied and the deformities remained corrected.
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| 8. |
- Tägil, Magnus, et al.
(författare)
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Wound healing after hand surgery in patients with systemic sclerosis-a retrospective analysis of 41 operations in 19 patients.
- 2007
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Ingår i: Journal of Hand Surgery (British Volume). - : SAGE Publications. - 0266-7681 .- 1753-1934 .- 2043-6289. ; 32E:3, s. 316-319
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Tidskriftsartikel (refereegranskat)abstract
- t This retrospective study evaluates the results of 41 consecutive hand and forearm operations in 19 patients with systemic sclerosis performed between 1985 and 2000. The mean age of the patients was 50 (14-84) years. Twenty-seven operations were elective and 14 were acute, carried out for skin breakdown and/or skin necrosis. One minor wound healing problem occurred in the elective group. In the acute group, seven of 14 operations healed uneventfully. Four patients had necrosis/ infections after surgery, which required further surgery. Two patients had repeated wound infections. Another patient only healed after he stopped smoking. In systemic sclerosis, surgery performed electively does not seem to have increased difficulty with wound healing. Even larger operations, such as wrist arthrodesis or wrist replacement, can be performed safely. In acute cases with spontaneous skin breakdown and/or necrosis and/or critically ischaemic fingers, wound healing is more precarious and several procedures may be necessary to achieve skin healing.
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