bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascularized autogenous canine coccygeal bone transfer
Authors: Yeh Lih‐Sen , Hou Sheng‐Mou , Lin An‐Chung
Published: March 2007

Based on cadaver studies in dogs, the 8th, 9th, or 10th canine coccygeal vertebra with overlying skin was designed for free vascularized bone transfer. In six dogs the coccygeal osteocutaneous flap was transferred to fill a defect of the tibia, anastomosing the median caudal artery and one of the two caudal veins to the tibial vessels. The overlying skin provided a reliable monitoring system for the transferred tissue. The behavior of the vascularized coccygeal vertebrae was then evaluated with radiographic and histologic examination and compared with control vertebrae transferred without reconnection of the blood vessels. The results revealed that the canine coccygeal bone graft is a reliable vascularized osteocutaneous flap, which can be applied either in clinical veterinary surgery or in orthopedic microsurgical research.
Importance of fibrinolysis in limiting thrombus formation following severe microarterial trauma: An experimental study in the rabbit
Authors: Arnljots Bjõrn , Wieslander Jan B. , Dougan Peter , Salemark Lars
Published: March 2007

In a blind randomized study, two groups of six rabbits were treated with either the fibrinolytic inhibitor tranexamic acid, 14 mg/kg bw, or isotonic saline solution (control group) given intraaortically as single bolus injections 5 min prior to arteriotomy and intimectomy of central ear arteries. Arteriotomic bleeding times, accumulations of 32P‐labeled platelets, patency, and sizes of thrombus deposits 2 hr after reperfusion were recorded. Fixed vessels were observed by scanning electron microscopy. Bleeding times were similar in the two groups. The patency rate in the tranexamic acid group was 2/12, i.e., a significant reduction (P < 0.05) from 7/12 in the control group. Thrombus deposits in occluded vessels contained large amounts of fibrin and red cells. Platelet accumulations in occluded vessels were significantly lower in the tranexamic acid group than in the control group, which indicates that the ratio of fibrin to platelets was increased in thrombi formed during antifibrinolytic treatment. This study has demonstrated the importance of normal fibrinolytic capacity in limiting thrombus formation following microarterial trauma. It is suggested that the use of antifibrinolytic agents in microvascular surgery should be restricted.
Free muscle transplantation combined with intercostal nerve crossing for reconstruction of elbow flexion and wrist extension in brachial plexus injuries
Authors: Akasaka Yoshihisa , Hara Tetsuya , Takahashi Masataru
Published: March 2007

Complete paralysis due to traumatic brachial plexus injury is extremely difficult to treat when the injury affects whole nerve roots and when motor function fails to show any signs of recovery. Seddon has suggested that arthrodesis of the shoulder and amputation at the humerus, combined with the use of a functional upper extremity prosthesis, was the most practical procedure available. Since 1965, in cases of irreparable lesions such as complete root avulsion type injuries, we have performed direct intercostal nerve crossing to the musculocutaneous nerve without free nerve graft to achieve elbow flexion. However, it is necessary to operate on the patient within 6 months following the injury to obtain good results. In the past there was no procedure for dealing with delayed cases of complete brachial plexus palsy. However, with the advent of microsurgical techniques, new approaches have become open to us. Since 1978, we have reconstructed the elbow flexor by the combined surgery of free muscle transplantation with intercostal nerve crossing in delayed cases of complete paralysis. This article introduces the operative technique and the results we have obtained.
Fiber type morphometry and capillary geometry in free, vascularized muscle transfers
Authors: Kuzon William M. , Rosenblatt J. David , Pynn Bruce R. , Plyley Michael J. , McKee Nancy H.
Published: March 2007

In order to establish the relationship among intraoperative ischemia time, the recovery of contractile function, muscle fiber morphometry, and capillary geometry following free muscle transfer, 15 male dogs underwent unilateral, orthotopic free transfer of the left gracilis muscle with microneurovascular anastomosis. Intraoperative ischemia time varied from 0 to 4 hours. After a recovery period averaging 14 months, isometric contractile function was measured in the transfers and the contralateral, control muscles. Muscle fiber type composition, fiber size, and capillary geometry were quantified from histochemical sections. Transferred and control muscles had similar type I fiber percentages, type I fiber sizes, and capillary densities. Type II fiber sizes were reduced in transfers relative to controls. There was no significant effect of intraoperative ischemia on any morphometric variable. Although contractile function was generally reduced after free, vascularized transfer, there was only a weak correlation between the recovery of tetanic tension and type I fiber percentage (r = 0.53, P < 0.05). It is concluded that free, vascularized muscle transfer results in minimal disturbance of muscle fiber type composition, fiber size, or capillary supply and that the diminished contractile function observed in this setting is still largely unexplained.
Histochemical staining of nerve endings as an aid to free muscle transplantation
Authors: Sanger James R. , Riley Danny A. , Yousif N. John , Matloub Hani S. , Bain James L. W.
Published: March 2007

Histochemical staining techniques that identify intact motor nerve fascicles are available to aid free muscle transplantation. Cholinesterase activity of myelinated axons can be identified by Karnovsky and Roots's technique. Axon viability can be assessed based on the presence of axoplasmic enzyme activity. By reacting serial sections for Cholinesterase activity and carbonic anhydrase activity, which labels sensory axons, an accurate cross‐sectional map of regenerating or functional sensory and motor nerve fibers can be constructed. Resolving the motor and sensory identities of fascicles in a mixed peripheral nerve should lead to more precise coaptation of recipient motor fibers to the motor nerve of the transferred muscle and enhance reinnervation.
Multiorgan transplantation in the rat: Development of a new microsurgical model
Authors: Pirenne Jacques , D'Silva Milbhor , Nakhleh Raouf E. , Lee Sun , Dunn David L.
Published: March 2007

Although transplantation of multiple abdominal viscera (MOTx) has been performed in humans, reproducible animal models and extensive laboratory work are needed to explore the physiological and immunological aspects of this new transplant procedure. We therefore developed a microsurgical model that allows en bloc transplantation of three major abdominal viscera. Using isogeneic rat strain combinations, 30% of the liver, pancreas, and duodenum and a segment of small bowel (SB) were heterotopically transplanted. A segment of aorta that included the celiac axis and the superior mesenteric artery provided the blood supply to the graft. Venous outflow occurred via the graft suprahepatic vena cava into the recipient's infrahepatic vena cava. The graft SB was anastomosed to the native SB. After a training period (N = 15), we could achieve a success rate of 83% (N = 23). Mean operation time was 105 minutes. Macroscopic and microscopic appearance of transplanted organs was normal. This study documents the feasibility of MOTx in the rat and provides a microsurgical model that should facilitate preclinical experimental research in this area.
Histomorphometric evaluation of intrahepatic changes following portal overflow in the rat
Authors: Benito Milagros , Del Pino Juan González , Hernández Lucia
Published: March 2007

Intrahepatic changes after an end‐to‐side renoportal arteriovenous shunt were studied in 60 rats. Portal and vena caval pressures did not increase from 3 weeks to 1 year. The number and diameters of the portal and hepatic vein lumens were determined through morphometric evaluation to calculate the relative areas. The proportion of area composed by the portal veins increased 3 weeks after shunt creation (P < 0.001), reaching its highest level at 1 year (0.08% in control rats vs. 2.45% ± 0.1% at 1 year). The proportionate area for hepatic veins also increased after 3 weeks (P < 0.001), reaching its highest value by 12 weeks (0.49% in controls vs. 1.73% ± 0.08% at 12 weeks). Our results suggest that there was a dramatic drop in the intrahepatic vascular resistance, especially at the portal bed, which may have compensated for the portal overflow. The theories regarding forward overflow compensatory mechanisms are discussed.
Experimental study of neurotization of denervated muscles with nerve‐to‐vein transfer
Authors: Tada Hiroshi , Hirayama Takakazu , Atsuta Yuji , Takemitsu Yoshiharu
Published: March 2007

Neurotization of denervated muscles was attempted by means of coaptation of peripheral nerves to the veins draining these muscles. In Sprague‐Dawley rats, the lateral gastrocnemius branch from the tibial nerve was severed and its proximal end was sutured to the distal stump of the lateral gastrocnemius vein. In all animals nerve‐muscle communication was confirmed electrophysiologically 2 and 6 months after the operation. However, histological examination revealed that the regenerated nerve fibers were not within the vessel lumen, but ran through the scar tissue in close proximity to the outside of the vessel, to enter the muscle. Control animals, in which only nerve resection was done, did not display nerve reinnervation. These results suggest that, although nerve fibers did not regenerate into the vein, the vein works well as va guide for regenerating nerve fibers to denervated muscle.
Morphologic and morphometric analyses of rat femoral arteries after crush injury
Authors: Chen Long‐En , Seaber Anthony V. , Glisson Richard R. , Mikat Eileen M. , Urbaniak James R.
Published: March 2007

Replantation after crush amputation has a relatively low success rate. An arterial crush injury was produced in rats under a range of pressure (8.5 to 2,551 g/mm2) and durations (10 to 60 minutes). The degrees of vessel injury and thrombus formation were evaluated as functions of both crush force and duration, and the healing process was followed for 8 weeks. Crushing resulted in morphologic damage to the arterial wall but did not impair patency. Damage was directly proportional to crush pressure and duration. Intimal denudation caused flat platelet adhesion but no thrombus formation or thrombosis. Re‐endothelialization was completed by 2 weeks. Intimal hyperplasia appeared at 1 week and consisted of endothelia in the most luminal layers and smooth muscle in the deeper layers. The internal elastic lamina was intact in all specimens and was thought to minimize platelet aggregation on the arterial wall after denudation of the intima.
Geometrical approach to the end‐to‐side anastomosis
Authors: Werker Paul M. N. , Kon Moshe , Green Colin J.
Published: March 2007

We analyzed the procedure of performing an arterio‐ or venotomy in rats and changed it from parallel to the long axis to perpendicular to the long axis. Simultaneously, geometrical analysis of the shape of an arterio‐ or venotomy led to a new approach for the end‐to‐side anastomosis in experimental free flap transplantation. This new method was applied in 268 anastomoses. It necessitated only six sutures and resulted in 100% arterial early and late patency and in 99% venous early and late patency.
Histomorphometric study of experimental extramucosal ureteroureterostomy
Authors: Castejón Rafael , Gamallo Carlos , Jaureguizar Enrique
Published: March 2007

The reconstruction of the urinary tract is still nowadays a controversial issue. This study is based on the use of histomorphometric techniques to describe the changes which take place in extramucosal ureteroureterostomy. A medial laparotomy was performed in 41 Wistar rats. The left ureter was sectioned and an extramucosal anastomosis was performed. All rats were sacrificed 25 days postsurgery. Histomorphometric studies were performed on the sutured ureters as well as on the contralateral (unrepaired) ureters. Two of the 41 cases operated died. Five others developed hydronephrosis and/or urinary fistula. Histomorphometric studies gave an average cross‐sectional area of 98,662.5 ± 31,927 μ2 for the anastomosed ureters versus 75,176.3 ± 16,732.4 μ2 for the control ureters (P ⩽ 0.01). Sutured ureters showed an increase in the area of the muscular layer (P ⩽ 0.001) and the submucosa (P ⩽ 0.01) compared with control ureters. Mucosa and lumen areas showed no significant differences between the groups. Sectioned ureters show an increase in total area and width based on a hypertrophy of the muscular and submucosal layers.
Anastomotic failure due to acute vasculitis in free flap transfer: A case report
Authors: Sanger James R. , Kadz Bruce B. , Tieu Thu Minh , Matloub Hani S. , Yousif N. John
Published: March 2007

We report a case of anastomotic failure secondary to acute vasculitis in a free flap. Following transfer of a latissimus dorsi myocutaneous flap, massive hemorrhage from the anastomosis occurred six days postoperatively. This was associated with segmental infarctions of the areas of the flap, which was removed. Transmural necrosis of the thoracodorsal artery, secondary to acute vasculitis was demonstrated by histology. Subsequent biopsies revealed an autoimmune vasculitis.
New method for autogenous vein grafting with the telescoping anastomotic technique
Authors: Saitoh Satoru , Nakatsuchi Yukio , Hart W. Steve , Burkhalter William E.
Published: March 2007

An experimental study was performed to examine whether a microsurgical telescoping anastomotic technique could be applied twice in one vessel, for use in autogenous vein grafting. The rat inferior epigastric vein was grafted into a defect created in the femoral artery. The original telescoping method of Lauritzen was used, with two additional suture placements, to allow anastomosis at both proximal and distal sites. By placing the four sutures symmetrically and carefully timing the removal of the proximal and distal clamps, we achieved a patency rate of 77.3%. This is a new method for autogenous vein grafting that may serve as a prototype for an easier and possibly faster vein grafting technique. Our results appear to indicate that complete coaptation of the severed vessel ends is not necessarily required for patency in microvascular repair.
Long‐term histologic results of vein grafting with the telescoping anastomotic technique
Authors: Saitoh Satoru , Nakatsuchi Yukio , Kitagawa Eiji , Burkhalter William E. , Hart W. Steve
Published: March 2007

We studied the long‐term histologic results of a new method for autogenous vein grafting to examine whether stenosis at the anastomosis is maintained over time. Nineteen rat inferior epigastric veins were grafted into the femoral artery using a telescoping sleeve technique at both the proximal and the distal anastomoses. Specimens were studied macroscopically and histologically three months later. Stenosis at the anastomosis was located near the tip of the inserted vessel. The smallest inner diameters of the proximal and distal anastomoses were about 80% of the corresponding femoral artery diameter; no statistically significant difference was found between the two anastomoses. The grafts had a thickened wall due to intimal hypertrophy and fibrosis of the media. The inner diameter of the graft was, however, about twice that of the femoral artery, and these graft changes did not create any apparent constriction within the graft.
Dilatation in anastomosed arteries can be an artifact of explantation
Authors: Legrand Edmund K. , Stoloff David R. , Kirsch Wolff M. , Zhu Yong H. , Boukouvalas Zisis , Hardesty Robert
Published: March 2007

Fusiform dilation of the anastomotic site was found at explantation in the majority of rabbit femoral arteries anastomosed with newly developed micro‐clips. This observation was also noted at sutured anastomoses. The mechanism responsible for this morphologic finding was studied by the following experiments: (1) measuring and explanting anastomosed arteries relaxed with 20% lidocaine, (2) latex casts of microclipped arteries, (3) comparing angiographic and histologic morphometric data, and (4) examining synthetic vascular graft anastomoses with identical dilatation. The observations demonstrate that trauma associated with explantation (direct dissection and fixative perfusion) leads to arterial vasoconstriction, but focal medial damage at the anastomotic site prevents constriction at this site.
Histochemical discrimination of fibers in regenerating rat infraorbital nerve
Authors: Wilke Russell A. , Riley Danny A. , Sanger James R.
Published: March 2007

In rat dorsal root ganglia, histochemical staining of carbonic anhydrase (CA) and cholinesterase (CE) yields a reciprocal pattern of activity: Sensory processes are CA positive and CE negative, whereas motor processes are CA negative and CE positive. In rat infraorbital nerve (a sensory peripheral nerve), we saw extensive CA staining of nearly 100% of the myelinated axons. Although CE reactivity in myelinated axons was extremely rare, we did observe CE staining of unmyelinated autonomic fibers.

Four weeks after transection of infraorbital nerves, CA‐stained longitudinal sections of the proximal stump demonstrated 3 distinct morphological zones. A fraction of the viable axons retained CA activity to within 2 mm of the distal extent of the stump, and the stain is capable of resolving growth sprouts being regenerated from these fibers. Staining of unmyelinated autonomic fibers in serial sections shows that CE activity was not retained as far distally as is the CA sensory staining.
Comparison of the influence of intralumenal irrigation solutions on free flap survival
Authors: Rumbolo Peter M. , Cooley Brian C. , Hanel Douglas P. , Gould John S.
Published: March 2007

Heparin is commonly included in the irrigation solution used during microvascular surgery. Evidence has accumulated to indicate a beneficial effect of heparin on anastomotic patency, implying that its topical use is critical to success even in routine microvascular repairs. This investigation compared heparin and urokinase as additives to the irrigation solution (Ringer's lactate) used during rat groin free flap replantation. A newly trained microsurgeon performed all surgical procedures to lower the possible success rate through microsurgical inexperience and, thus, to create a stronger challenge for the topical irrigant. Solutions were administered on a blinded, randomized basis. Vessel patency and flap survival were followed for 7 days. No statistically significant differences were found between any of the treatment goups: patency and survival rates of 67% for heparin, 57% for urokinase, and 73% for controls (vehicle only). The flap failures that occurred may have been attributable to undetected technical errors due to the microsurgical inexperience of the surgeon. In a separate series, an experienced microsurgeon achieved 93% success using vehicle without additives for irrigation. These results suggest that topical heparin or urokinase is not essential for achieving high levels of success during microvascular surgery.
Restoration of venous outflow by simultaneous creation of an arteriovenous shunt and pedicle flap using a rat model of foot replantation
Authors: Zhou Zhao Yi , Rickard Thomas A. , Nichter Larry S. , Zemel Norman P. , Ashworth Charles R. , Kassabian Garo
Published: March 2007

Replantation of amputated rat feet utilizing an efferent arteriovenous shunt constructed between the distal posterior tibial artery and the proximal posterior tibial vein, in the absence of all other venous drainage, provides an alternative pathway to the normal venous drainage in a replanted rat foot. However, this substitute venous drainage was insufficient to prevent progressive ischemia and necrosis of some or all of a replanted rat foot. When a cutaneous pedicle flap supplemented the arteriovenous shunt, venous drainage was much improved, tissue hypoxia and edema began to subside on the third day, severe tissue necrosis was prevented, and seven of eight feet replanted by this technique survived. These observations may be useful in replantation in humans when veins in the amputated part are too small to be used or so damaged that they cannot be repaired or reconstructed by a vein graft, but arteries can still provide a means of returning blood from the amputated part. Constructing an alternative pathway to the normal venous drainage pattern may allow severely damaged parts to survive after replantation.
Continuous local intraarterial infusion after prolonged arterial stasis in the fingers and toes
Authors: Fukui Akihiro , Maeda Masami , Mine Takako , Inada Yuji , Mizumoto Shigeru , Tamai Susumu
Published: March 2007

Seven patients with trauma to eight digits and one toe went untreated for arterial stasis, with subsequent development of posttraumatic changes in skin coloration. In two patients involving two digits, a daily dose of 2,000 ml containing 240,000 U urokinase, 80 μg prostaglandin E1, and 10,000 U heparin in lactated Ringer's solution was administered by intravenous infusion for 10 consecutive days; one of the two digits became necrotic. In all subsequent patients, a daily dose of 80 ml containing 240,000 U urokinase, 40 μg prostaglandin E1, 10,000 U (maximum) heparin, and low‐molecular‐weight dextran was administered by continuous local intraarterial infusion for 10 consecutive days. These seven extremities survived, even in the case of two digits and one toe with over 50 hr of arterial stasis. We believe that revascularization of extremities following prolonged periods of arterial stasis may be possible by means of continuous local intraarterial infusion of antithrombotic agents. © Wiley‐Liss, Inc.
Survival characteristics of the epigastric free flap in DA‐rats
Authors: Werker Paul M. N. , Kon Moshe , Green Colin , Franken Ralph J. P. M. , Overgoor Max L. E.
Published: March 2007

Epigastic flaps measuring approximately 6 × 4 cm with borders related to well‐defined anatomical structures were isografted (Dark Agouty to Dark Agouty inbred rats) with or without anastomosing their epigastric pedicle, after various periods of ischaemia, ranging from 0 to 120 h. During the ischaemic insult the flaps were stored at 0°C in a hypertonic citrate solution.

The non‐revascularized flaps exhibited survival percentages varying from 2 to 34% (mean, 16%) of the original flap. independent of the storage interval. The flaps that were revascularized after ischaemia had a 100% survival when transplanted immediately after isolation and following 48 h of cold storage. Mean survival percentages of 78% after 72 h of ischaemia, 32% after 96 h, and 4% after 120 h of ischaemia were found. It is concluded that the model described in this study is suitable for free flap research, because of its delineated borders. However, when the area of flap survival is lower than 30% in revascularized flaps there is a distinct likelihood that the flaps have survived regardless of the pedicle as simple Wolfe or composite grafts. Results must therefore be interpreted with great care. © Wiley‐Liss, Inc.
Influence of topical heparin on stasis‐induced thrombosis of microvascular anastomoses
Authors: Li Xiaolu , Cooley Brian C. , Gould John S.
Published: March 2007

An experiment was done to determine whether topical heparin and the association of anastomoses with dependent tissue (free flaps) exert any influences on stasis‐induced microvascular thrombosis. Rat femoral vessel anastomoses with or without free flap construction were used in a total of 50 male Sprague‐Dawley rats. Saline either with or without heparin was used for intralumenal irrigation during the anastomosis. Following anastomotic repair, the femoral vessels were reclamped, inducing stasis for either 2 or 4 hr. Our results showed that static blood had little adverse effect on thrombosis at the arterial anastomosis when reclamped for up to 4 hr in both standard and flap‐associated anastomoses. Topical heparin significantly reduced the incidence of stasis‐induced thrombosis of venous anastomoses. The venous patency rates in standard anastomoses were lower than those in flap‐associated anastomoses after both 2 and 4 hr of stasis. From these results, we conclude the following. (1) Arteries may be reclamped for up to 4 hr without detriment despite static blood being in contact with the anastomotic site. (2) Topical heparin may be helpful in increasing the patency rate of venous anastomoses after a period of blood stasis. (3) Free flap construction may play a role in decreasing stasis‐induced microvascular thrombosis. © Wiley‐Liss, Inc.
Achieving better patency rates and neoendothelialization in 1‐millimeter polytetrafluoroethylene grafts by varying fibril length and wall thickness
Authors: Lanzetta Marco , Owen Earl
Published: March 2007

This study evaluates the effects of different fibril lengths and wall thicknesses on patency and neoendothelialization in 1 mm inner diameter polytetrafluoroethylene (PTFE; Gore‐Tex) grafts and highlights the importance of longer fibril lengths and matching wall thicknesses. Fibril lengths tested were 30, 60, and 90 μm. The grafts had a wall thickness ranging from 0.18 to 0.34 mm. Ninety‐six grafts were implanted in the infrarenal aorta of Wistar rats. Grafts were harvested at various intervals and examined macroscopically, by light microscopy, and by scanning electron microscopy. Both the highest patency rates and the best grades of neoendothelialization were observed in the 90 μm fibril length grafts, while the lowest of both were seen in the 30 μm fibril length grafts. From this study we conclude that 90 μm fibril length PTFE can be considered a valid micrograft for bridging arterial defects in microvascular reconstructive procedures. © Wiley‐Liss, Inc.
Subcutaneous injection of oral cyclosporin A solution
Authors: Midha Rajiv , Mackinnon Susan E. , Evans Peter J. , Best Timothy J. , Wong P. Y.
Published: March 2007

Cyclosporin A (CyA) is the agent of choice for immunesuppression in the majority of rodent organ and tissue allotransplantation experiments. Subcutaneous injection of suitably dissolved pure CyA powder preparation is the acceptable standard of drug administration. We investigated the possibility of using oral CyA solution in an injectable form and compared its availability with that of the standard solution in a rat model. Oral CyA solution diluted in placebo (olive oil) and standard solution prepared from pure compound were injected subcutaneously at a dose of 5 mg/kg/day to two groups of rats. Trough whole blood CyA concentrations were measured on day 10 following initiation of treatment. Blood CyA levels of the standard solution group (1,167 ± 246 μg/liter, mean ± SD) were virtually identical to those of the oral solution group (1,105 ± 179 μg/liter; P > 0.05). In addition, the oral solution was easier to prepare and caused less injection site morbidity than the standard solution. We conclude that placebo‐diluted oral CyA solution may be safely injected subcutaneously to rats and results in consistent blood levels, comparable to those achieved with standard solution prepared from pure compound. © Wiley‐Liss, Inc.
Slip‐knot suspension technique: A fail‐safe microanastomosis for small‐caliber vessels
Authors: Szabo Zoltan , Stellini Ludovico , Rose Elliott H. , Ellis Mark S. , Burch Buford H.
Published: March 2007

The most common technical error associated with microvascular anastomotic failure is accidentally snagging the opposite wall and including it in the stitch, thereby reducing the vessel lumen diameter or occluding it altogether. A simple, safe microsuturing technique is described that combines the use of the slip‐knot and the suspension technique in a procedure that allows direct visual inspection of suture placement from first to last stitch. This technique is applicable to end‐to‐end and end‐to‐side microvascular anastomoses, for thick‐walled ducts such as the vas deferens and the fallopian tube, and in laparoscopic suturing. © Wiley‐Liss, Inc.
The interrupted‐continuous microsurgical suture technique
Authors: Morris Donald J. , Pribaz Julian J.
Published: March 2007

Interrupted microsurgical sutured anastomoses are the standard to which all new anastomotic techniques must be compared. In 1902, Alexis Carrel described a continuous suture technique for large vessels that initially triangulated the anastomosis with three stay sutures. Our technique is a modification of Carrel's original technique combined with other previously published microvascular methods. This is an attempt to address the inherent problems associated with the standard interrupted technique and previously described continuous suture techniques. © Wiley‐Liss, Inc.
Metabolic effect of pancreaticoduodenal transplantation in diabetic rats
Authors: Spadella César T. , Breim Luiz C. , Mercadante Maria C. S. , De Macedo Célia S. , De Macedo Arthur R.
Published: March 2007

Outbred Wistar rats were randomly assigned to three experimental groups: GI, 10 nondiabetic control rats; GII, 10 alloxan‐diabetic control rats; GIII, 25 alloxan‐diabetic rats that received pancreaticoduodenal transplantation (PDT) from normal donor Wistar rats and were immunosuppressed with cyclosporin A. For 7 prior and 4, 7, 14, 21, and 30 days posttransplantation (during which the animals were housed in metabolic cages for periods of 24 hours) body weight, water and food intake, urine output, blood and urinary glucose, plasma insulin, and glucagon were recorded. These parameters were also concurrently recorded for diabetic and nondiabetic control rats. Animals were sacrificed after 30 days and histological and immunohistochemical studies of the pancreas were performed. Pancreatic transplants consistently and significantly improved the metabolic abnormalities of the diabetic rat (P<0.01) by restoring body weight gain, and by immediate relief of hyperglycemia, glucosuria, polyuria, polydipsia, and also the low levels of plasma insulin. The plasma glucagon, elevated in diabetic control rats, did not change after transplant. © 1992 Wiley‐Liss, Inc.
formation of endovasal structures and intramural channels in rat vena cava after application of microsurgical suture: Prophylactic effect of heparin and trental administration
Authors: Vyalov Sergey L. , Rekhter Mark D. , Sidorov Vladimir B. , Pshenisnov Kirill P. , Mironov Alexander A.
Published: March 2007

The study addresses the histopathology of end‐to‐end microanastomosis in the rat inferior vena cava. The vessels were harvested in 4 hours and 1,3,7, 14, and 30 days after the operation and were evaluated using light, scanning, and transmission electron microscopy. The endothelium was completely restored within 7 days after the surgical procedure. Endovasal structures at the microsuture site and intramural endothelial channels opening into the vena cava lumen developed as a result of endothelialization and parallel substitution of the three‐dimensional fibrin framework of the mural microthrombus with connective tissue. By 1 month, aggregates of platelets, fibrin, and adhering leukocytes were observed in the intramural channel mouths. Administration of heparin and Trental for 1 week after the operation reduced the number of intramural channels and prevented the formation of endovasal structures at the site of microvenous anastomosis. © 1992 Wiley‐Liss, Inc.
Enhancement of motor nerve regeneration by nerve growth factor
Authors: He Chongliang , Chen Zhongwei , Chen Zhengrong
Published: March 2007

The sciatic nerves of adult Wistar rats were severed bilaterally. Each nerve was sutured into a silicone tube used as a conduit, leaving a 5 mm gap in length between the nerve ends. Nerve growth factor in a saline solution vehicle was injected into the silicone chamber on the right side and normal saline solution (control) on the left. Six weeks after surgery, electrophysiological studies were performed. The motor nerve conduction velocities (MNCV) were significantly increased in the NGF‐treated nerves. In one rat, the MNCV on the NGF‐treated side was 66.6 m/s, in the range of normal nerves. There was no significant difference between the two sides in the amplitudes of evoked muscle action potentials. There are apparently no reports on the effect of NGF on motor neuron regeneration in vitro. In this study, NGF was found to enhance motor nerve regeneration. © 1992 Wiley‐Liss, Inc.
Replantation of an amputated upper lip
Authors: Husami Tarek W. , Cervino A. Lawrence , Pennington Gary A. , Douglas Barry K.
Published: March 2007

Soft tissue defects of the face are a difficult reconstructive problem. Replantation of large amputated segments of the face has been rarely successful and has lagged well behind extremity trauma due in part to the relative rarity of these defects. Presented is a case of successful microvascular replantation of half of the upper lip after a dog bite. © 1992 Wiley‐Liss, Inc.
Forearm flap in orthopaedic and hand surgery
Authors: Soucacos Panayotis N. , Beris Alexandros E. , Xenakis Theodore A. , Malizos Konstantinos N. , Touliatos Alexandros S.
Published: March 2007

This study was undertaken in order to evaluate the usefulness of the forearm flap in reconstruction of severe injuries of the upper and lower extremities. A total of 34 patients with extensive skin defects of the upper and lower extremities were treated using radial forearm flaps during the last 4 years. Twentyfour patients had lower extremity injuries, while the remaining ten had upper extremity reconstruction. In two patients, the radial forearm flap was used as an island flap in retrograde direction for coverage of skin defects of the dorsum of the hand. In two patients, the palmaris longus tendon was included in the flap to reconstruct the extensor tendon of the index finger. In one patient, it was used as an innervated flap to cover a skin neurotrophic defect of the sole of the foot. None of the patients had the bony portion of the radius included. Of the 34 flaps, 29 survived. Of the remaining 5, 3 failed totally and 2 partially. The 2 partially failed flaps required reoperation and revision of the venous anastomosis, which was found to be occluded. The patients, eight women and twenty‐six men, were examined and questioned regarding the cosmetic appearance of the donor site. The final cosmetic appearance was acceptable to all patients. We conclude that the radial forearm flap is a useful, easily elevated flap, suitable for skin defects of upper and lower extremities. Major advantages of the flap are its ability to be used as an island flap and that the surgery can be performed under axillary block anaesthesia. © Wiley‐Liss, Inc.
Free vascularized fibular graft: A versatile graft for reconstruction of large skeletal defects and revascularization of necrotic bone
Authors: Malizos Konstantinos N. , Beris Alexandros E. , Xenakis Theodore A. , Korobilias Anastasios B. , Soucacos Panayotis N.
Published: March 2007

The microvascular transfer ot a fibular graft that was initially introduced for the treatment of massive bone loss in the appendicular skeleton has more recently found another useful application in the management of the osteonecrosis of the femoral head. Since 1989, we have successfully used the free vascularized fibula in two patients with segmental bone loss, one in the fore arm and the other in the distal femur. We have also attempted revascularization of the femoral head in fifteen patients (eighteen hips) with osteonecrosis. Although our follow‐up is short, the results have been encouraging and this method is now the treatment of choice in the early stages of the disease. © Wiley‐Liss, Inc.
Use of free flaps in the aesthetic reconstruction of face and neck deformities
Authors: Stamatopoulos C. , Panayotou P. , Tsirigotou S. , Ioannovich John D.
Published: March 2007

Three cases of face and neck deformities, reconstructed with free flaps in order to obtain better aesthetic results, are presented here. Nasal tip, carti lage, and soft tissue defects as well as facial burn contractures were recon structed with a free radial forearm flap, latissimus dorsi myocutaneous flap, and groin flap, respectively. Case specifics are discussed. © Wiley‐Liss, Inc.
Hemodynamic and histological differences in end‐to‐side anastomoses
Authors: Zoubos Aristides B. , Seaber Anthony V. , Urbaniak James R.
Published: March 2007

An end‐to‐side anastomosis is often a necessity in replantation surgery. This study examines the effects of elliptical versus slit arteriotomy and the angle of anastomosis on vessel patency and aneurysm formation. Forty male rats were divided into four groups of ten rats each. The right and left common iliac arteries were selected as a model. The results showed no significant statis tical difference in patency rates among our four experimental groups. The end‐to‐side anastomotic technique of choice uses the elliptical arteriotomy placed at a 90° angle. It provides good visualization and easy suture placement. © Wiley‐Liss, Inc.
Cutaneous trunci myocutaneous flap: A new and reliable model for muscle free flap research in the rat
Authors: Werker Paul M. N. , Kon Moshe
Published: March 2007

This paper deals with the first myocutaneous flap in the rat. It is located just caudal to the axilla and consists of the insertion of the cutaneous trunci mus cle with overlying subcuticular fat and skin and is supplied by the lateral thoracic vessels. It exhibits an all‐or‐none survival pattern. Because the skin can serve as a marker for muscle viability, we believe that this flap has great potential in future free muscle research. © Wiley‐Liss, Inc.
Free flap transfer of the cutaneous maximus muscle in the rat: Comparison to the latissimus dorsi muscle flap
Authors: Li Xiaolu , Cooley Brian C. , Gruel Suzann M. , Ye Zhong , Gould John S.
Published: March 2007

A new rat model of free muscle flap transfer is presented. Microvascular transplantation of the cutaneous maximus muscle flap is performed at the groin site, with anastomosis of the axillary vessels to the appropriate femoral vessels. This muscle flap has many useful attributes for experimental manip ulation. It has a high success rate following transplantation, the anatomy is consistent, the dissection is straightforward, the length of pedicle is relatively long (10 mm), the vessels for repair are of sufficient size (1.0‐1.35 mm diameter), and the microsurgical procedure can be performed in a relatively short period. The donor site deficit causes minimal impairment to animal mobility, and no evidence of limb ischemia is noted after ligation of the axillary vessels. The cutaneous area adjacent to the muscle is perfused by muscular perforators supplied by the flap pedicle; thus a skin island may be used to monitor the flap or to create a composite myocutaneous transfer. The cuta neous maximus muscle has mixed muscle types and anatomic dimensions similar to those of the latissimus dorsi muscle, and it provides ample tissue for pharmacological and biochemical studies, yet it presents easier dissection and microanastomoses than the latissimus flap, with more potential for ver satility in application. The advantages of this muscle flap make it a very useful experimental model for flap transfer research. © Wiley‐Liss, Inc.
Prefabrication of free flaps using the omeimtum in rats
Authors: Zhang Ling , Tuchler Robert E. , Chang Benjamin , Bakshandeh Norman , Shaw William W. , Siebert John W.
Published: March 2007

The omentum used as a vascular carrier is a new experimental model for prefabrication of free flaps in the rat. A 2.5 × 4 cm patch of omentum with gastroepiploic vessels and its rich vascular arcades was transferred under a bipedicled 2.5 ± 6 cm right abdominal panniculocutaneous flap. At subse quent time intervals (postoperative days 0, 3, 5, 7, and 14), the skin pedicles were divided and the skin flap was raised as a composite island flap vascu‐larized only by the underlying omental patch. The composite flap was then sutured back in place. Prefabricated flaps examined postoperatively demon strated a dye fluorescence index (DPI) of 4.60% ± 2.82% and 1.67% ± 4.08% flap survival (FS) in the day 0 group; in the day 3 group, 9.83% ± 1.47% of DFI and 15.00% ± 10.35% of FS; in the day 5 group, 28.39% ± 5.25% of DFI and 86.0% ± 12.74% of FS (P<0.05); in the day 7 group, 38.19% ± 7.52% of DFI and 98.13% ± 3.72% of FS (P<0.05); and, in the day 14 group, 49.55% ± 6.70% of DFI and 100% of FS (P<0.05). India‐ink injection and histologic examination confirmed revascularization of the overlying skin by day 5. © Wiley‐Liss, Inc.
Vascularized fibula graft for reconstruction after resection of aggressive benign and malignant bone tumors
Authors: Yajima Hiroshi , Tamai Susumu , Mizumoto Shigeru , Sugimura Masahito , Horiuchi Katsuhiro
Published: March 2007

From 1982 to 1991,19 patients at Nara Medical University, Kashihara, Japan, underwent resection of aggressive benign and malignant bone tumors, with limb salvage and reconstruction by free vascularized fibula grafts. The patients were followed up for an average of 54 months. The reconstructed site was the jaw in 6 cases, upper extremity in 3, spine in 1, pelvis in 2, and lower extremity in 7. Six patients had aggressive benign lesions, and 13 had malignant lesions. The sizes of the resultant bone defect ranged from 6 to 20 cm, and the lengths of fibula used ranged from 8 to 24 cm. The average time to union was 4.1 months (2–9 months) in the extremities and pelvis. Local recurrence was observed in 3 cases, for whom vascularized fibula grafts were performed for recurrent tumors. In cases of primary untreated tumors, no recurrences occurred. Therefore, this procedure should be performed at the time of primary operation after extensive resection of an aggressive benign or malignant bone tumor. © Wiley‐Liss, Inc.
Vein grafts in reconstructive microsurgery of the lower extremity
Authors: Vlastou Catherine , Earle A. Scott , Jordan Roderick
Published: March 2007

This paper describes surgical techniques and results of lower extremity microsurgical reconstruction using vein grafts. During a 5 year period, free tissue transfers were used to reconstruct 118 lower extremity defects in 109 patients. In 28 of these cases (24%), saphenous vein grafts were used when reconstruction would otherwise have been difficult or impossible. A preliminary arteriovenous fistula was established between the proximal arterial source and the final venous drainage in the majority (26) of cases. Venous drainage was left intact at the point of entry into the deep venous system in 23 cases. Three complications included anastomotic clotting in 2 patients and postoperative blow‐out of the vein graft in another; all were treated without flap loss. Flap survival was 86% in vein grafted patients and 94% in those cases in which vein grafts were not used. Flap loss was related in each case to the nature of the pre‐existing condition, rather than to vein grafting per se. © Wiley‐Liss, Inc.
Hair growth following scalp microvascular flap transfer for baldness due to burn injury
Authors: Tambwekar Suresh R.
Published: March 2007

A female patient, 8 years of age, presented with baldness of the right scalp following deep scalds from boiling soup landing on the head, neck, and chest. The depth of the burn was severe enough to cause baldness. She was primarily advised to wear a wig to address the problem of baldness on one side. Surgery was planned to use uninjured scalp skin to offer hairy skin coverage of the bald site. A left scalp skin flap (2.5 by 7 cm) based on the superficial temporal artery and vein was transferred to the bald area, with microvascular anastomosis to the superficial temporal vessels on the right side. There was complete survival of the flap with uneventful recovery and satisfactory growth of hair. Hair growth from the flap was comparatively thicker than from the rest of the scalp. This microvascular flap has produced sufficient hair to cover the entire area of the baldness and the patient does not need to wear a wig. © Wiley‐Liss, Inc.
Successful replantation of digits and restoration of partial hand function: A case report
Authors: Hu‐Rui Zhao , Wei Zhou , Guan‐Hen Zhou , Wen‐De Zhang
Published: March 2007

A case of a five‐finger amputation and avulsion injury with salvage of two digits combined with island flap coverage of the remaining skin defect is reported. The salvaged digits were replanted onto the ulnar and radial borders of the hand stump and rotated to oppose one another. 1 Recovery of partial hand function is reported. © Wiley‐Liss, Inc.
Vascularization of skin following implantation of an arteriovenous pedicle: Implications in flap prefabrication
Authors: Falco Nancy A. , Pribaz Julian J. , Eriksson Elof
Published: March 2007

In a rat model, a skin flap was fabricated by implantation of a distally ligated arteriovenous pedicle. The femoral artery and vein were implanted as a unit beneath the abdominal skin, a portion of which was later raised as an island flap, based on these vessels. Percentage area of survival, tissue blood flow, and pattern of vascularity were compared in two groups of flaps. In group I, the pedicle to be implanted was dissected with a cuff of surrounding muscle still attached; in group II, the pedicle was skeletonized to the level of adventitia. Flap survival in the two groups was similar (73% vs.77%), as was skin blood flow (5.4 vs. 5.7 ml/100 g/min). Angiography demonstrated two principal patterns of vascularization: connection between donor and recipient vessels (inosculation), and sprouting and arborization of new vessels. Strengths and limitations of this and other models of flap “prefabrication” are discusssed. © Wiley‐Liss, Inc.
Vascularized and nonvascularized parathyroid gland transfer: A comparative study
Authors: Monsivais Jose J. , Cordts Paul R. , O'Hair Kevin C. , Moreno Albert J.
Published: March 2007

There is currently no animal model available to study the results of vascularized parathyroid gland autotransfers and nonvascularized autotransfers in the same model. This study was undertaken to determine the technical feasibility of performing microvascular parathyroid gland autotransfers in the dog, and to compare the postoperative levels of calcium, phosphorous, and parathyroid hormone (PTH) levels to a group of dogs who underwent nonvascularized parathyroid gland transfers.

Dogs in the nonvascularized group were unable to maintain normal calcium without supplements, whereas dogs in the vascularized group maintained levels in the normal range. Microsurgical techniques allow transplant of a precise amount of parathyroid gland with its vascular supply to another part of the body with almost immediate restoration of function. © Wiley‐Liss, Inc.
Microsurgical use of polydioxanone (PDS) suture: An experimental report
Authors: Takeishi Meisei , Hirase Yuichi , Kojima Tadao
Published: March 2007

Although many technological advances have been made in surgical materials, nylon is still the main suture material used for microvascular surgery. This study sought to evaluate polydioxanone (PDS) sutures for use in microvascular anastomoses. Twenty‐eight male Sprague‐Dawley rats were used in this experiment. Spatula‐type needles with 9‐0 PDS suture were used to anastomose the right femoral arteries, with 9‐0 nylon used on the left side. The arteries were observed for 1, 2, 3, 4, 8, 12, and 16 weeks after surgery to determine arterial patency and to evaluate vascular pathology. Results were comparable between PDS and nylon. We suggest that if the suture material is redesigned to allow smooth passage through the tissue, and if the needle used in conjunction with the suture is improved, PDS may offer an excellent material for microvascular anastomosis. © Wiley‐Liss, Inc.