
Hanno MillesiIndependent Researcher
Hanno Millesi
Univ.Prof..Dr.med.,Dr.h.c.
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Publications (271)
In diesem Kapitel soll dargestellt werden, in welche Richtungen sich die Plexuschirurgie in den letzten 10 Jahren entwickelt hat. Diese Darstellung beruht auf Erfahrungen, die an eigenem Krankengut gewonnen werden konnten, auf neuen Erkenntnissen aus dem Schrifttum und nicht zuletzt auf der Analyse von Patienten, die auswärts wegen einer Plexus-bra...
Dupuytren contracture is a disease of a local tissue structure responsible for the soft and precise gripping function of the hand. This tissue system was for the first time described as a unit in 1959 using the term “Dense connective tissue body of the palmar side of the hand.” Today we know that this tissue has special elastic properties and belon...
The fundamental biology of Dupuytren’s contracture is poorly understood. Study of the mechanical characteristics of the palmar
fascia in the context of the function of this structure suggests that changes in the viscoelastic properties of the palmar
fascia precede visible and histologic changes characteristic of Dupuytren’s disease.
KeywordsConnec...
Die chirurgische Wiederherstellung durchtrennter peripherer Nerven basiert auf der Erkenntnis, dass deren Fasern Fortsätze der Ganglionzellen (Neurone) des Rückenmarks sind und Reize von diesen Zellen auf das entsprechende Erfolgsorgan übertragen. Die Durchtrennung führt zur Degeneration des peripheren Anteils (Waller-Degeneration). Durch Aktivität...
In brachial plexus avulsion, a recent technique connects the ending of the disrupted musculocutaneous nerve to the side of the intact phrenic nerve to regain elbow flexion. This requires the phrenic nerve to perform a new double function: independent control of breathing and elbow flexion. Neuroplastic changes associated with acquisition of double...
End-to-end nerve repair is a widely used and successful experimental microsurgical technique via which a denervated nerve stump is supplied with reinnervating motor or sensory axons. On the other hand, questions are still raised as concerns the reliability and usefulness of the end-to-side coaptation technique. This study had the aim of the reinner...
Dupuytren's contracture (DC) is a unique disease. It does not cause intolerable pain, it does not endanger life. It is located superfi cially and its course can be followed and documented easily. It is understandable that this disease attracts researchers and as far as I know about 30 publications appear every year about DC. Still we do not have a...
To bring some light into the ongoing controversy concerning end-to-side coaptation in brachial plexus surgery, the authors organized a symposium in 2006 titled How To Improve Peripheral Nerve Surgery. The authors sought the participation of experienced surgeons and researchers who had made personal contributions to the field. This article contains...
Unter Dupuytren-Kontraktur (DK; Morbus Dupuytren, “Dupuytren’s disease”) versteht man eine Erkrankung der kollagenen Faserbündel
des straffen Bindegewebssystems der Palmarseite der Hand. Es kommt zu einer Fibrose mit Knotenbildung und Umbauvorgängen,
in deren Verlauf sich eine Verkürzung der Faserbündel mit einer Kontraktur der betroffenen Gelenke...
Autologous nerve grafting has been performed since 1876 without success. Since the 1960s, the interfascicular nerve grafting technique has provided a reliable method to bridge very long nerve defects with predictable results. Personal experience of over 40 years has demonstrated that donor site morbidity is minimal if certain precautions are observ...
End-to-side nerve repair has re-emerged in the literature in recent years but clinical applications for this technique are not yet fully defined and clinical reports are rare and controversial. Hypothetically, there might be useful functional results performing peripheral end-to-side nerve graft repair using synergistic terminal branches with defin...
End-to-side coaptation is still a controversial procedure. Many authors reported surprisingly good results; others showed mediocre results only. There are also reports of complete failures. Apparently all authors are right. According to our experience the results depend on the level of end-to-side coaptation and on the nerve fiber composition. End-...
In the early years of brachial plexus surgery the surgeon was happy if the patient developed voluntary movement of certain muscles especially of the biceps to flex the elbow joint. Degree of flexion and force of flexion were utilized to prove success.
For the patient, however, flexion alone is not of much use if he cannot do external rotation. The...
It is well known that tendons have to be able to move if the muscle contracts. It is still not generally known that any structure in the body has to be able to move passively against other structures. This is especially important for the movement of limbs. In a monoaxial joint like the humero-ulnar joint only structures in the plane of the joint ax...
In peripheral nerve surgery main attention is frequently paid to surgery on the nerves, and possibilities to increase the chances of useful recovery by surgery on the muscles are often overlooked. Overstretching of paralyzed muscles reduces the chances of useful recovery even if the nerve regenerates well. The same is true if the paralyzed muscles...
All over the world research is going on to improve the outcome of the treatment of peripheral nerve lesions. Questions over questions arise. Is the autologeous nerve grafting still the golden standard in bridging defects? Have alternative techniques to overcome defects reached a level to replace autografting? To which length are they effective? Wha...
Over the last 40 years, various factors that influence the outcome of peripheral nerve surgery have been recognized. Some of these factors, such as age of the patient and time interval between injury and surgery, cannot be controlled by the surgeon. On the other hand, other factors related to technical details are the topic of constant debate and i...
We studied the passive motion of the brachial plexus in relation to movement of the upper extremity by observation during surgery and by measurements in cadavers. The spaces for these movement are defined. The passive motion is provided by gliding tissue. Pathologic changes of the gliding tissue may contribute to the development of the symptoms of...
BACKGROUND: Spinal nerve avulsion frequently occurs in brachial plexus injury, becoming irreparable lesions. Nerve transfer
at the very proximal site within a limited time interval after injury leads to satisfactory functional results. Oberlin reported
a neurotization technique at a more peripheral location. Hypothetically, there might be useful fu...
Summary BACKGROUND: It is generally known that the prognosis of peroneus nerve lesions is much worse when compared to other nerves. One of the reasons for this fact might be the imbalance between the peroneus-innervated muscles of the anterior compartment and the much stronger muscles of the calve. METHODS: Transferring the tibialis posterior muscl...
Summary BACKGROUND: An explanation is offered for the contradicting results of the clinical application of end-to-side coaptation. METHODS: We used small monofunctional nerves as donors and small monofunctional nerves as recipients. In one case a direct end-to-side coaptation was performed. In the majority of cases the nerve graft was applied end-t...
The term internal neurolysis means removal of fibrotic tissue inside a nerve trunk. Unfortunately the term was used for procedures with complete isolation of fascicles with all consequences like damage of links between the fascicle and impairment of blood supply. The conclusion based on some negative experiences that all surgery within a nerve trun...
Die Plexus brachialis-Chirurgie hat in den letzten 40 Jahren eine stürmische Entwicklung erfahren. Mehrere grundsätzlich verschiedene Behandlungsverfahren werden derzeit angewendet:
Hinzu gekommen sind in den letzten zehn Jahren neue technische Möglichkeiten:
Der Nerventransfer von C7 der gesunden kontralateralen Seiten nach Gu (1991) [[12]], womit...
Circular shaped specimens (45 mm diameter) were excised from the medial and lateral lower leg and shortly post mortem tested in an apparatus consisting of six machine axes (12 loading points arranged at the circumference of a 30 mm diameter circle). The apparatus developed by the authors allows deformation controlled loading of the specimens. Used...
BACKGROUND: The surgical treatment of a complete brachial plexus lesion is a real challenge. An analysis of operated cases reveals the fact that many surgeons focus on elbow flexion without e.g. taking into account that even good elbow flexion is not of great value if it can only be performed in internal rotation and external rotation is impossible...
Prostate cancer metastases induce a predominantly osteoblastic response in bone tissue, resulting in new bone formation and associated morbidity; however, the mechanisms of these tumor-host responses are not fully understood.
Supernatants of prostate (PC3, DU145, LNCaP), breast (BT20, ZR-75-1), colon (SW620, Colo 320DM), pancreatic (ASPC1, Capan-1)...
During the past 10 years, these authors have treated 19 cases of lumbosacral plexus lesions. In the majority of the cases, the cause was a fracture of the pelvis with dislocations. Types of lesions can be divided into three groups: 1) lesions of the lumbar plexus alone-these are treated via a retroperitoneal approach; 2) lesions of S1 to S3-these c...
Der N. suprascapularis enthält Nervenfasern aus den Segmenten C4, C5 und C6. In der Regel entsteht der Nerv am distalen Ende des Truncus superior, wo sich dieser in eine vordere und hintere Verzweigung teilt. Der Nerv kann aber auch nach der Teilung von der vorderen oder von der hinteren Verzweigung abgehen, er kann sich ausnahmsweise schon in Höhe...
The nerve graft can be completed using many different techniques. This article elaborates the general principles and many details that can be approached in different ways when dealing with nerve grafting. A review of the reasons for the poor performance of early nerve grafts, as well as the origins of nerve grafts, is included. This article discuss...
Es wird über sieben Patienten berichtet, bei denen zusammen viermal der N. axillaris und sechsmal der N. suprascapularis ohne einmaliges Trauma eine Parese entwickelten. Bei einem Patienten mit einer Axillarisparese war eine Traumatisierung des Nervs durch eine immer wiederkehrende Schultergelenkluxation als Ursache anzunehmen. Ein zweiter Patient...
Über den Bau des Karpalkanales wurde viel geschrieben. Wenig hervorgehoben wurde die Tatsache, daß der N. medianus selbst in einem synovialen Kanal liegt, der vom Innenraum des Karpalkanales ebenso abgetrennt ist wie die synoviale Auskleidung der Fingerbeugesehnen und getrennt davon die synoviale Auskleidung des Flexor pollicis longus. Darüber hina...
Pollicisation of a single long finger is the method of choice to treat congenital thumb aplasia or thumb hypoplasia. Using Millesi's scale for the functional analysis of the hand, we examined six patients treated in the years 1983 to 1994 in our service. Average age at the time of surgery was 2.4 years and the follow-up time was seven years on aver...
Radiation-induced brachial plexus lesions are progressive and irreversible complications. Until now, there is no way to successful prevention and treatment of this problem. In our series, relief of pain could be achieved by neurolysis in some cases, but there was no recovery of sensory and motor function. In order to improve the vascularity and ner...
According to several studies, results after reconstructive procedures in children are generally superior compared to those in adults. In the present retrospective study, 20 patients after reconstruction of one or more major nerves in the upper limb (median, ulnar, and radial nerves) were examined. At the time of operation, the patients' age was 8.9...
Neurological complications in clavicle fractures are rare. As a primary lesion, it is caused by the trauma itself. More often
however, the neurological symptoms develop later by large callus formation that encroach on the costoclavicular space. A case
report is presented of delayed injury to the brachial plexus due to clavicular fracture with non-u...
Neurological complications in clavicle fractures are rare. As a primary lesion, it is caused by the trauma itself. More often however, the neurological symptoms develop later by large callus formation that encroach on the costoclavicular space. A case report is presented of delayed injury to the brachial plexus due to clavicular fracture with non-u...
Normal tendons and palmar aponeuroses from patients with carpal tunnel syndrome and tissues of the palmar aponeuroses from patients with Dupuytren’s contracture were subjected to biomechanical tests. Several parameters characterizing the viscoelastic load response of the tissues were investigated. The tissues from patients with Dupuytren’s contract...
Intradural spinal root lesions cannot be recognized by dissecting the brachial plexus and lead to ineffective surgery if they remain undetected. Therefore, patients need to undergo a diagnostic procedure to assess the intradural status of the spinal roots. Although motor recovery is the main goal of brachial plexus surgery, the techniques currently...
: Intradural spinal root lesions cannot be recognized by dissecting the brachial plexus and lead to ineffective surgery if they remain undetected. Therefore, patients need to undergo a diagnostic procedure to assess the intradural status of the spinal roots. Although motor recovery is the main goal of brachial plexus surgery, the techniques current...
39 fingers in 31 patients were examined on the average of 117,6 months after flexor tenolysis of the finger. Results were classified according to Millesi's scheme and compared to the preoperative situation. For control, the criteria according to Buck-Gramcko were applied as well. In 23 fingers tenolysis resulted in an improved function, 13 cases re...
Twenty-five patients with severe brachial plexus lesions (having a rather poor prognosis in general), were subjected to a variety of split nerve graft procedures, with 22 achieving useful functional recovery. Thirty-eight nerves were reconstructed, with 32 of them achieving useful recovery. Results in these patients were no better nor worse than th...
The goal of this experimental study was to confirm the reliability of motor evoked potential (MEP) in testing the function of anterior motor roots in brachial plexus surgery. On central stimulation, nerve compound action potentials (NCAPs) are registered from the exposed spinal nerves. If NCAPs can be recorded, the anterior root is considered to be...
A recent work reports on the necessity to localize the most proximal site of leprous ulnar neuritis with intraoperative electroneurodiagnostics. In the present study we wanted to verify the applicability of this method on leprous median nerves. In six patients, seven median nerves were exposed at the wrist, all showing a typical leprous granuloma t...
Peripheral nerve trunks are viscoelastic tissues with unique mechanical characteristics. Tensile strength, which includes elastic limit and mechanical failure, concerns surgeons. This study shows that measurements of the load necessary to achieve certain elongations on specimens outside the body do not correspond with in situ measurements. The nece...
We describe a method of partial limb salvage for the treatment of large primary malignant tumours of the arm. The tumour-bearing area is resected as a cylindrical segment and the distal arm is then replanted with the necessary shortening. The method is suitable for stage-IIB tumours with or without neurovascular involvement which, because of their...
Normal tendons, normal palmar aponeuroses and palmar aponeuroses from patients with Dupuytren's disease were subjected to elastase or chondroitinase treatment. Young's modulus was derived from the linear portion of stress-strain graph. It showed the lowest value for the apparently normal palmar aponeuroses and the highest value for tendon samples....
Normal tendons, normal palmar aponeuroses and specimens from patients with Dupuytren's disease, namely apparently normal palmar aponeuroses and contracture bands were subjected to elastase and chondroitinase ABC digestion. Maximum Young's modulus, normalized hysteresis loop and residual elongation were determined before and after enzyme treatment....
In 10 patients with leprous ulnar neuritis, we investigated the most proximal site of lesion in the affected nerves. Spinal roots C8 and T1 were stimulated intraoperatively to evoke efferent mixed compound nerve action potentials which were recorded from the exposed ulnar nerves. The site at which amplitudes reached a maximum was considered the mos...
Grundlagen: Sobald die Diagnose einer kompletten Läsion des Plexus brachialis feststeht und Aussicht auf spontane Regeneration bei Vorliegen eines Schadens 1. oder 2. Grades auszuschließen ist, wird der Plexus brachialis freigelegt. Je nach dem Ausmaß des Schadens wird eine mikrochirurgische Neurolyse, eine Wiederherstellung der Kontinuität durch N...
Forty-six patients with Dupuytren's contracture (DC) and 55 control persons were HLA-typed for class I and HLA-DR class II antigens and were investigated for the presence of autoantibodies against elastin (ELAB) and collagen types I-IV (ACA I-IV). Using the chi 2 test, obtained from 2 x 2 contingency tables, a significant association was found betw...
One hundred and fifty upper extremities of 75 nonrandomized human cadavers were dissected to study the topographical relationship between the brachioradialis muscle tendon (BRMT) and the superficial branch of the radial nerve (SBRN). A split BRMT was found in nine arms, while in five of those nine arms the SBRN emerged from under the brachioradiali...
The hypothesis that autoimmune phenomena might be associated with the pathogenesis of Dupuytren’s contracture (DC) was advanced by Gay and Gay in 1972 [1]. This hypothesis was bolstered by Menzel et al. [2], who demonstrated the presence of circulating antibodies to collagen (ACA) in DC patients. These results were confirmed by Pereira et al. [3],...
The purpose of this study was to investigate the biomechanieal properties of Dupuytren’s disease (DD) tissue with special reference to viscoelasticity and to set the result in relation to (a) normal palmar aponeurosis (NPA) and (b) different stages of the disease.
The prognosis of surgical treatment of the tarsal tunnel syndrome (TTS) with regard to total pain relief is worse than following surgery of the carpal tunnel syndrome. In TTS, additional static factors play a role. The indication for surgery, therefore, is made with utmost reluctance. The surgical strategy is described extensively. In the majority...
Neurolysis is a procedure which has to be performed if the gliding apparatus of a peripheral nerve does not function, and consequently, adhesions and fibrosis develop. The gliding tissue has to provide the ability for the nerve to adapt to the different position of the extremity by longitudinal passive movement. The paraneurium provides movements b...
This study was undertaken to detect growth alterations after surgery for prominent ears. The cartilage excision technique was used in all 77 patients seen for follow-up. Two hundred students served as controls. Auricular measurements were done according to standardized guidelines of anthropometry. There was no significant difference between the ret...
Human palmar aponeurosis was treated with elastase in the presence or absence of soybean trypsin inhibitor. The removal of elastic fibers was complete as proved by electron microscopy. Cyclic loading was performed at a constant strain rate. Residual strain was measured and the stiffness and the fraction of dissipated energy of strain energy was cal...
The adaptation of the median nerve to limb motion was studied in cadaver extremities without damaging the nerve bed. The difference in length upon extension and flexion amounted to 100.5±5.7 mm. The length of the median nerve has to increase by 4% when the arm is fully extended and to decrease by 14.9% at flexion. The adaptation of nerve tissue to...
Every nerve must have the capacity to adapt to different positions by passive movement relative to the surrounding tissue. This capacity is provided by a gliding apparatus around the nerve trunk. There is another level of gliding provided by the interfascicular epineurium which allows the fascicles to glide against one another. The clinical signifi...
The development of peripheral nerve surgery over the past 15 years has been fascinating to watch. Significant improvements have been achieved by the wide application of techniques which were developed before this period. New approaches may revolutionize the tactics of nerve repair in the near future.
Passive movement of nerves is possible because the epifascicular epineurium is connected to the surrounding tissue by a loose connective tissue. In the carpal tunnel tendon sheaths have been developed to facilitate gliding of tendons produced by muscle contraction. By cadaveric dissection and by intraoperative examination of the carpal tunnel, a sp...
Between January 1980 and March 1988 twenty-two patients with compression neuropathies of the ulnar nerve in the Guyon's canal were treated. In seven patients the ulnar nerve was simultaneously decompressed at the elbow. Nine patients suffered from disorders of the sensibility and thirteen patients had sensory and motor symptoms. The ulnar nerve com...
A follow-up of thirty-seven patients with ulnar nerve entrapment at the elbow is presented. External neurolysis was performed in fourteen cases, whereas internal neurolysis involving interfascicular dissection was performed in twenty-three cases. When indicated, internal neurolysis can lead to very good results. However, unnecessary interfascicular...
This study was performed to investigate the mechanical properties of the median and the ulnar nerve in ten fresh cadaver extremities in situ and in a second series in vitro in a strain controlled testing equipment. In situ the nerves were fixed in the equipment at the level of the insertion of the pectoral muscle. The extensions of the nerves were...
Brachial plexus lesions with complete or partial palsy of the dependent musculature are a severe handicap for the patient. By microsurgery of lesions in continuity and nerve grafting in cases with complete interruption, some recovery can be achieved. Comparing the present-day results with the ones of earlier years, a significant increase of the per...
A rapid chemiluminescence assay for choline acetyltransferase activity in tissue extracts is described. A constant amount of choline is incubated in the presence of excess of acetyl-coenzyme A and the sample to be measured. The residual choline is determined, after oxidatioin catalyzed by choline oxisdase, by a chemiluminescence assay with microper...
The present study has attempted to determine the volume, square measure as well as length, width and thickness of the individual muscles of facial expression by photogrammetry. 15 fresh male head specimens were employed for a careful dissection of muscle layers. The volume was measured using the immersion procedure. The mean values of each paramete...
Primary anatomic studies served for identification and differentiation of the individual mimetic muscles. As a second step, we investigated the clinical potential of ultrasound imaging to visualize the mimetic musculature in 15 volunteers. This examination technique was used to diagnose pathological alterations, especially associated with facial pa...
The introduction of a reliable technique for nerve transplantation and the development of microsurgical neurolysis have made it possible to improve the degree of functional restoration that can be achieved following post-traumatic lesions of the brachial plexus. Although the functional recovery achieved still leaves a great deal to be desired, it i...