bluuebunny/crossref_metadata_2025 huggingface dataset:
Microsurgical arterialization for vascular impotence
Authors: Wagenknecht L. V.
Published: March 2007

Out of 400 patients with erectile lesions, Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phalloarteriography in 22 males demonstrated an occlusion of the interna pudendal artery in 21. In 15 patients penile arterialization was done by interposition of a saphenous vein‐graft between the iliac artery and the deep dorsal penile vein. In four of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively, two of three of the patients are doing well. Failures in five included four diabetic neurovascular lesions and one postoperative priapism.
Epididymal microsurgery: Current techniques and new horizons
Authors: Southwick Graeme J. , Temple‐Smith Peter D.
Published: March 2007

Surgical treatment for obstructive azoospermia was introduced about 30 years ago with the development of Bayle's vasoepididymal fistula technique (Bayle: Enc Med Chir 41:435, 1966). More recently this has been replaced by single tubule end‐to‐end microvasoepididymal bypass procedures with improved success rates. We describe the use of animal models in the development and application of a modified end‐to‐end microanastomosis technique in which the vas deferens is attached to a single surface convolution of the ductus epididymidis. In comparison with other microvasoepididymostomy (micro‐VE) procedures, this technique results in less postoperative scarring and allows for easier access to the epididymis in those patients requiring subsequent epididymal surgery. With this procedure 60% of patients produced spermatozoa after operation, and 10% of 102 patients have so far achieved pregnancies. For patients, such as those with congenital absence of the vasa deferentia, whose infertility cannot be corrected by microvasoepididymal surgery, we describe a microaspiration procedure that can be used to collect spermatozoa from the epididymis for use in in vitro fertilization (IVF). This procedure has a low success rate at present, with an 18% fertilization and 3% pregnancy rate per cycle. Improvements in treatment procedures for aspirated sperm samples, such as the use of motility stimulators and in vitro maturation by coculture with epididymal tubule segments before IVF, may enhance the success for this technique. Microinjection of sperm collected by epididymal microaspiration into oocytes may be an alternative method of treatment for these patients in the future. Two procedures (microepididymoepididymostomy and the vas bridge bypass) that are currently being modelled in the rabbit may provide new directions for epididymal microsurgery and for examining epididymal function. Although the two methods are technically more difficult than standard micro‐VE procedures, preliminary studies are encouraging and suggest a future role for these techniques in treating obstructive azoospermia. Such techniques make use of the epididymis distal to the obstruction site and may be particularly important in improving the success of surgery for obstructive azoospermic patients with high‐level obstructions in whom sperm quality following micro‐VE surgery is often poor.
New directions in male reproductive microsurgery
Authors: Gilbert Bruce R. , Goldstein Marc
Published: March 2007

During the past decade, microsurgery has become a urologic subspecialty. Historically, vascular and vasal anastomosis have formed the foundation of genitourinary microsurgery. With the advent of improved instrumentation and the interest of devoted urologic microsurgeons, a multitude of new applications of microsurgery in urology have developed. In this paper, we discuss some of the new directions in male reproductive microsurgery.
Heterotopic renal transplantation in the rat: An advanced microsurgical training exercise
Authors: Korber Kenneth E. , Kraemer Bruce A.
Published: March 2007

Microsurgical training programs have instructed trainees from many surgical specialties with the expansion of these techniques into all areas of clinical surgery and experimental research. Most programs employ the rat femoral vessel model in microsurgical training. A more complex and less frequently used model, the rat renal transplantation procedure, can be used for advanced training in microsurgical and microurological techniques and offers several advantages over other microsurgical models. In the heterotopic renal transplant model, the left kidney from a donor rat is transferred to the inguinofemoral region of a syngeneic recipient. The method of revascularization can be varied from end‐to‐end repairs of vessels of equal diameter to those of unequal diameter. In addition to the variety of possible vascular repairs, an advantage of this model over others is that the kidney graft can be harvested by a technician, thus reducing the time commitments of the trainee. This model is ideal for microsurgeons, immunologists, and urologists, since it affords the opportunity for developing technical skills while preparing an experimental model that can be used for further research. We describe the model, the operative techniques, and the variations one can employ in performing the vascular repairs.
A technique for replantation of the finger tip
Authors: Tsai Tsu‐Min , McCabe Steven J. , Maki Yutaka
Published: March 2007

The finger‐tip replantation technique reported here has evolved over 15 years. Indications for surgery include both strong patient desire and specialized use of the finger tip. Palmar flaps are elevated as full‐thickness skin grafts to avoid injury to palmar veins. Arteries and palmar digital veins are repaired using an open‐vessel technique. Postoperative care varies from immediate discharge with follow‐up to inpatient care using surgical leeches or continuous bleeding as a method of drainage should venous congestion develop. The survival rate of 26 finger tips replanted using this technique between 1981 and 1987 was 69%. Two‐point discrimination returned in 75% of patients, and 25% had two‐point discrimination of less than 5 mm. The distal interphalangeal joint retained an average range of motion of 56°. Appearance was excellent, and patient satisfaction was high.
A microvascular anastomotic device: Part i. a hemodynamic evaluation in rabbit femoral arteries and veins
Authors: Blair William F. , Steyers Curtis M. , Brown Thomas D. , Gable Ronald H.
Published: March 2007

This study quantitatively assesses the hemodynamic consequences of inserting a 1.5‐mm polyethylene anastomotic device in both small arteries and veins. The device was placed in 20 rabbit femoral arteries and 20 femoral veins. Using 20‐MHz pulsed ultrasonic Doppler velocimetry techniques, blood flow was measured in 5 immediate postoperative intervals and at the 24‐hour and 3‐week postoperative intervals. In arteries, volumetric flow (Q) was not statistically different in any postoperative interval; maximum spatial velocity (Vmax) was significantly increased in the immediate postoperative intervals but was not different at 24 hours or 3 weeks. In veins, significant decreases in Q and increases in Vmax occurred in the immediate postoperative intervals, but differences were not noted at the 24‐hour or 3‐week intervals. The results of this study indicate that the hemodynamic consequences of anastomosing small vessels with a polyethylene device are minimal and that this mechanical technique is an effective method for experimental microvascular repairs.
A microvascular anastomotic device: Part II. A Histologic Study In Arteries And Veins
Authors: Blair William F. , Steyers Curtis M. , Morecraft Robert J. , Maynard Jerry A.
Published: March 2007

This study analyzes the histology associated with the polyethylene ring‐pin device. The device was placed in 20 rabbit femoral arteries and 20 femoral veins. Specimens were harvested at 24‐hour and 3‐week postoperative intervals and were analyzed using light, scanning electron, and transmission electron microscopy. Generally, the reparative process in the arteries and veins was similar. In 24‐hour artery and vein specimens, the endothelial cells were absent, the media tapered within the device, but smooth muscle cells (SMC) remained partially viable. In 3‐week specimens, the device junction was well healed and reendothelialized. Subintimal hyperplasia was present, the internal elastic lamina was not reconstituted, and the SMCs were partially viable. Small vascular channels formed at the device junction, and small venous valves were noted near the device. Macrophages lined the margins of the device. The early reparative process proceeds favorably, by histologic criteria, after vessel repair with the polyethylene ring‐pin device.
Neointima formation in expanded polytetrafluoroethylene vascular grafts with different fibril lengths following implantation in the rat aorta
Authors: Hess Frits , Steeghs Suzanne , Jerusalem Christoph
Published: March 2007

Expanded polytetrafluoroethylene (PTFE) prostheses with fibril lengths of 30 and 60 μm were implanted in the rat infrarenal aorta. Sequential scanning electron and light microscopic studies of the prostheses after implantation demonstrated a different pattern of endothelialization. Prostheses with a fibril length of 60 μm had a continuous multilayered neointima at week 25 postimplantation, whereas prostheses with a 30‐μm fibril length had a discontinuous and single layer of endothelium after the same interval. It was concluded, therefore, that a prerequisite for the development of a lining in a vascular prosthesis is for the inner surface of the prosthesis to have adequate pores for effective anchoring of the invading endothelioid cells. Expanded PTFE prostheses with an internodular distance of 60 μm provided sufficient anchoring possibilities for invading endothelioid cells to form a continuous neointima.
Experimental nerve reconnection: Importance of initial repair
Authors: de Medinaceli Luis , Seaber Anthony V.
Published: March 2007

We believe that the randomness of sprout regrowth is the cause of most poor experimental and clinical functional results after nerve repair. We have elaborated a technique of repair, called “nerve reconnection” aiming to minimize randomness of regrowth. This technique enhances the precision of repair by minimizing physical and chemical damage to the stumps and by ensuring stress‐free stump abutment. In this study, the reconnection technique was compared to the conventional microsuture method. First, both techniques were tested as the primary method of repair. A method of behavioral evaluation, the sciatic functional index, was used to assess the results. The reconnection groups consistently showed satisfactory functional results, even after two successive procedures. In contrast, only one‐third of the animals in the suture groups reached satisfactory functional levels. In the second part of the study, animals with unsatisfactory results after primary suture were reoperated in an attempt to improve the poor results of initial surgery. The secondary procedures used were either the reconnection technique or conventional microsuture. All secondary procedures failed to improve poor preexisting functional conditions. These findings stress the importance of the original “blueprint” of the nerve and the necessity of maintaining this unique pattern during initial repair.
Treatment of skin and median nerve defects with peroneal neurofasciocutaneous flap
Authors: Fukui Akihiro , Inada Yǔji , Tamai Susumu , Mizumoto Shigeru
Published: March 2007

A large neurofasciocutaneous flap that consisted of a peroneal flap and a segment of sural nerve was used in the simultaneous reconstruction of a large soft tissue and nerve defect caused by a crushing injury of the distal forearm. A 10×15 cm peroneal flap, including a 10 cm segment of sural nerve, was successfully transferred to an 8×12 cm skin defect, reconstructing a 5 cm defect of the median nerve. Two years after repair, the opponens pollicis muscle showed good contraction, although palmar abduction of the thumb remained poor. Static two‐point discrimination was 20 mm on the pulp surface of both thumb and index finger and 15 mm on the middle finger.
Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: Experience in 13 cases
Authors: Minami Akio , Ogino Toshihiko , Itoga Hideya
Published: March 2007

We have carried out 13 vascularized iliac osteocutaneous flaps (VIOF) based on the deep circumflex artery (DCIA) and accompanying veins for cases with compound skin and bone defects. Ten of 13 cases obtained bony union at both ends of the iliac crest with only VIOF. Two of the remaining 3 cases obtained bony union at one end only with the VIOF but united at another end with an additional conventional bone grafting procedure. The final case, a traumatic bone defect of the tibia, failed to obtain bony union at either end of the iliac segment. In 5 of 11 patients in which an osteocutaneous flap was used, complete skin flap survival occurred. Of the remaining 6, one flap went on to complete necrosis, and five flaps were complicated by superficial or partial necrosis. The incidence of flap complications was analysed according to the size of flap. Five flaps with complete survival averaged 6.8 × 10.6 cm in size; however, five flaps with superficial or partial necrosis averaged 10.0 × 15.8 cm. These results suggest that the maximal safe skin flap dimension from the DCIA supply alone is probably 10×15 cm.
Use of small‐caliber polytetrafluoroethylene (gore‐tex ®) grafts in microsurgical training
Authors: Korber Kenneth E. , Kraemer Bruce A.
Published: March 2007

We present the use of polytetrafluoroethylene (PTFE) graft material as a microsurgical training model that better simulates live vessel repairs. PTFE grafts have mechanical advantages over polyethylene or silicons tubing in that they better mimic the “feel” of an arterial vessel wall, thus allowing the student to perfect counterpressor maneuvers before attempting live vessel repairs. Saving the PTFE “repairs” for later comparison and study provides the student with positive feedback that is not possible with living models. This cost‐effective model has helped to shorten our directed teaching program and has reduced the use of laboratory animals.
Enhancement of peripheral nerve regeneration by pharmacological activation of the cyclic amp second messenger system
Authors: Klein Howard W. , Kilmer Suzanne , Carlsen Richard C.
Published: March 2007

This paper reviews the history of attempts to study peripheral nerve regeneration, focusing upon pharmacologic agents that may prove to be useful clinically. In particular, forskolin is described as a model for such an agent, and its mechanism of action, as a stimulator of the cyclic AMP second messenger system, is described.
Relationship between sensibility and ability to read Braille in diabetics
Authors: Nakada Mayumi , Lee Dellon A.
Published: March 2007

Twenty‐five vision‐impaired diabetics received an evaluation of sensibility. Each subject had received 2 years of instruction in braille reading at the Konan Rehabilitation Center prior to the sensibility testing. Sensibility evaluation consisted of cutaneous pressure threshold measurements with the Semmes‐Weinstein monofilament and evaluation of moving and static two‐point discrimination with Disk‐Criminator™. The ability to read braille was graded by the braille‐teaching instructors as good, fair, and unable. The results of the evaluation of sensibility demonstrated that the value of the cutaneous pressure threshold did not correlate with the ability to read braille. Moving and static two‐point discrimination were found to correlate highly (P <.001) with the ability to read braille at a level of fair or good. No patient in this study with a moving two‐point discrimination value of 4 or more or a static two‐point discrimination value of 5 or more was able to read braille even at the fair level of ability.
Results of primary nerve repair in the upper extremity
Authors: Mailänder P. , Berger A. , Schaller E. , Ruhe K.
Published: March 2007

The results of primary repair of peripheral nerve injury in the upper extremity are reported for 143 nerves in 120 patients, with a mean follow‐up of 24 months. Normal values for static and moving two‐point discrimination were established and related to the person's age. Sensory reeducation was employed routinely in the postoperative rehabilitation program. Moving two‐point discrimination recovered to a better level in 61%, the same level in 38%, and a worse level in 1% than static two‐point discrimination after nerve repair. Results for digital, median, ulnar, and radial nerve repairs are reported.
Intravascular thrombosis in skeletal muscle microcirculation after ischemia
Authors: Hartsock Langdon A. , Seaber Anthony V. , Urbaniak James R.
Published: March 2007

This study was undertaken to elucidate the role of thrombosis in blood vessels less than 0.1 mm in diameter in skeletal muscle after an ischemic episode. Capillaries were examined after normothermic ischemia using intravital video microscopy of the cremaster muscle of an anesthetized rat. Histologic sections of the cremaster muscle and silicone rubber intravascular casts were also analyzed. Our model demonstrates that, after 3 hours of warm ischemia, up to two‐thirds of capillaries are clotted, as is most of the venous system. Our findings also indicate that capillaries may reopen during 30 minutes of reperfusion. These findings suggest that ischemia may cause thrombosis in the microvasculature of skeletal muscle but the thrombosis appears to be partially reversible.
Quantitative fluorimetric effects of leeching on a replanted ear
Authors: Anthony James P. , Lineaweaver William C. , Davis James W. , Buncke Harry J.
Published: March 2007

Leeching is used to relieve venous congestion in microscopically replanted tissues. A quantitative description of the effects of leech application on tissue perfusion has not been reported. We report a case of an ear replantation in which venous congestion was consistently improved with leeching. In four instances, quantitative fluorimetry, which indicated impaired circulation and prompted leech application, showed restoration of normal circulation patterns following leech application. The fluorometric studies suggested that arterial inflow improved and venous congestion was relieved.
Laser‐doppler versus fluorometry in the postoperative assessment of a cutaneous free flap
Authors: Durlik M. , Benichoux R. , Mainard D. , Merle M.
Published: March 2007

To find the optimal means for monitoring the vascularity of a cutaneous free flap in the postoperative period, we have experimentally compared laser‐Doppler velocimetry and fluorometry. Using the rat groin model, five groups were evaluated: 1. flap isolation without division of the pedicle vessels (island flap); 2) flap isolation, division, and repair of the pedicle artery and vein (free flap); 3) flap isolation, with ligation of the pedicle artery immediately or 1 hour later; 4) flap isolation, with ligation of the pedicle vein immediately or 1 hour later; 5) flap isolation, with ligation of the pedicle artery and vein immediately or 1 hour later. The laser‐Doppler processes the signal by combination of the root mean square and differential amplification. The fluoroscan gives an index in relation to the fluorescence of a control area. The results obtained with both methods correlated well with findings in clinical situations. However, the laser‐Doppler readings were more rapid and sensitive than those with fluorometry. We suggest that laser‐Doppler velocimetry is a superior means of monitoring the vascular status of a free tissue transfer or digital replant.
Sutureless microvascular anastomosis using the THC:YAG laser: A preliminary report
Authors: Bass Lawrence S. , Treat Michael R. , Dzakonski Carl , Trokel Stephen L.
Published: March 2007

Laser anastomosis of the rat carotid artery was performed using a new midinfrared laser, the pulsed thulium‐holmium‐chromium:YAG (THC:YAG) laser (2.15 μm). Solid silicone stents made stay sutures unnecessary for coaptation of vessel edges during laser bonding. Grossly, the laser anastomoses displayed minimal thermal distortion of the vessel contour and no tissue carbonization. Of the 30 anastomoses performed, 27 were patent and 3 had separation of the weld shortly after the approximator clamp was released. Mean anastomotic time was 4 min 48 sec. Mean bursting pressure for the 9 vessels tested was 400 mm Hg. Thrombosis did not occur at any time during our examination of these anastomoses. Fusion of collagen fibers in the media was confirmed histologically. Unlike the CO2 laser, the THC:YAG is transmissible through flexible silica fibers, which greatly facilitates delivery of the laser in a microsurgical operative field. The THC:YAG provides shallower absorption depth than Nd:YAG and argon lasers but somewhat deeper tissue penetration than CO2. For microvessels, this intermediate absorption results in full‐thickness fusion of the media, with minimal thermal damage to vascular tissue adjacent to the anastomosis.
Lack of portal‐venous hypertension after an arterioportal fistula in the rat
Authors: Benito Milagros , del Pino Juan Gonzalez , Hernandez Lucia , Pardo Juan Diez
Published: March 2007

The hepatic effects of an end‐to‐side arteriovenous fistula between the right renal artery and the portal vein were studied in rats. Fifty rats underwent surgery and were studied 3, 12, 24 weeks and 1 year later. Another 15 rats were used as controls. Rats did not have any portohepatic abnormality. Portal and caval pressure were measured, and the liver was evaluated histologically. No statistically significant differences were achieved between the control portal (10.37 M‐1 0.29 cm H2O) and vena cava pressures (1.22 M‐1 0.19 cm H2O) and those of the experimental groups. The overall liver architecture remained unchanged. A progressive enlargement of the intrahepatic portal and hepatic veins was noted. No hypertrophy of the fibrous tissue into the portal triads, hypertrophy of the muscularis of the portal vein radicals, or wall sclerotic thickening was seen. The forward overflow compensatory mechanisms are discussed.
Reliability of sciatic function index in assessing nerve regeneration across a 1 cm gap
Authors: Shenaq Jihad M. , Shenaq Saleh M. , Spira Melvin
Published: March 2007

To evaluate the validity of sciatic function index as a reliable functional parameter in assessing regeneration of rat sciatic nerve through a 1 cm gap, we undertook the following investigation. Sixty‐three adult male Sprague‐Dawley rats were assigned to four groups for repair of a 1 cm gap created in the right rat sciatic nerve; 19 rats were repaired with amniotic collagen conduits, 20 with nerve autograft, and 17 with silicone tubes. In seven rats, the gap was not repaired and served as a control. Functional recovery was assessed by de‐Medinaceli SFI and by clinical observations, compared with quantitative and qualitative histological results at 4,10, and 17 weeks postoperatively. The SFI results did not correlate with the histological findings and clinical observations over the observation period in all groups.
Sciatic nerve regeneration in the rat. Validity of walking track assessment in the presence of chronic contractures
Authors: Dellon A. L. , Mackinnon S. E.
Published: March 2007

The ability of the walking track assessment of sciatic nerve function to correlate with results of a nerve repair has been well documented following acute nerve injury and after recovery of the nerve following nerve repair. The longterm effects of partial denervation upon the lower extremity of the rat include the development of chronic contractures due to residual partial muscle paralysis and imbalance. The present study evaluated the ability of the walking track technique to portray accurately the walking pattern in animals following chronic contracture as a result of sciatic nerve repair. Animals 18 months and 24 months after sciatic nerve repair were found to have morphometric analysis distal to the repair that was not statistically significantly different from normal. However, the walking track assessment was inadequate at twentyfour months due to the development of clawing, interphalangeal joint contractures, and ankle inversion or aversion with or without dorsiflexion. The presence of these chronic deformities invalidated the walking track as an appropriate assessment technique for long‐term assessment of nerve function following nerve repair.
Self‐evaluation of walking‐track measurement using a sciatic function index
Authors: Brown C. J. , Mackinnon S. E. , Evans P. J. , Bain J. R. , Makino A. P. , Hunter O. A. , Hare G. M. T.
Published: March 2007

Recovery of function is of prime importance after peripheral nerve injury and repair. This paper describes a method of obtaining and measuring walkingtracks and generating a Sciatic Function Index (SFI) to quantify functional sciatic nerve recovery in the rat. The reader is provided with a series of walking‐tracks to measure, analyze and compare to those analyzed by experienced observers.
Variations in two‐point discrimination as a function of terminal probes
Authors: Levin L. S. , Regan N. , Pearsall G. , Nunley J. A.
Published: March 2007

A study was designed to investigate the role of terminal probes as determinates of two‐point discrimination in the normal hand. A Vernier caliper was modified to allow an exchange of probes with different diameters and with different terminal shapes. These terminal devices included flat, sharp, and rounded probe tips of various diameters. There was variability in normal subjects for different end probes and our results indicated that spherical probes give the largest variation in two‐point discrimination while pointed end probes provide the least variation. Variations of up to two millimeters can occur between large and small diameter probes. This study quantitatively supports the contention that different terminal devices will produce different recruitment of the sensory end organs in the hand, and strongly suggests the need for standardization of condition in assessment of sensory recovery.
Sensory recovery in transplanted toes
Authors: Leung P. C.
Published: March 2007

This study reports the results of 30 patients who entered a program of sensory reeducation following toe‐to‐thumb transfer. Results were analyzed after subdividing the patients into those whose injury had produced severe scarring (fibrotic group, N = 15) and those with clean, more distal amputations (nonfibrotic group, N = 15). Patients who were unable to complete sensory reeducation were considered as “drop‐out” controls. Although the follow‐up time was less than 1 year, the group receiving sensory reeducation did improve to a greater degree and more quickly than the controls, with the level of two‐point discrimination recovered being better than that originally present in the toe.
Long‐term measurement of innervation density in second toe‐to‐thumb transfers receiving immediate postoperative sensory reeducation
Authors: Vitkus K. , Vitkus M. , Krivulin A.
Published: March 2007

Three male patients, each receiving microvascular tissue transfer of the second toe to the thumb of their dominant hand, underwent a formal program of sensory reeducation immediately following the transfer. A high degree of functional sensation is reported.
Internal neurolysis and flexor tenosynovectomy: Adjuncts in the treatment of chronic median nerve compression at the wrist in hemodialysis patients
Authors: Corradi M. , Paganeli E. , Pavesi G.
Published: March 2007

This retrospective clinical study reports our results with surgical treatment of chronic median nerve compression at the wrist in 27 hemodialysis patients with a mean follow‐up of 22 months. Due to the high incidence of amyloidosis in our patient population, an extensive tenosynovectomy was done in all patients. Statistically significantly (P = .03) better results were obtained when a microsurgical internal neurolysis was added to the procedure, than simple decompression alone (82% vs. 63% good to excellent results).
Treatment of recurrent metatarsalgia by neuroma resection and muscle implantation: Case report and proposed algorithm of management for Morton's “neuroma”
Authors: Lee Dellon A.
Published: March 2007

This report describes the theoretical basis for an approach to treating a recurrent Morton's “neuroma.” The recurrence, being a true, classic neuroma, is treated by a technique validated in the treatment of the upper extremity painful neuroma: neuroma resection and muscle implantation. A plantar approach, implanting into the deep layer of intrinsics, was used. The three year success of this technique in a long‐distance runner is reported.
Microcirculatory responses to vascular washout following ischemia
Authors: Howell Scott T. , Seaber Anthony V. , Urbaniak James R.
Published: March 2007

This study examined the microcirculatory alterations in the hindlimb of the rat caused by ischemia and vascular washout with lactated Ringer's solution. Experimental groups consisted of innervated and denervated animals, each subjected to 2 hours of hindlimb ischemia. The ischemic period was then followed by either vascular washout or no washout prior to reperfusion. The cutaneous capillary blood flow was measured using laser Doppler velocimetry. The results demonstrated a substantial increase in early reperfusion flow above baseline in the innervated groups, more apparent in the group subjected to vascular washout. In all cases where there was elevated early flow, later flow levels were decreased. The results and proposed mechanisms of the response are discussed.
Single pedicle microvascular transfers of the serratus anterior and latissimus dorsi muscles in rats
Authors: Briones Rafael , Lineaweaver William C. , Newlin Leonard , Whitney Timothy M. , Buncke Harry J.
Published: March 2007

In the rat, the serratus anterior and latissimus dorsi muscles receive axial vascular pedicles from the thoracodorsal artery. This anatomy was confirmed by dissections, and 10 microvascular transfers of the latissimus‐serratus flap on a common pedicle were performed with a 90% success rate. The flaps had an average weight of 1.8 g. This flap is a reliable small animal model for microvascular muscle transplants and contains sufficient tissue to be used in multiple biochemical assays.
Long‐term histological changes in 1 millimeter polytetrafluoroethylene (gore‐tex) prosthetic arterial grafts
Authors: Samuels Roslyn M. , McGeachie John K. , Prendergast Francis J. , Storrie Elizabeth A.
Published: March 2007

Vein grafts are used extensively to repair blood vessels. However, when suitable vein segments are unavailable, alternative graft materials must be used. This study tested the suitability of 1 mm diameter polytetrafluoroethylene (PTFE) grafts for small‐calibre arterial replacements. Grafts of 4 mm length were inserted microsurgically into the iliac arteries of 26 rats. The grafts were removed between 3 and 22 months postoperatively and examined with light microscopy and scanning and transmission electron microscopy (SEM:TEM). Anastomotic intimal hyperplasia was minimal, consisting of a few smooth muscle cells extending 100–200 μm onto the graft. The rest of the PTFE was covered with endothelium. In a few isolated areas, there was a subendothelial layer of smooth muscle, 2–10 cells thick. The short segments used in this study were highly successful, with an overall long‐term patency rate of 80%. These grafts showed no evidence of excessive neo‐intimal hyperplasia.
New canine model for free jejunal graft studies
Authors: Scher Natan , Garza Jaime R. , Haughey Bruce H.
Published: March 2007

The need to more fully understand the function and physiology of the free jejunal graft prompted us to develop a new canine model. Twelve dogs were used to transplant a free jejunal graft in the neck with proximal and distal stomas exteriorized to the skin. The techniques used, complications encountered, and the potential for acute and chronic studies with this animal model are presented.
Phrenic nerve transfer for brachial plexus motor neurotization
Authors: Yu‐Dong Gu , Min‐Ming Wu , Yi‐Lu Zhen , Jia‐Ao Zhao , Gao‐Meng Zhang , De‐Song Chen , Ji‐Geng Yan , Xiao‐Ming Cheng
Published: March 2007

We report a series of 164 patients who underwent phrenic neurotization to elements of the brachial plexus with root avulsion injuries. Recipient nerves included musculocutaneous nerve in 125 patients (78 direct neurotizations and 48 with intervening autograft), median nerve in 10 patients, and a variety of other nerves in 28 patients. Sixty‐five patients presented a follow‐up period of 2 or more years. Of this group, 55 patients (84.6%) achieved a recovery of M‐3 or better. We observed no long‐term deleterious effects on respiratory function.
Experimental peripheral nerve repair: Environmental control directed at the cellular level
Authors: Zellem Ronald T. , Miller David W. , Kenning James A. , Hoenig Eugene M. , Buchheit William A.
Published: March 2007

This study recognizes recent advances in the understanding of the anatomy and physiology of peripheral nerves at the cellular level. It has reproduced study conditions originally advocated by de Medinaceli and coworkers, with modifications. Eighty‐four rats were divided into three groups. Group A underwent sciatic nerve transection and standard perineurial repair. Group B nerves were frozen, severed with a vibrating blade, and reconnected by tubulization with a rubber cuff while bathed in solutions designed to inhibit Ca++‐calmodulin activation, maintain colloid osmotic pressure, and mimic ambient electrolytic conditions. Group C underwent a similar procedure as group B, with the rubber cuff replaced by a polyglycolic acid mesh. All animals were randomized and evaluated functionally in terms of a sciatic index. By post‐operative day 225, animals of group A recovered 37% of function, group B recovered 74%, and group C recovered 67%. Compound action potential recordings revealed a velocity recovery of 41% in group A, 70% in group B, and 81% in group C. Microscopic evaluation provided evidence for corresponding structural improvement. This new method of nerve repair is uncomplicated, relatively inexpensive, and easily adaptable to other animal models.
Emergency knee joint salvage utilizing a free musculofasciocutaneous flap based on the anterior tibial artery: Case report
Authors: Comtet J. J. , Saint Cast Y. , Remy D. , Herzberg G. , Michel A.
Published: March 2007

A young adult male presented with a traumatic amputation at the upper third of his left leg and an extensive soft tissue loss around his left knee. A free musculofasciocutaneous flap was elevated on the anterolateral part of the amputated segment and transferred to the soft tissue defect around the proximal left tibia in order to avoid an above‐knee amputation. The entire flap depends on the anterior tibial artery for its blood supply. The anatomy of the flap is outlined. The importance of the musculocutaneous blood supply as well as the presence of an extensive fascial component make the flap very reliable. An 18‐month follow‐up period showed a uniformly well‐contoured soft tissue coverage and an optimal functional result.
Foot salvage in arteriolosclerotic and diabetic patients by free flaps after vascular bypass: Report of two cases
Authors: Shenaq Saleh M. , Dinh Tue A.
Published: March 2007

Vascular bypass has been a successful procedure for the salvage of ischemic limbs. Amputation after vascular bypass procedures alone is common when extensive ulceration, osteomyelitis, or bone‐tendon exposure is present, especially in the diabetic patient. We report two patients in whom the foot was salvaged by microsurgical free flap after revascularization with bypass grafting. Both patients are diabetic who presented with severe arteriolosclerotic foot, associated with extensive ulceration as well as bone and tendon exposure.
“Window technique” for approximation during end‐to‐end vascular anastomosis
Authors: Guity Afrassiab , Young Paul H.
Published: March 2007

A new, simple, and atraumatic technique for prevention of tension at the site of an anastomosis during end‐to‐end vascular anastomoses without using an approximator clamp is described.
An easy and safe way to dress limb flaps in the dog
Authors: Dvir E. , Morrison W. A. , O'Brien B. M.
Published: March 2007

When a flap is elevated In a human, the patient is usually managed with bed rest. The same conditions are impractical in dogs. Sometimes a flap in the dog must be protected from the dog itself by applying a special cast or a bucket on the head. An easy, safe, inexpensive, and quick method to dress the dog, by simply applying hot pepper into the dressing, is described.
Free‐flap reconstruction of large head and neck defects in the elderly
Authors: Peters Glenn E. , Grotting James C.
Published: March 2007

Advanced‐stage and recurrent malignancies of the head and neck place severe demands on both the surgical team and the patient. Marked alterations in cosmesis and function are to be expected following major ablative surgery. The use of free tissue transfer with microvascular anastomoses has provided the head and neck surgeon the freedom to resect these lesions aggressively and to provide the patient with improved cosmesis, function, and protection of vital structures. A series of six cases involving patients at The University of Alabama at Birmingham over the past year is presented.
A survey of microsurgery training in the United States
Authors: Goossens Dennis P. , Gruel Suzann M. , Rao Venkat K.
Published: March 2007

The increasing use of clinical and experimental microsurgical techniques has created a need for standardized, high‐quality training programs in microsurgery. Towards this end, we conducted a study of the microsurgery instruction available in the United States. The data were collected from responses to surveys mailed to 55 microsurgery training centers across the country. Survey questions asked for a general characterization of each training program and its participants and for a specific description of course content. The results indicated that, even though training programs differed considerably, there were common elements. Total course length ranged from less than 40 hours to 80 hours, with a range of 32–40 hours devoted to basic microsurgery techniques. Forty percent of instructional programs were not certified for continuing medical education (CME) credit. Half of all reported trainees were residents in training. The basic microsurgery techniques common to most programs included instruction in microvascular end‐to‐end and end‐to‐side anastomoses of femoral arteries and veins in rats. Instruction in peripheral nerve repair was not offered. We conclude that, although there are merits to a diverse curriculum, it is time to institute a minimum level of standardized basic microsurgery training.
Flow field mapping in the anesthetized rat
Authors: Joos Karen M. , Blair William F. , Brown Thomas D. , Gable Ronald H.
Published: March 2007

This study measured the hemodynamics of peripheral arterial sites in the rat, using 20 MHz pulsed ultrasonic Doppler velocimeter (PUDVM) methods. The lower extremities of 14 male Sprague‐Dawley rats were studied. The targeted sites included the abdominal aorta, external iliac, proximal femoral, mid‐femoral, and saphenous arteries. The hemodynamic variables of pulse period, maximum centerline velocity, lumen diameter, and mean volumetric flow were calculated interactively from temporal‐spatial plots of local velocity distributions. An analysis of variance revealed significant differences between right and left sides for lumen diameter (P = 0.028) and mean volumetric flow (P < 0.0001). The analysis showed no statistical difference for pulse period (P = 0.0836) among sites. However, three distinct groupings of sites: (1) abdominal aorta, (2) external iliac, proximal femoral, and mid‐femoral arteries, and (3) saphenous artery were noted for the remaining hemodynamic variables (P < 0.05). These results indicate that three hemodynamically distinct regions are available for microvascular research in the rat lower extremity arterial tree.
Comparison of laser‐assisted and conventionally sutured microvascular anastomoses by bursting pressure: A reanalysis and further studies
Authors: Flemming A. F. S. , Bown S. G. , Colles M. J. , Brough M. D.
Published: March 2007

Methods of testing the strength of microvascular anastomoses are reviewed historically, in the light of recent applications to laser‐assisted microvascular anastomosis techniques. The results of two experiments using hydrostatic distension to bursting point to determine the strengths of laser‐assisted and conventionally sutured anastomoses of rat arteries and veins are presented. Considerable variation of the bursting pressures was found at any given time after anastomosis, and by the third postoperative day, the sutured vessels showed a significant fall in strength to their weakest level, with not as great a fall in the laser group. The sutured vessels were stronger than were the laser‐anastomosed vessels, except at 3 days and after 6 weeks, when there were no significant differences between the two types of anastomosis. Aneurysmal vessels did not always burst at lower pressures than did nonaneurysmal vessels of comparable age.
Microsurgical reconstruction: The weightbearing surface of the foot
Authors: Meland N. Bradly
Published: March 2007

Microsurgical reconstruction in the weightbearing surface of the foot is discussed. Thirty‐eight patients treated at the Mayo Clinic are reviewed as well as a review of the current literature, leaving 122 patients for analysis. Minor complication rates in the skin grafted muscle flaps were 18.5% and major complication rates requiring further surgery were found in 12.9%. Fasciocutaneous and cutaneous flaps had a 25% incidence of minor complications and a 26% incidence of major complications requiring further surgery. No definite conclusions can be drawn as to which flap is indeed the best, but the newer, thinner fasciocutaneous flaps with innervation seem to hold promise. Future considerations are also discussed.
Technical successes and functional failures after free tissue transfer to the tibia
Authors: Yakuboff Kevin P. , Stern Peter J. , Neale Henry W.
Published: March 2007

A retrospective study evaluated functional outcome in 59 patients with 61 successful free tissue transfers performed after open tibial fractures. Twentyone patients had transfers done within 7 days, 13 between 7 and 21 days, and 25 were done greater than 3 weeks after injury. All 59 patients had Type III injuries as classified by Gustilo and Anderson. Nineteen patients (32%) were identified as late functional failures. Each of these patients underwent as average of 10 procedures. In this group chronic osteomyelitis was noted in 13 of 19 patients and chronic venous insufficiency with skin ulceration in 9 of 19 patients. Fracture nonunion was seen in 8 of 19. Degenerative joint problems and foot deformities were identified in 7 or 19 patients. Seven patients (12%) ultimately required below‐knee amputation. Functional failure did not correlate with the timing of flap application, but rather with the severity of the initial injury. Free tissue transfer is not a panacea. It is but one step in the overall reconstruction of complex tibial wounds.
Reconstruction of tibial bone defects in tibial nonunion
Authors: Ward W. G. , Goldner R. D. , Nunley J. A.
Published: March 2007

The management of tibial nonunions with small and large bony defects is discussed. Factors that prevent union and techniques for eliminating or minimizing these factors are presented.
Femoral reconstruction by vascularized bone transfer
Authors: Wood Michael B.
Published: March 2007

Thirty‐five patients with extensive femoral defects or recalcitrant nonunions were reconstructed by microvascular bone transfer with a follow‐up period exceeding 12 months. The cause of bone defect included trauma, debridement for osteomyelitis, or tumor resection, and the cause of nonunion included trauma or postirradiation osteonecrosis. Sixty‐nine percent of patients healed primarily, whereas 83% of patients ultimately progressed to union following secondary surgery. One patient who initially healed later required amputation for late graft fracture with nonunion; therefore, at final follow‐up, 80% of patients were fully healed. Vascularized bone transfer merits strong consideration for reconstruction of atypical and particularly difficult femoral nonunions.
Experimental investigation of cross‐nerve transfers relating to repair of brachial plexus avulsion injuries
Authors: Battiston Bruno , Guizzi Pierangelo , Vigasio Adolfo , Brunelli Giorgio
Published: March 2007

There is a lack of agreement regarding the potential for peripheral nerve cells with short axons to regenerate and innervate the terminal end organs of nerve cells with long axons. We designed a study to evaluate experimentally the possibility of neurons to reconstitute much longer axonal segments. Twenty Wistar rats were used. The brachial plexus was isolated and the radial nerve transected immediately after its origin. The proximal end of the axillary nerve (previously cut) then was coapted to the distal stump of the radial nerve. In 10 other rats, the cut radial nerve was simply recoapted to itself without involvement of the axillary nerve; these animals served as controls. Finally, in 10 rats, nerves were cut without repair to evaluate the degenerative changes. After 90 days, the distal part of the radial nerve was examined by light microscopy, calculating the number and area of regenerated axons. We also checked the motor end‐plates of reinnervated muscles. In the nerve‐transferred group, good axonal regeneration with good reinnervation of the muscles was seen. In this way, we have experimentally demonstrated a plasticity of regeneration in peripheral nerves. This suggests that the surgeon may use nerves connected to proximal muscles to neurotize avulsed nerves of distal muscles.
Magnification angiography and histology for the evaluation of microvascular anastomosis
Authors: Banic Andrej , Nilsson Ulf , Francis Issam
Published: March 2007

Magnification angiography was compared with histology in order to assess the value of each of the two techniques for the evaluation of microvascular anastomoses. At postmortem, angiography of 108 end‐to‐end anastomoses of the rat carotid artery (4.5 × magnification) was performed, followed by histological examination. Each method assessed the degree of stenosis or aneurysmal dilatation independently, expressing it as a percentage of lumen change compared to a noninvolved vessel segment of the same artery. Results were plotted for each carotid separately. Both methods were found to be equally useful, but were of rather low sensitivity and specificity. Each failed to diagnose roughly one‐third of all stenoses and even more aneurysms. A possibility for further improvement of the results is discussed. Both methods proved to be complementary; at least one‐third of the vascular changes would have been missed if only one method had been used. A combination of both techniques should therefore be used in studies of microvascular anastomoses.