Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 159

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189

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Operation .- December 1, 1910. The fascia which was placed in the ice box 48 hours before was sutured on the ribs, under the muscle. The wound was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

January 24, 1911. Animal sacrificed. Autopsy .- The fascia was thickened but otherwise it seemed normal. It was movable on the ribs.

Histology .- (Microscopic examination.) The sections showed normal fascia with clearly stained nuclei and fibers.

EXPERIMENT 9 .- Male, black and white fox terrier; about 2 years old.

Operation .- December 1, 1910. The right femur was exposed and the periosteum was stripped back for about 2 cm. Into this defect a band of fascia lata was sutured around the bone. The wound was closed in the usual manner. No dressing. Condition on leaving the table excellent. Per primam healing.

December 27. Death from pneumonia. Autopsy .- The band of fascia was somewhat thickened and was intimately blended with the periosteum on either side. The structure of the fascia could be plainly seen.

Histology .- (Microscopic examination.) The sections showed normal fascia with no signs of degeneration.

EXPERIMENT 43 .- Female, white mongrel; about 2 years old.

Operation .- March 14, 1911. The trachea was exposed and a large flap of fascia was sutured on it. This fascia had been removed from another animal on February 7, 1911, and had been in cold storage since that date. The wound was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

April 10. Death from distemper. Autopsy .- The fascia was somewhat thickened but otherwise it seemed normal. It was closely adherent along the margins and seemed to blend with the tissues on the surface of the trachea.

Histology .- (Microscopic examination.) The sections showed normal, well-nourished fascia.

Comment .- In this group free fascia flaps were success- fully transplanted into the subcutaneous tissue, into fat, on muscle, periosteum, bone, cartilage, tendons and ligaments.

Microscopic examination of the specimens showed that the fascia retained it own structure after transplantation and was apparently healthy and well nourished. This was true

2 I take this opportunity of thanking Dr. C. D. Deming for assistance in the histological examinations.

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even after the fascia had been kept in cold storage for thirty- five days and then transplanted into another animal.

The clinical uses suggested by these experiments are of considerable importance, and cover a wide field.

GROUP II .- TRANSPLANTATION OF FREE FASCIA INTO TENDON AND MUSCLE DEFECTS.

EXPERIMENT 16 .- Male, black mongrel; about 6 months old. Operation .- December 19, 1910. The right tendo Achillis was exposed and a section about 2.5 cm. long was removed. The stumps were held in position by a strong tension suture, and then a flap of fascia lata was placed in the defect so as to sur- round the stumps like a tube. This tube was then drawn tight and the ends were securely sutured around the stumps. The tension suture was cut and the dead spaces obliterated. The wound was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

FIG. 1 .- Experiment 16. Fascia to replace tendo Achillis. Operation, December 19, 1910. Specimen removed, March 7, 1911. Comparison of new and normal tendons. The new tendon is thicker than the normal. The + marks the operated leg.

March 7, 1911. Distemper. Sacrificed. The animal had been very active and had no limp. It was imposible to tell which leg had been operated on without close inspection. Autopsy .- The replaced tendon was thicker than normal, but seemed strong and satisfactory in every way. (Fig. 1.)

. Histology .- (Microscopic examination.) Cross section of the new tendo Achillis showed normal staining fascia which was folded on itself. Surrounding the fascia was connective tissue, which caused the apparent thickening of the new tendon.

EXPERIMENT 20 .- Male, white fox terrier; about 4 months old. Operation .- January 3, 1911. The sartorius muscle was ex- posed and a section about 2.5 cm. long was removed. The muscle ends were held in position and a flap of fascia lata was sutured into the defect surrounding the muscle stumps by a tube of fascia. The dead space was obliterated and the wound was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

February 1. Death from pneumonia. Since the healing the animal had been very active and no difference could be detected

in the gait. Autopsy .- The fascia was firmly united r. muscle ends. (Fig. 2.)

Histology .- ( Microscopic examination.) The sectioss fascia with fibers and nuclei clearly stained.

Comment .- This group shows that muscle and . fects may be bridged by free flaps of fascia. Musia may be bridged by means of fascia flaps and thus ! amount of the muscle function saved. The fasa : firmly with the muscle ends and formed a strong spur band between them.

FIG. 2 .- Experiment 18. Fascia replacing defect in st. muscle. Operation, December 27, 1910. Specimen January 14, 1911. The thick muscle ends can be seen. ==: necting them is the fascia which has united firmly to the

The use of fascia flaps to replace tendons is w # importance and most promising clinically. While : well-known fact that free tendon transplantation can : cessfully done, it must be borne in mind that it is efter cult to secure either long or short pieces of tendon :" doing considerable damage.

There are large amounts of fascia available in th which can be secured without damage to any other part. Thus tendons of any desired length might !" from strips of the ilio-tibial band of the fascia lata.

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Enight also be used to prevent tendons from being caught .r tissue. The final results after replacing tendons with material are more satisfactory than with any foreign ial or transplantable tissue with which I am familiar.

UP III .-- TRANSPLANTATION OF FREE FASCIA AROUND VESSELS AND NERVES.

ERIMENT 33 .- Female, black and yellow mongrel; about 1 1d.

ration .- February 14, 1911. The right jugular vein was ted out and a flap of fascia lata was wrapped about it. vound was closed in the usual manner. Dry dressing. :ion on leaving the table excellent. Per primam healing. ch 3. Death from pneumonia. Autopsy .- The fascia was ned but otherwise seemed normal. It was quite adherent

3 .- Experiment 11. Fascia around vessels and on trachea. ion, March 14, 1911. Specimen removed, April 11, 1911. right carotid can be seen a flap of fascia which was lanted immediately from the same animal. On the left . and trachea are flaps of fascia from another animal had been in cold storage for 35 days.

vessel wall. The lumen of the vessel was not encroached

logy .- (Microscopic examination.) The sections showed ucture of the vessel to be normal. It was surrounded by : of fascia which was apparently well nourished and no signs of degeneration.

RIMENT 41 .- Female, yellow and white mongrel; about 1 d.

Ition .- March 14, 1911. Both common carotid arteries posed. Around the right carotid a piece of fascia lata ured, which had just been removed from the right thigh. the left carotid was sutured a piece of fascia which In removed from another animal on February 7, 1911, I been in cold storage since that date. The wound was n the usual manner. Dry dressing. Condition on leav- table excellent. Per primam healing.

10. Death from pneumonia. Autopsy .- The fascia on otids was thickened, but otherwise seemed normal. The

lumen of the vessels was not encroached upon. (Fig. 3.)

Histology .- (Microscopic examination.) The sections showed apparently normal fascia in both instances. No signs of de- generation.

EXPERIMENT 44 .- Male, black and white fox terrier; about 1 year old.

Operation .- March 21, 1911. The right sciatic nerve was ex- posed and a flap of fascia lata was sutured around it. The wound was closed in the usual manner. Dry dressing. Con- dition on leaving the table excellent. Per primam healing. Gait unaffected.

April 20. Distemper, animal sacrificed. Autopsy .- The fascia was thickened but otherwise seemed normal. It could be moved on the nerve to a slight degree. There was no constriction of the caliber of the nerve.

Histology .- (Microscopic examination.) The sections showed a normal nerve surrounded by well-nourished, apparently normal, fascia.

FIG. 4 .- Experiment 22. Fascia filling defect made by removal of patella. Operation, January 9, 1911. Specimen removed, Feb- ruary 2, 1911. Note the amount of extension and flexion possible. The fascia can be seen firmly healed to the joint capsule.

Comment .-- This group shows that free flaps of fascia may be successfully transplanted around arteries, veins and nerves, without in any way interfering with the lumen of the vessels, or compressing the nerves.

Clinically, fascia flaps might be of use in protecting suture lines in vessel surgery and in reenforcing weakened areas in vessel walls. The site of nerve plastic operations might be surrounded and protected by such flaps. It might also be of use in protecting a nerve after it was freed from callus or scar tissue.

GROUP IV .- TRANSPLANTATION OF FREE FASCIA INTO JOINTS AND FOR SUTURING FRACTURED BONES.

EXPERIMENT 22 .- Female, yellow mongrel; about 6 months old. Operation .- January 9, 1911. The left patella was removed

· and a piece of fascia lata was substituted for it. The fascia

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was folded on itself so that its inner smooth surface was next to the joint, and also under the skin. It was sutured to the capsule and the wound was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

February 2. Pneumonia, animal sacrificed. The joint was freely movable and as far as could be seen had been as service- able as the normal knee. (Fig. 4.) Autopsy .- The fascia was easily separated from the skin. It had adhered firmly to the joint capsule. On opening the joint the surface of the fascia was perfectly smooth. There were no adhesions. The fascia was slightly thickened.

Histology .- (Microscopic examination.) The sections showed a double thickness of apparently normal fascia. The staining of fibers and nuclei was well marked. (Fig. 5.)

(a)

(b)

(c)

FIG. 6 .- Experiment 29. Fascia into joint after removal of the cartilage. Operation, February 6, 1911. Specimen removed, Feb- ruary 28, 1911. (a) Leg extended, compared with normal. (b) Leg flexed, compared with normal. (c) Inside of joint. The + marks the operated joint.

EXPERIMENT 29 .- Female, white fox terrier; about 8 months old.

Operation .- February 6, 1911. The right knee-joint was opened and the entire articular cartilage was removed as thoroughly as possible. Then a piece of fascia lata was inserted and sutured over the denuded portion of the femur and well up under the patella. The joint was closed. Dry dressing. Condition on leaving the table excellent. Per primam healing.

February 27. Death from pneumonia. Since the dressing was removed the animal has been using the operated knee-joint without apparent discomfort. Autopsy .- The joint was movable. The fascia was slightly thickened. It was adherent to the de-

nuded end of the femur, but to no other portion of the Its structure was well preserved. (Fig. 6.)

Histology .- (Microscopic examination.) The sections shore normal staining, well-nourished fascia. No signs of degesz tion or absorption.

EXPERIMENT 31 .- Male, yellow and white mongrel; about months old.

Operation .- February 13, 1911. The right tibia was erpor and the periosteum stripped back: The bone was sawed thrige and then two strips of fascia lata were passed through til holes and tied. The tied ends were made additionally per by sutures. The wound was closed and a small drain was de serted in the lower angle. Dry dressing, crinolin and splat

(a)

(b)

FIG. 7 .- Experiment 38.

Fascia into skull and dura del Operation, March 6, 1911. Specimen removed, April 20, 20 (a) Bone defect from outside with fascia adherent to bone el (b) From within the outline of the bone defect can be The fascia is closely adherent to the dura which extends yond it. The fascia is smooth except for one small adhes in the center.

Condition on leaving the table excellent. The stitches wet moved on the fifth day. The wound was apparently healed. It was practically impossible to immobilize the best bone.

February 23. Distemper, animal sacrificed. Autopsy- moving the dressing the wound was found badly infected spite of the infection the strength of the fascia was appare but little affected and the strips were still holding the end the bone together. This specimen was accidentally lost

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re the place of patella which had been removed. Both se procedures are suggestive clinically.

nes were fractured and the fragments sutured with of fascia. The result of these last experiments were isfactory on account of the difficulty in immobilizing agments. However, the use of fascia strips in the open nent of fractures in human beings may be of great use ally, as immobilization can be secured.

e fascia does not act as a foreign body and has strength

h to stand any reasonable strain put upon it.

P V .- TRANSPLANTATION OF FREE FASCIA INTO DE- FECTS IN THE SKULL AND DURA, ALSO INTO TRACHEAL DEFECTS.

ERIMENT 38 .- Male, yellow mongrel; about 1 year old. ration .- March 6, 1911. The left temporal muscle with the ying periosteum was turned back and a %-inch button le was removed. The dura under this area was excised flap of fascia lata was tucked under the bone edges. The i muscle side of the fascia was placed next to the brain. emporal muscle was replaced and sutured, and the wound losed in the usual manner. Dry dressing. Condition on g the table excellent. Per primam healing.

il 20. Distemper, animal sacrificed. Autopsy .- There was nall adhesion of the cortex to the central portion of the The edges of the fascia and dura were intimately

d. The structure of the fascia could be plainly seen. The was tightly stretched across the bone defect and was nd did not bulge on pressure. (Fig. 7.)

ology .- (Microscopic examination.) The sections showed 1 staining, apparently well-nourished fascia.

ERIMENT 62 .- Female, black mongrel; about 1 year old. 'ation .- June 12, 1911. The trachea was exposed and an mm. square was excised. Over this defect was sutured ly a flap of fascia lata. The wound was closed in the manner. Dry dressing. Condition on leaving the table nt. Per primam healing. There was no cough or any .tory symptom following the operation.

3. Animal sacrificed. Autopsy .- The fascia was some- thickened and firmly adherent to the surface of the L. There had been no leakage whatever. On opening the from behind, the defect was made out as a very shallow sion and the fascia seemed to be entirely covered with membrane, which had grown over it. (Fig. 8.) logy .- (Microscopic examination.) The sections showed 'ect filled by normal staining, apparently well-nourished Over this fascia, as a base, the mucous membrane had completely covering it. (Fig. 9.)

ment .- This group shows that flaps of fascia inserted 1 defects between the dura and bone edges will heal ve a strong membrane which will resist considerable e from within and without. When the dura is re- in addition to the bone the fascia flap tucked under ne edges will unite with the dura and also become adherent to the bone edges.

e was in each instance a single fine adhesion of the

'o the center of the fascia flap.

a flaps might be used clinically in repairing skull de- d as an aid in the closing of a spina bifida.

without subsequent infection, and that the mucous mem- brane grows across the fascia covering the defect.

It might be of use, clinically, in closing old tracheotomy wounds, where there has been considerable destruction of cartilage, and also in reenforcing sutures of the trachea.

(a)

(b)

(c)

FIG. 8 .- Experiment 62. Fascia over defect in trachea. Opera- tion, June 12, 1911. Specimen removed, July 3, 1911. (a) Shows normal trachea with opening in it the size of that covered by the fascia. (b) The fascia healed over a similar defect. (c) The same specimen from within, showing a slight depression which marks the defect. The mucous membrane has grown com- pletely over the fascia.

GROUP VI .- TRANSPLANTATION OF FREE FASCIA INTO PRE- PARED DEFECTS IN THIE ABDOMINAL WALL.

EXPERIMENT 17 .- Male, white and black fox terrier; about 1 year old.

Operation .- December 22, 1910. All the tissues of the ab- dominal wall between the skin and the peritoneum were excised from an area about 4 x 7 cm. Into this defect a flap of fascia

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lata 3 x 6 cm. was sutured. The skin was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

June 27, 1911. Animal sacrificed. Autopsy .- There was no hernia or bulging of the abdominal wall at the site of operation. From within there was no depression in the parietal peritoneum. On holding the specimen to the light the outline of the inserted fascia could be readily seen. The fascia itself was slightly thickened but normal in every way and was strong and tough.

Histology .- (Microscopic examination.) The sections showed normal staining fascia with no signs of degeneration.

EXPERIMENT 19 .- Male, brown and black mongrel; about 1 year old.

Operation .- December 29, 1910. The peritoneum was exposed and an area 4 x 2 cm. was excised. Into this defect a piece of fascia lata was sutured. The wound was closed in the usual manner. Dry dressing. Condition on leaving the table ex- cellent. Per primam healing.

February 7, 1911. Animal sacrificed. Autopsy .- The fascia edges had blended with the peritoneum. It was thickened but otherwise seemed normal. There was a small omental adhesion.

Histology .- (Microscopic examination.) The sections showed normal, well nourished fascia.

EXPERIMENT 46 .- Male, yellow and white mongrel; about 1 year old.

Operation .- March 23, 1911. A section of the abdominal wall 3 x 7 cm., including everything except the skin, was excised. Into the peritoneal defect was sutured a flap of fascia lata from one thigh, and into the muscle defect a fiap from the other thigh. The skin was closed in the usual manner. Dry dressing. Con- dition on leaving the table excellent.

The animal developed distemper three days after the opera- tion and on the fifth day the skin wound broke down. There was no hernia as the fascia held firmly.

April 6. Death from distemper. Autopsy .- There was a crater like ulcer whose base was made up of fascia on which granu- lations could be seen both at the edges and scattered over the surface. There was no hernia whatever and the fascia seemed to be strong and intact. On opening the abdominal cavity there was free pus and this was also found in the pleural cavity. The omentum was adherent over a small part of the fascia. The fascia was incorporated with the peritoneum and had healed firmly in position.

Histology .- ( Microscopic examination.) The sections showed infiltration with leucocytes, and marked signs of infection. The fascia was apparently in good condition with clearly stained fibers and nuclei. There was definite granulation tissue grow- ing from the ulcer edges out on the fascia.

Comment .- This group shows that free flaps of fascia may be sutured into peritoneal and muscle fascia defects in the abdominal wall, and that it will incorporate itself with the surrounding peritoneum and muscle edges. A small omental adhesion was present on examination of the specimen in each instance, but in no case was there adhesion of the gut or any other abdominal organ to the fascia.

When a hernia was produced by the removal of a portion of the abdominal wall, except the skin, it was readily cured several weeks later by the transplantation of fascia flaps.

These experiments suggest the use of fascia flaps in the cure of large hernia where the muscle is atrophied, and for strengthening any weakened area in the abdominal or chest wall. ". facility with which the fascia unites with the

peritoneum suggests its further use in pleural and periczt defects.

GROUP VII .- TRANSPLANTATION OF FREE FASCIA CE STOMACH, INTESTINE AND BLADDER.

EXPERIMENT 23 .- Female, brown and black mongrel; year old.

Operation .- January 10, 1911. The bladder was brought through a mid-line incision and a flap of fascia lata ma to it with a continuous suture. The bladder was dropped and the wound was closed in the usual manner. Dry dre Condition on leaving the table excellent. Per primom het

July 27. Animal sacrificed. Autopsy .- There were adhesions to the fascia. The peritoneum on the surface bladder was somewhat puckered under and immediately the fascia edges. The fascia itself was thickened but ofan seemed normal.

Histology .- (Microscopic examination.) Normal SIE fascia found. The peritoneal covering of the bladder co2 !!: be differentiated.

EXPERIMENT 24 .- Female, yellow mongrel; about 6 month: Operation .- January 16, 1911. The stomach was expose. an incision 3.5 cm. long was made in it, down through the c: This was then closed with the Cushing continuous ste: over the suture line was placed and sutured a flap of tasca . The stomach was dropped back and the wound was closed :" usual manner. Dry dressing. Condition on leaving the excellent. Per primam healing.

January 27. Distemper, animal sacrificed. Autopi ?- fascia was thickened but otherwise seemed normal. [ closely adherent to the stomach wall. There were a few oc- adhesions to the fascia but these could be easily separate:

Histology .- (Microscopic examination.) The sections : the line of suture. Above this was the layer of fascis was apparently normal and well nourished.

EXPERIMENT 61 .- Male, black and white fox terrier: &3. year old.

Operation .- June 5, 1911. A loop of gut was brous: through an abdominal incision and a purse string sutar placed opposite the mesentery. When the suture was c: tight and tied the portion within the suture projected oc ... The tip of the projection was cut off exposing the lumen bowel. Over this area a flap of fascia lata was sutured : and the gut was dropped back. The wound was closed : usual manner. Dry dressing. Per primam healing.

July 3. Animal sacrificed. Autopsy .- The omentum ti herent to the fascia but this was easily separated. Te was somewhat thickened but otherwise seemed normal. : closely adherent and seemed incorporated with the peri: of the bowel. There was a definite puckering of the wall gut around and under the fascia. There had been no From within a small depression in the mucous membrane ponding to the pucker made by the purse string could be :-

Histology .- (Microscopic examination.) The sections !! normal staining, well-nourished fascia. There was ma:k. filtration of the tissue beneath the fascia with polynucks kocytes. There was a great mass of these cells in th: corresponding to the made defect. On the surface of the! was the remains of the adherent omentum.

Comment .- In this group free fascia flaps were fully transplanted onto the stomach, the intestine .. bladder. The fascia seemed to incorporate itself =" peritoneum (Fig. 10).

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use in closing fistula of one sort or another.

(a)

(b)

(c)

10 .- Experiment 19. (a) Fascia in peritoneal defect. tion, December 29, 1910. Specimen removed, February 7, Experiment 23. (b) Fascia on bladder. Operation, January 11. Specimen removed, June 27, 1911. Experiment 61. (c) L over defect in intestine. Operation, January 5, 1911. men removed, July 3, 1911. all of these the fascia was thickened. It was incorporated he peritoneum and there was a puckering of the peritoneum margin of the fascia. There was adherent omentum in ase. A small tag can be seen in (a).

GROUP VIII .- TRANSPLANTATION OF FREE FASCIA ON LIVER, KIDNEY AND SPLEEN.

EXPERIMENT 36 .- Female, brindle mongrel; about 18 months old.

Operation .- February 21, 1911. Through a lumbar incision the left kidney was exposed and after the capsule was stripped back an abrasion of the surface was made and a flap of fascia lata was sutured over it. The hemorrhage ceased promptly. The kidney was dropped back and the wound was closed in the usual manner. Dry dressing. Condition on leaving the table excellent. Per primam healing.

March 7. Distemper, animal sacrificed. Autopsy .- The skin wound which had apparently healed became infected after the development of the distemper. The fascia was adherent to the surrounding tissues. It was not much thickened and seemed normal. It was tightly adherent to the kidney at the edges, but could be stripped up more easily in the center of the flap.

Histology .- (Microscopic examination.) The sections showed normal fascia closely adherent to the parenchyma.

EXPERIMENT 52 .- Male, black mongrel; about 3 months old.

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Twentieth Century History of Findlay and Hancock County, Ohio, and Representative Citizens, Part 159

Author: Jacob Anthony Kimmell Publication date: 1910 Publisher: Number of Pages: 1189

Author: Jacob Anthony Kimmell
Publication date: 1910
Publisher:
Number of Pages: 1189