Fingertip reconstructions using partial-toe transfers

Fifty-six partial toes were transferred to reconstruct fingertip deficits. The transfers from the big toe mainly consisted of 3 trimmed big toetips, 3 vascularized nail grafts, 3 onychocutaneous flaps, 19 thin osteo-onychocutaneous flaps, and 2 hemipulp flaps. The transfers from the second toe mainly consisted of 8 trimmed second toetips, 5 reduced second toes, and 9 whole distal phalanges. The average values of postoperative sensory recovery of the osteo-onychocutaneous flaps including the vascularized nail grafts were 3.1 (Semmes-Weinstein test) and 6.3 mm (moving two-point discrimination) at 2.6 years after the transfer; those of the thin osteo-onychocutaneous flaps were 3.1 and 7.2 mm at 2.0 years after surgery; those of the trimmed big toe tip transfers were 3.61 and 6.5 mm at 1.8 years after surgery; and those of the trimmed second toetip transfers were 3.37 and 6.3 mm at 2.6 years after transfer. Those of the distal phalanx of the second toe were 3.41 and 7.9 mm at 1.2 years after surgery, and those of the reduced second toe were 3.2 and 6.7 mm at 10.6 months after surgery.     

A randomized prospective study of polyglycolic acid conduits for digital nerve reconstruction in humans

This article reports the first randomized prospective multicenter evaluation of a bioabsorbable conduit for nerve repair. The study enrolled 98 subjects with 136 nerve transections in the hand and prospectively randomized the repair to two groups: standard repair, either end-to-end or with a nerve graft, or repair using a polyglycolic acid conduit. Two-point discrimination was measured by a blinded observer at 3, 6, 9, and 12 months after repair. There were 56 nerves repaired in the control group and 46 nerves repaired with a conduit available for follow-up. Three patients had a partial conduit extrusion as a result of loss of the initially crushed skin flap. The overall results showed no significant difference between the two groups as a whole. In the control group, excellent results were obtained in 43 percent of repairs, good results in 43 percent, and poor results in 14 percent. In those nerves repaired with a conduit, excellent results were obtained in 44 percent, good results in 30 percent, and poor results in 26 percent (p = 0.46). When the sensory recovery was examined with regard to length of nerve gap, however, nerves with gaps of 4 mm or less had better sensation when repaired with a conduit; the mean moving two-point discrimination was 3.7 +/- 1.4 mm for polyglycolic acid tube repair and 6.1 +/- 3.3 mm for end-to-end repairs (p = 0.03). All injured nerves with deficits of 8 mm or greater were reconstructed with either a nerve graft or a conduit. This subgroup also demonstrated a significant difference in favor of the polyglycolic acid tube. The mean moving two-point discrimination for the conduit was 6.8 +/- 3.8 mm, with excellent results obtained in 7 of 17 nerves, whereas the mean moving two-point discrimination for the graft repair was 12.9 +/- 2.4 mm, with excellent results obtained in none of the eight nerves (p < 0.001 and p = 0.06, respectively). This investigation demonstrates improved sensation when a conduit repair is used for nerve gaps of 4 mm or less, compared with end-to-end repair of digital nerves. Polyglycolic acid conduit repair also produces results superior to those of a nerve graft for larger nerve gaps and eliminates the donor-site morbidity associated with nerve-graft harvesting.     

Normal cutaneous sensibility of the face

Normal values for facial sensibility were determined in 36 healthy subjects. Sensation was evaluated using static and moving two-point discrimination and pressure and vibratory threshold in four major regions of the head and neck. Each region was directly related to the area innervated by a particular peripheral sensory nerve (supraorbital, infraorbital, inferior alveolar-mental, or the great auricular nerve). Cutaneous sensibility varied from region to region but was consistent from one normal individual to another and in the same subject on different days. Measurements of pressure and vibratory thresholds provided the most reliable, reproducible data. A relationship of these data to the types of sensory receptors in facial skin and vermilion is postulated.     

Effects of 20 days horizontal bed rest on kinesthesia during knee flexion and two-point discrimination in skin of young subjects

Investigating the effect of 20 days bed rest (BR) on kinesthesia and two-point discrimination, 10 young volunteers participated in this study as subjects. Angle position sensation of right knee was measured in the prone position during flexion and extension monitored by a goniometer after two-point discrimination in skin was determined on the same lower leg. Flexed constant error was unchanged but directional constant error and absolute error were increased after BR (p<0.05). Two-point discrimination was unchanged after BR, which brought about a decline of the orientation of moving the joint indicated as over shooting of the angle during knee flexion, while it did not affect superficial sensation observed by two-point discrimination. Probably, an adjustment of deep sensation to the knee joint is lowered by the reduction in kinesthesia as well as the sensory disturbance during BR, which is independent on information from superficial sensation.     

Retrograde tracing and toe spreading after experimental autologous nerve transplantation and crush injury of the sciatic nerve: a descriptive methodological study

ABSTRACT: Evaluation of functional and structural recovery after peripheral nerve injury is crucial to determine the therapeutic effect of a nerve repair strategy. In the present study, we examined the relationship between the structural evaluation of regeneration by means of retrograde tracing and the functional evaluation analysis of toe spreading. Two standardized rat sciatic nerve injury models were used to address this relationship. As such, animals received either a 2 cm sciatic nerve defect (neurotmesis) followed by autologous nerve transplantation (ANT animals) or a crush injury with spontaneous recovery (axonotmesis; CI animals). Functional recovery of toe spreading was observed over an observation period of 84 days. In contrast to CI animals, ANT animals did not reach pre-surgical levels of toe spreading. After the observation period, the lipophilic dye DiI was applied to label sensory and motor neurons in dorsal root ganglia (DRG; sensory neurons) and spinal cord (motor neurons), respectively. No statistical difference in motor or sensory neuron counts could be detected between ANT and CI animals. In the present study we could indicate that there was no direct relationship between functional recovery (toe spreading) measured by SSI and the number of labelled (motor and sensory) neurons evaluated by retrograde tracing. The present findings demonstrate that a multimodal approach with a variety of independent evaluation tools is essential to understand and estimate the therapeutic benefit of a nerve repair strategy.     

The three-dimensional microanatomy of Meissner corpuscles in monkey palmar skin

The Meissner corpuscle is a rapidly-adapting mechanoreceptor in the dermal papillae of digital skin. For an analysis of how the sensory endings detect tissue deformations, an examination of their fine structure and relationships with dermal collagen was carried out in the Japanese monkey, Macaca fuscata, using a combination of three methods: SEM of cell architecture denuded by 6N sodium hydroxide maceration, SEM of collagen networks exposed by a mild alkaline corrosion, and TEM according to a conventional procedure. Observations showed the sensory corpuscles to be represented by a stack of discoid components consisting of flattened axon terminals sandwiched between Schwann cell lamellae, as reported previously. Each corpuscle was entirely covered by a connective tissue capsule, which was linked with the basal aspect of the epidermis by dermal collagen fibers. Margins of the discoid components of the corpuscles were serrated with numerous fine projections of lamellar Schwann cells, which tightly held collagen trabeculae on the inner aspect of the pericorpuscular capsule. Central portions of the discoids, on the other hand, displayed extremely smooth surfaces, which were covered by a thick layer of basal lamina-like matrix. The former portions of the discoids appear susceptible to mechanical deformations of surrounding tissues, while the latter may follow the tissue movements rather slowly because of their indirect linkage with the dermal collagen network. The resulting distortions of the axon endings during dynamic phases of the tissue deformations will be in favor of the generation of rapidly adapting receptor potentials in the sensory corpuscle.     

End-to-end linkage (EEL) clustering algorithm: a study on the distribution of Meissner corpuscles in the skin

A novel hierarchical clustering algorithm was applied to the distribution of Meissner corpuscles in the skin of mammals. This method, called end-to-end linkage (EEL), is useful for grouping data that consists of chain-like contingencies in the multivariable space. Unlike the traditional techniques which uncover hyperspherical clusters (e.g. single linkage), EEL considers the shortest distance between the predefined end pairs of the two clusters as an inter-group distance. This scheme allows characterizing the internal structure of data better than other hierarchical techniques. The anatomical data used in the case study is important for studying the sense of touch. The results show a substantial improvement over the traditional single-linkage method. On average, the number of correctly classified corpuscles is increased to twice the number identified by the single-linkage method. EEL can also be used for analyzing other sensory modalities where geometric relationships need to be explored. In addition, the report contains corpuscle density and epidermal-ridge width data obtained from several species.     

A versatile one-stage neurovascular flap for fingertip reconstruction: the dorsal middle phalangeal finger flap.

The dorsal middle phalangeal finger flap is an extremely reliable flap that is indicated for fingertip injuries which require sensory reconstruction. This flap originates from the dorsum of the middle phalanx of the finger and is elevated with a vascular pedicle of the digital artery and the dorsal branch of the digital nerve. After transfer of the flap to the injured site, epineural neurorrhaphy is done between the digital nerve and the dorsal sensory branch of the flap. This flap can be thought of as an island flap of the innervated cross-finger flap that provides excellent sensory recovery and aesthetic improvement. We used this flap in a series of eight consecutive patients and were able to follow up seven patients for longer than 6 months (mean follow-up time 10.7 months). All patients achieved measurable two-point discrimination, with an average of 4.9 mm in the moving two-point discrimination. In this study, we report our consecutive series of the dorsal middle phalangeal finger flap and its versatile utility.     

Electron microscopic observations of degeneration of human Pacinian corpuscles in amputated fingers.

Amputated human fingers were used to observe the morphologic changes in degeneration of Pacinian corpuscles, and postoperative moving two-point discrimination of the replanted fingers was examined to analyze sensory recovery after replantation. Normal corpuscles are composed of an axon terminal and inner and outer cores, resembling a sliced onion. The inner core is composed of thin, multilayered lamellar cells, and the outer core consists of multiple layers of thin perineurial cells. Based on our morphologic findings, following mitochondrial degeneration in the axon terminal, the terminal and inner core cells disappeared within 9 to 16 hours, but the outer core did not lose its structure until more than 24 hours after amputation. Collagen fibrils in the corpuscles appeared from 5 hours after amputation and periodically increased their amount up to 27 hours after amputation. Postoperative sensory recovery of the replanted fingers was significantly poorer with 9 hours or more of cold ischemia. These findings suggest that the inner core cells originating from Schwann cells degenerate at over 9 hours after amputation, and this may be related to the poor sensory recovery of replanted fingers. It also appears that the outer core cells originating from the perineurial cells in the amputated fingers survive even up to 27 hours after amputation and produce collagen fibrils in the extramatrix spaces of the outer core cells.     

Quantitation of breast sensibility following reduction mammaplasty: a comparison of inferior and medial pedicle techniques

The preservation of sensitivity within the nipple-areola complex is of paramount importance to patients presenting for reconstructive and aesthetic breast procedures. Previous attempts to measure sensation in the breast before and after surgery have relied primarily on the Semmes-Weinstein monofilament test, which is an imprecise study that measures the logarithm of force necessary to bend a series of six to 20 filaments. Within the last 10 years, various authors have published normative pressure threshold data for the breast that have varied by a magnitude of greater than 10-fold. Recently, precise anatomic studies have been performed that have elucidated the innervation of the nipple-areola complex medially and laterally from cutaneous branches of the intercostal nerves. Despite this knowledge, no quantitative sensibility studies have yet been performed that compare postoperative sensation when medially versus laterally innervated pedicles have been used in reduction mammaplasty. The present study is the first to use computer-assisted neurosensory testing to generate normal breast sensation data and to compare sensory outcomes between the inferior and the medial pedicle techniques of reduction mammaplasty.A total of 34 patients were divided into four groups and underwent breast sensory testing (67 breasts total) using the Pressure-Specified Sensory Device, a computer-assisted force transducer that measures static and moving one and two-point discrimination. Sensation in the nipple and in the four quadrants of the areola was measured. Groups I and II were composed of 17 unoperated controls with breast sizes ranging from 34A to 36C (group I; 18 breasts) and 36DD to 46EE (group II; 16 breasts) who presented to a general plastic surgery clinic. Groups III and IV were composed of 17 patients who underwent either medial or inferior pedicle reduction mammaplasty between July of 1997 and March of 1999. Pressure thresholds in the most sensitive breasts were as low as 0.3 g/mm2, a marked contrast to data from previous studies using Semmes-Weinstein monofilaments documenting the lowest recordable pressure threshold as greater than 2 g/mm2. Several findings from previous studies using Semmes-Weinstein monofilament testing were confirmed in unoperated controls, including an inverse relationship between sensitivity and breast size, superior nipple sensitivity when compared with the areola, and significant interpatient variability with respect to static and moving two-point discrimination among women matched according to age and breast size. When comparing medial with inferior pedicle reduction mammaplasty patients, it was found that despite significantly greater reductions using the medial pedicle technique (mean of 1.7 kg versus 1.1 kg of breast tissue removed), there were no significant differences in postoperative sensory outcomes in the sample size of 17 patients. Furthermore, within each group of patients undergoing either the medial or inferior pedicle technique, the amount of breast tissue removed did not correlate with postoperative sensory outcomes.Computer-assisted quantitative neurosensory testing is a highly accurate technique for measuring sensibility. The use of this technology demonstrates a 10-fold difference in measurable sensory thresholds in normal patients from preexisting data using Semmes-Weinstein monofilaments. Advances in measurement methods have allowed the authors to compare postoperative sensory outcomes reliably using two popular techniques of reduction mammaplasty.     

Sensory reconstruction of the fingertip using the bilaterally innervated sensory cross-finger flap

The authors present a series of 15 patients with large soft-tissue defects of the fingertips as a prospective, nonrandomized study. In all cases, reconstruction was achieved using a bilaterally innervated sensory cross-finger flap. This sensory fasciocutaneous flap relies on the dorsal branch of the proper digital nerves, which branch off at the level of the head of the proximal phalanx; sensory supply to the dorsal skin of the middle phalanx is thus ensured. The reconstructive procedure consists of two steps. First, the contralateral dorsal branch of the proper digital nerve is elevated with the flap at proximal interphalangeal joint level. Microsurgical coaptation is performed to the proximal nerve stump of the injured fingertip. After 3 weeks, when the pedicle is dissected, the second nerve is dissected and coapted. Clinical results were evaluated after 12 months. Because the regenerative distance is only 1.5 to 2.5 cm, good sensory regeneration should be expected. In nine of 16 flaps, sensory quality of S2+ (Highet) was present in the flap after 3 weeks. After 12 months, two-point discrimination was present in all patients, the values ranging between 2 and 6 mm (for two-point discrimination), with an average of 3.6 mm. The rate of complications was low. With acceptable additional operative action, a good functional result can be achieved. The indications of this method are discussed in comparison with other methods of fingertip reconstruction.     

An innervated cross-finger flap for fingertip reconstruction

An innervated cross-finger flap for treatment of severe fingertip injuries is described. With this method, the dorsal skin over the middle phalanx, together with its sensory nerve, is transferred as a compound skin-nerve flap. A neurorrhaphy is performed between this nerve and the cut end of the digital nerve at the injury site. Seven of eight patients (88 percent) treated with this method (mean follow-up time 14.4 months) achieved measurable two-point discrimination. The average for those who did was 4.8 mm. A group of patients with similar injuries treated with standard cross-finger flaps exhibited slower sensory return that progressed to a lower level. In this group (mean follow-up time 16.3 months), three of six (50 percent) achieved measurable two-point discrimination with a mean value of 9 mm.     

Clinical nerve reconstruction with a bioabsorbable polyglycolic acid tube

Microneurosurgical techniques to reconstruct nerve gaps with nerve grafts frequently fail to achieve excellent functional results and create donor-site morbidity. In the present study, 15 patients had gaps of 0.5 to 3.0 cm (mean 1.7 cm) in digital nerves reconstructed by one surgeon with a bioabsorbable polyglycolic acid (PGA) tube. A final evaluation of sensibility was done by a second surgeon at a mean postoperative interval of 22.4 months (range 11 to 32 months). These were all secondary reconstructions. The evaluation included a digital nerve block with local anesthetic for the intact (not reconstructed) digital nerve. Excellent functional sensation (moving two-point discrimination less than or equal to 3 mm and/or static two-point discrimination less than or equal to 6 mm) was present in 33 percent and good functional sensation (moving two-point discrimination of 4 to 7 mm and/or static two-point discrimination of 7 to 15 mm) in 53 percent of the digital nerve reconstructions. One patient with poor sensory recovery and one with no recovery were judged as functional failures (14 percent). Absence of pain at the site of reconstruction was judged by the patient to be excellent in 40 percent, good in 33 percent, and poor in 27 percent. We conclude that reconstruction of nerve gaps of up to 3.0 cm with a bioabsorbable PGA tube gives clinical results at least comparable to the classic nerve graft technique while avoiding donor-site morbidity.     

Laterality and sex differences in tactile detection and two-point thresholds modified by body surface area and body fat ratio

Tactile detection and two-point discrimination tests are commonly used in neurological examinations. However, questions remain about the influence of both body and patient characteristics on test thresholds. The left side of the body has sometimes been reported more tactilely sensitive than the right, and females are said to be more sensitive than males. We measured tactile detection and two-point discrimination thresholds on the finger, palm, and forehead of a large sample of young adults (N=171), examining laterality and sex differences, and the effects of body surface area (BSA) and body fat ratio (BFR). In tactile detection, there were no effects of laterality, BSA, or BFR, although females had lower thresholds than males. In two-point discrimination, there was an effect of laterality, with lower thresholds on the left side. This probably reflects hemispheric spatial processing differences. A significant BFR effect implies that subcutaneous fat affects skin deformation, but there were no effects of sex or BSA. The two-point discrimination findings differ in several respects from recent findings using grating orientation discriminations. A small positive correlation between the tasks, falling far short of test-retest reliabilities, indicates that they use largely disjoint but partially overlapping processes.     

Cutaneous Collateral Axonal Sprouting Re-Innervates the Skin Component and Restores Sensation of Denervated Swine Osteomyocutaneous Alloflaps

Reconstructive transplantation such as extremity and face transplantation is a viable treatment option for select patients with devastating tissue loss. Sensorimotor recovery is a critical determinant of overall success of such transplants. Although motor function recovery has been extensively studied, mechanisms of sensory re-innervation are not well established. Recent clinical reports of face transplants confirm progressive sensory improvement even in cases where optimal repair of sensory nerves was not achieved. Two forms of sensory nerve regeneration are known. In regenerative sprouting, axonal outgrowth occurs from the transected nerve stump while in collateral sprouting, reinnervation of denervated tissue occurs through growth of uninjured axons into the denervated tissue. The latter mechanism may be more important in settings where transected sensory nerves cannot be re-apposed. In this study, denervated osteomyocutaneous alloflaps (hind- limb transplants) from Major Histocompatibility Complex (MHC)-defined MGH miniature swine were performed to specifically evaluate collateral axonal sprouting for cutaneous sensory re-innervation. The skin component of the flap was externalized and serial skin sections extending from native skin to the grafted flap were biopsied. In order to visualize regenerating axonal structures in the dermis and epidermis, 50um frozen sections were immunostained against axonal and Schwann cell markers. In all alloflaps, collateral axonal sprouts from adjacent recipient skin extended into the denervated skin component along the dermal-epidermal junction from the periphery towards the center. On day 100 post-transplant, regenerating sprouts reached 0.5 cm into the flap centripetally. Eight months following transplant, epidermal fibers were visualized 1.5 cm from the margin (rate of regeneration 0.06 mm per day). All animals had pinprick sensation in the periphery of the transplanted skin within 3 months post-transplant. Restoration of sensory input through collateral axonal sprouting can revive interaction with the environment; restore defense mechanisms and aid in cortical re-integration of vascularized composite allografts.     

Enhancement of motor coordination by applying high frequency repetitive TMS on the sensory cortex

The sensory function plays an important role for successful motor performance. We investigated the modulating effects of high frequency repetitive transcranial magnetic stimulation (rTMS) on sensory discrimination and motor coordination. Twenty healthy participants were assigned into two random groups; the real- and sham-rTMS group. Total of 900 rTMS pulses at a frequency of 10 Hz (stimulus intensity of 90% RMT) were given over deltoid representational areas of the somatosensory cortex. Sensory discrimination ability was evaluated using two-point discrimination test. Motor coordination was measured by the latency difference between the synchronized contraction of deltoid and abductor pollicis brevis muscles before and after rTMS. The sensory discrimination was significantly increased only in the deltoid area and the difference in the latency of synchronized contraction of two muscles was significantly shortened after real-rTMS compared sham condition, which had tendency of negative correlation following real-rTMS condition. The results of this study demonstrated rTMS-induced enhancement of sensorimotor integration, which may contribute to develop effective therapeutic strategies for rehabilitation of various sensorimotor disorders in the clinical setting.     

Target-derived BMP signaling limits sensory neuron number and the extent of peripheral innervation in vivo

The role of target-derived BMP signaling in development of sensory ganglia and the sensory innervation of the skin was examined in transgenic animals that overexpress either the BMP inhibitor noggin or BMP4 under the control of a keratin 14 (K14) promoter. Overexpression of noggin resulted in a significant increase in the number of neurons in the trigeminal and dorsal root ganglia. Conversely, overexpression of BMP4 resulted in a significant decrease in the number of dorsal root ganglion neurons. There was no significant change in proliferation of trigeminal ganglion neurons in the noggin transgenic animals, and neuron numbers did not undergo the normal developmental decrease between E12.5 and the adult, suggesting that programmed cell death was decreased in these animals. The increase in neuron numbers in the K14-noggin animals was followed by an extraordinary increase in the density of innervation in the skin and a marked change in the pattern of innervation by different types of fibers. Conversely, the density of innervation of the skin was decreased in the BMP4 overexpressing animals. Further Merkel cells and their innervation were increased in the K14-noggin mice and decreased in the K14-BMP4 mice. The changes in neuron numbers and the density of innervation were not accompanied by a change in the levels of neurotrophins in the skin. These findings indicate that the normal developmental decrease in neuron numbers in sensory ganglia depends upon BMP signaling, and that BMPs may limit both the final neuron number in sensory ganglia as well as the extent of innervation of targets. Coupled with prior observations, this suggests that BMP signaling may regulate the acquisition of dependence of neurons on neurotrophins for survival, as well as their dependence on target-derived neurotrophins for determining the density of innervation of the target.     

Free flap reconstruction of the sole of the foot with or without sensory nerve coaptation

The authors present a retrospective study on major plantar foot reconstruction to evaluate the role of the free fasciocutaneous flap and the importance of sensory nerve reconstruction in improving long-term results. Between 1995 and 1999, 20 patients with major defects of the sole of the foot underwent free forearm flap reconstruction performed by the senior author (F.S.). Sensory nerve reconstruction was added to this technique in 1997. The age and sex of the patients and the cause, location, and dimensions of their defects were recorded. The patients were clinically and neurophysiologically evaluated at 3, 6, and 12 months after the procedure for the following parameters: flap contour, flap stability, load capacity, walking ability, touch sensation, pain sensation, static two-point discrimination, and thermal sensibility. Dermatomic somatosensory-evoked potentials were also tested at 12 months. Follow-up ranged from 1 to 5 years. Patients were divided into two groups according to sensory nerve reconstruction. Group A consisted of 11 patients with nerve repair, and group B consisted of nine patients without nerve repair. One patient from group A who had an idiopathic neuropathy was excluded from the study because of interference with the reinnervation process. Five more patients (three from group A and two from group B) were lost at follow-up and excluded from the study. The final sample size in each group was seven. Data from both groups were compared and statistically analyzed with the Mann-Whitney test and the Fisher exact test. Long-term results confirmed in all reconstructions long-lasting stability. During the first postoperative year, patients with sensory nerve reconstruction showed better sensibility. The statistical analyses confirmed significant differences between the two groups to be dependent upon surgical technique at 3 and 6 months. Two-point discrimination and dermatomic somatosensory-evoked potentials were recorded. After 12 months, flaps without surgical nerve repair showed progressive improvement of sensitive thresholds, achieving a good protective sensibility, similar to that of the other group, but these flaps never regained two-point discrimination or dermatomic somatosensory-evoked potentials.     

A reverse ulnar hypothenar flap for finger reconstruction

A reverse-flow island flap from the hypothenar eminence of the hand was applied in 11 patients to treat palmar skin defects, amputation injuries, or flexion contractures of the little finger. There were three female and eight male patients, and their ages at the time of surgery averaged 46 years. A 3 x 1.5 to 5 X 2 cm fasciocutaneous flap from the ulnar aspect of the hypothenar eminence, which was located over the abductor digiti minimi muscle, was designed and transferred in a retrograde fashion to cover the skin and soft-tissue defects of the little finger. The flap was based on the ulnar palmar digital artery of the little finger and in three patients was sensated by the dorsal branch of the ulnar nerve or by branches of the ulnar palmar digital nerve of the little finger. Follow-up periods averaged 42 months. The postoperative course was uneventful for all patients, and all of the flaps survived without complications. The donor site was closed primarily in all cases, and no patient complained of significant donor-site problems. Satisfactory sensory reinnervation was achieved in patients who underwent sensory flap transfer, as indicated by 5 mm of moving two-point discrimination. A reverse island flap from the hypothenar eminence is easily elevated, contains durable fasciocutaneous structures, and has a good color and texture match to the finger pulp. This flap is a good alternative for reconstruction of palmar skin and soft-tissue defects of the little finger.     

Compensation in behavioral disorders in rats receiving 5,7-DHT neonatally and by transplantation of embryonic raphe nucleus tissue

In 62 male Wistar rats the influence was studied of the transplanted embryonal tissue of raphe nuclei (NR) on the mechanisms of compensation of disturbances of exploratory activity, sensory attention, learning and emotional reactivity induced by neonatal injection of 5,7-DHT. In histochemical studies by Falk-Hillarp method the presence of yellow fluorescence confirmed the specificity of transplanted 5-HT neurones. It is found that NR transplantation causes in animals after 3 months recovery of orienting reaction to sensory stimuli, reduces rats reactivity in the open field, restores the ability to discrimination of emotionally positive influence, disturbed by neonatal injection of 5,7-DHT. The obtained data show the possibility of compensation of behaviour disturbances caused by chronic deprivation of 5-HT system activity by transplantation in the neocortex parenchyma of the embryonal tissue, containing serotoninergic neurones.