Regeneration of Denervated Skeletal Muscles - Brunelli's CNS-PNS Paradigm.

The restoration of voluntary muscle activity in posttraumatic paraplegia in both animal experiments and other clinical applications requires reproducibility of a technically-demanding microsurgical procedure, limited by physicians' understanding of Brunelli's spinal cord grafting paradigm. The insufficient clinical investigation of the long-term benefits of the CNS-PNS graft application warrants additional inquiry. The objective of this study is to explore the potential benefits of the first replicated, graft-induced neuroregeneration of denervated skeletal muscle regarding long-term clinical outcomes and to investigate the effect of Cerebrolysin on neuromodulation.

Dome-shaped osteotomy for distal radius fracture malunions.

After having hinted to the various component of the malformity caused by malunions of the distal radius fracture, the various possibilities of correcting this deformity are described. The difficulty to correct all the components of the deformity are considered. Then a Dome-shaped osteotomy of the distal radius is described that allows to correct all the deformities in all the directions as the gliding plane of the osteotomy is spherical.

Reconstructive surgery for permanent palsy of the median nerve.

Permanent palsies of the median nerve cause severe impairment of hand functions. This chapter reviews both the various surgical methods able to restore functions and complex mechanisms necessary for brain adaptation to the new functions of the cortical areas. Different methods of reconstructive surgery, according to both the severity of palsy and patients' needs, are presented.

Sensory nerves transfers.

Various types of sensory nerve transfer in the hand are presented. They were all performed after brachial plexus injury to restore sensation, mainly to the adjacent borders of the thumb and index finger or to the ulnar aspect of the little finger. Twenty one cases were assessed.

Prevention of damage caused by sural nerve withdrawal for nerve grafting.

Sural nerve withdrawal in peripheral nerve surgery is commonly performed for grafting nerve lesions with gap. Notwithstanding its popular use, this procedure is not entirely without fault as painful neuromas can occur after the withdrawal. We have treated 24 cases of painful neuromas of sural nerve after withdrawal; 11 of which were treated surgically.

The future: surgery of the spinal cord?

Surgery of the spinal cord is still experimental, and outcomes must be confirmed by more cases. In this field, knowledge and research are still figuratively in the Stone Age. Nevertheless, the author is confident that in the future, with the improvement of surgical and resuscitation techniques and with the introduction of new biotechnologic drugs and molecules that favor axon regeneration and inhibitor blocking, CNS-peripheral nerve connections can be performed with some functional improvement, even in tetraplegia.

Instability of the Trapezio Metacarpal Joint: Related Arthritis and Surgery.

Arthritis of the trapezio metacarpal joint (TMJ) is a very frequent condition, which affects women more than men, especially in the fifth or sixth decade of life. It can be very painful and disabling and the patient will need surgery for relief even if it can result in painless stiffening (in adduction of the metacarpal and hypertension of the metacarpal, which in turn is very disabling). TMJ arthritis is rarely primary or idiopathic; in general, it is secondary to instability of the joint, which, in turn, may be primary or secondary.