Anastomosis

“ SUCCESSFUL cases of the anastomosis of motor nerves presiding over different groups of muscles have been several times reported since 1897. Some of these cases have resulted in the transference of function between the flexor and the extensor nerves of the same extremity; in other cases, nerves serving so different purposes as the sympathetic and the pneumo-gastric have been successfully crossed. The anastomosis of mixed nerves offers, of course, a more complicated problem. ”

“ There is everywhere a mutual anastomosis and inosculation of the arteries with the veins, and they severally transmit both blood and spirit, by certain invisible and undoubtedly very narrow passages. Now if the mouth of the pulmonary artery had stood in like manner continually open, and nature had found no contrivance for closing it when requisite, and opening it again, it would have been impossible that the blood could ever have passed by the invisible and delicate mouths, during the contractions of the thorax, into the arteries; for all things are not alike readily attracted or repelled ”

“ Ligature of the common carotid has been had recourse to, in order to stop bleeding from the mouth, nostrils, and other parts connected with the face,—for the cure of large or deep-seated aneurism by anastomosis,—and as a preliminary step to the removal of large and firmly attached morbid growths of the face or neck. ”

“ Further there is no anastomosis between the vessels of the round ligament and those of the medullary cavity, which must have been the case were the blood-vessels of the former destined to nourish the frame-work of the reticulated interior of the head of the femur. ”

“ REPAIR IN INDIVIDUAL TISSUES
_Skin and Connective Tissue._--The mode of regeneration of these tissues under aseptic conditions has already been described as the type of ideal repair. In highly vascular parts, such as the face, the reparative process goes on with great rapidity, and even extensive wounds may be firmly united in from three to five days. Where the anastomosis is less free the process is more prolonged. The more highly organised elements of the skin, such as the hair follicles, the sweat and sebaceous glands, are imperfectly reproduced ”

“ Such exercise is a powerful agent in promoting physiological and functional development.
Nerve anastomosis, which seeks to provide a new channel for the transmission of motor impulses to the paralysed muscles, has as yet a restricted field of application—for example, the tibial and peroneal nerves may be anastomosed when the muscles supplied by one of them are paralysed. Stoffel of Heidelberg lays stress on regard being paid to the anatomical arrangement of the nerve bundles within the nerve-trunk so that motor fibres may be joined to motor ones and not to sensory. ”

“ Intestinal anastomosis, whereby two portions of a severed or resected bowel can be intimately joined, excluding from fecal circulation the portion of bowel which has become obstructed, was originally suggested by Maisonneuve, and was studied experimentally by von Hacken. Billroth resorted to it, and Senn modified it by substituting decalcified bone-plates for sutures. Since that time, Abbe, Matas, Davis, Brokaw, Robinson, Stamm, Baracz, and Dawburn, have modified the material of the plates used, substituting catgut rings, untanned leather, cartilage, raw turnips, potatoes, etc. ”

“ It consists of a very fine granular matrix traversed throughout by a fine meshwork 254of minute fibrillæ, the neurospongium of Hickson. In the young cockroach (Periplaneta) the optic nerve separating the cerebral ganglion from the opticon is much longer in proportion than it is in the adult blow-fly.
Fig. 266.—Periopticon and terminal anastomosis of Agrion, showing the character of the elements of the periopticon (p.op) and the structure of the terminal anastomosis (t.a) . 1. The first layer of the terminal anastomosis, consisting of a plexus of fibrils and nerve-cells (n.c) . 2. ”

“ An·aÏstat¶ic (?) , a. [Gr. ? up + ? to make to stand: cf. ? causing to stand.] Pertaining to a process or a style of printing from characters in relief on zinc plates.
In this process the letterpress, engraving, or design of any kind is transferred to a zinc plate; the parts not covered with ink are eaten out, leaving a facsimile in relief to be printed from.
AÏnas¶toÏmose (?) , v. i. [imp. p. p. Anastomozed (?) ; p. pr. ? vb. n. Anastomosing.] [Cf. F. anastomoser, fr. anastomose. See Anastomosis.] (Anat. & Bot.) To inosculate; to intercommunicate by anastomosis, as the arteries and veins. ”

“ If a strong band is applied high up on the leg, and the saphena vein is injected below, it does not fill above the band, but the injection goes into the crural. In the same manner the internal jugular may be filled by the temporal, &c.
The anastomoses between the superficial and deep veins are more necessary in man than in any other animal, on account of his clothing, by which the neck, the ham, the arms, &c. are subjected to compressions that would be dangerous without these anastomoses. We can say that upon them alone is founded the possibility of a variety of modes in clothing. ”

“ Injection of blood vessels may be performed on small animals, or on individual human organs after removal from the body. The object is to fill the vessels with a coloured fluid which will solidify afterwards. It is possible in the same organ to inject the arteries with a red medium, the veins blue, and secretory ducts, such as bile ducts, yellow or blue.
The most convenient basis for an injection mass is gelatine, as its solutions liquefy at a temperature of about 100° F., and solidify a little below that point, and when solidified cut readily, and do not tend to become brittle. ”

“ To further facilitate the injection the operator should raise the skin with the needle introduced subcutaneously.
Only one injection of small amount (10 to 15 drops) should be done at a sitting. The injected mass, unless too easily introduced, and thus forming a tumefaction, need not be molded out, since the pressure of the skin overlying it will accomplish it more satisfactorily, while the pressure required in molding tends only to press out more or less of the mass, thus lessening the benefit of the operation. ”

“ That the growth is not limited by the size of the mass injected is the author’s belief; in other words, the replacement of the new tissue is not proportionate to the injection, but that other forces, such as adjacent tissue pressure and presence and outer influences, as, for instance, the daily massage of the parts with the hands, have much to do with the final amount of tissue caused to be developed by the initial stimulus of the injection. ”

“ The gap in the muscle becomes filled with blood, and this in time is replaced by connective tissue, which forms a bond of union between the ends. When the space is considerable the connecting medium consists of fibrous tissue, but when the ends are in contact it contains a number of newly formed muscle fibres. In the process of repair, one or both ends of the muscle or tendon may become fixed by adhesions to adjacent structures, and if the distal portion of a muscle is deprived of its nerve supply it may undergo degeneration and so have its function impaired. ”

“ The mass grows smaller to a degree, according to the amount injected; finally, at the [236] end of a month or more, the entire mass is replaced by a tissue perceptibly analogous to cartilage.
Freeman, like Eckstein, claims that encystment of the paraffin occurs soon after the injection, much like that following a bullet or other foreign body in the tissues, but, unlike the latter author, that a limited amount of the connective tissue also penetrates the mass, which is speedily converted into a solid cartilagelike body. ”

“ It consists of two layers, an outer fibrous and an inner cellular layer; the cells, which are called osteoblasts, are continuous with those lining the Haversian canals and the medullary cavity.
The arrangement of the blood vessels determines to some extent the incidence of disease in bone. The nutrient artery, after entering the medullary canal through a special foramen in the cortex, bifurcates, and one main division runs towards each of the extremities, and terminates at the ossifying junction in a series of capillary loops projected against the epiphysial cartilage. ”

“ Hyperinjection.—The injection of too much vaselin or paraffin is one of the most common faults found with operators. In the first instance a tumefaction of the site results which with the production of the tissue which takes the place of part of the filling makes the result very unsatisfactory and requires one or more cutting operations to reduce it. A peculiar fact with these hyperplastic growths is that even though they may be reduced with the knife to a normal size they seem to redevelop again and again, giving both surgeon and patient great concern. ”

“ Galen maintained, though he could not prove the fact, that the ultimate branches of the arteries and veins communicated together somehow or other, by what he called 'anastomoses', and that these 'anastomoses' existed not only in the body in general but also in the lungs. In the next place, Galen maintained that all the veins of the body arise from the liver; that they draw the blood thence and distribute it over the body. People laugh at that notion now-a-days; but if anybody will look at the facts he will see that it is a very probable supposition. ”

“ The author advises, when injecting about the neck, to use a stout, dull-pointed needle introduced under local ethyl chloride anesthesia and to elevate the tissue with the needle as the injection is made. In this way the operator can observe the behavior or placing of the injected mass, at the same time stretching the skin to permit of the injection without encroaching upon the blood vessels. The mass is immediately molded after each injection. ”

“ A recent dislocation may generally be reduced by extension alone, which must always be greater or less according to the strength of the muscles which move the joint, the age, robustness, and other circumstances of the patient. When the bone has been out of its place for any considerable time, and a swelling or inflammation has come on, it will be necessary to bleed the patient, and, after fomenting the part, to apply soft poultices with vinegar to it for some time before the reduction is attempted. ”

“ Care, however, should be taken to inject just sufficient of the solution to penetrate beyond the zone of operation laterally, to insure sufficient space for the insertion of sutures into anesthetized tissues. Only a small quantity of fluid is necessary in this procedure as it comes in direct contact with nerve terminals. By touching the injected line with the needle in several places along its length and inquiring of the patient if it is felt, we may make sure of the completeness of the anesthesia before making the incision which should begin and end inside the anesthetized area. ”

“ Treatment, in addition to that of the nerve lesion underlying the arthropathy, consists in supporting and protecting the joint by means of bandages, splints, and other apparatus. In the lower extremity, the use of crutches is helpful in taking the strain off the affected limb. When there is much distension of the joint, considerable relief follows upon withdrawal of fluid. The best possible result being rigid ankylosis in a good position, it may be advisable to bring this about artificially by arthrodesis or resection. ”

“ The capillaries around the seat of injury dilate slightly, the fixed cells of the tissues become active, dividing by karyokinesis as already described. The endothelial cells lining the divided blood vessels multiply and take an active part in the process. In spite of the congestion and the new cells produced, the reaction is much less than that of inflammation. The new cells invade the blood clot, consuming it and also any foreign matter, or any tissue which may have been killed by the injury. ”

“ When the ligature is applied to the lower third of the vessel, the collateral circulation will be comparatively free through the anastomoses of the two profundi and anastomotic branches with the radial, interosseous, and ulnar recurrent branches. If the artery happen to divide in the upper part of the arm into either of the branches of the forearm, or into all three, a ligature applied to any one of them will, of course, be insufficient to arrest the direct circulation through the forearm, if this be the object in view. ”

“ The incited action of the bloodvessels is followed by increased discharge, which is less glairy and albuminous, partaking more of the serous character. When the incited action soon terminates, and the activity of the absorbents is diminished, the fluid accumulates within the joint, producing Hydrops Articuli. This accumulation of fluid in joints may take place without being preceded by any apparent inflammation, and may remain a long time without any visible change of structure in the membrane. The knee is more frequently the seat of dropsy than any other joint. ”

“ Granulation Tissue.#--The essential and invariable medium of repair in all structures is an elementary form of new tissue known as _granulation tissue_, which is produced in the damaged area in response to the irritation caused by injury or disease. The vital reaction induced by such irritation results in dilatation of the vessels of the part, emigration of leucocytes, transudation of lymph, and certain proliferative changes in the fixed tissue cells. These changes are common to the processes of inflammation and repair ”