bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic cyclosporin A therapy in rats
Authors: Midha Rajiv , Mackinnon Susan E. , Wade Judy A. , Evans Peter J. , Best Timothy J. , Wong P. Y.
Published: March 2007

We investigated the pharmacokinetics of cyclosporin A (CsA) blood levels and drug toxicity in a chronic rat study in which long‐term (30 weeks) CsA was administered. Ninety Lewis rats received subcutaneous CsA at 5 mg/kg/day for 12 weeks, at which time CsA injections were stopped in 50 animals. The remaining 40 rats were maintained on 5 mg/kg CsA daily until week 18 and then switched to an alternate day dosing until week 30. All rats were observed daily and weighed weekly. Whole blood CsA levels were determined by a commercially available radioimmunoassay kit. The daily dosing regimen resulted in greatly elevated trough CsA levels (>1,600 μg/liter) and substantial chronic systemic toxicity, with weight loss and death in eight animals. Alternate day dosing reduced trough levels (mean 1,311 μg/liter) and decreased toxicity. Chronic administration by the subcutaneous route resulted in a considerable depot effect, with constancy of drug levels over a 48 hr dosing interval and a slow decline of drug levels (15 days) upon cessation of treatment. These results underscore the importance of monitoring both body weight and blood CsA levels in rodent studies when CsA is employed. Investigators should be aware of drug accumulation with chronic therapy and the consequent need to modify dosing to prevent toxicity. © Wiley‐Liss, Inc.
Experimental study of free toe replantation in rats
Authors: Jiang Ji‐Fu , Gu Yu‐Dong
Published: March 2007

A rat model for free second toe replantation, free hallux‐to‐thumb transplantation, and combined free haltux‐to‐thumb transplantation and free second‐toe‐to‐index transfer is described. Experimental devices, operative methods, and the keys to success are discussed. © Wiley‐Liss, Inc.
Low‐molecular‐weight heparin exerts an early antithrombotic effect in small arteries and veins following severe trauma
Authors: Zhang Baimeng , Wieslander Jan B.
Published: March 2007

Administration of low‐molecular‐weight heparin (LMWH) and standard heparin was studied by evaluating vessel bleeding, patency, and thrombotic material following severe vascular trauma. Arteriotomy and intimectomy or venotomy and intimectomy were performed on small rabbit arteries or veins in two separate blinded studies. All vessels were closed using a continuous microvascular suture. Patency and weight of thrombotic materials were evaluated 2 hr after reperfusion. In the arterial study, two groups of 23–24 arteries were treated with saline or LMWH systemically. Bleeding times were 89 ± 15 sec in the control group and 103 ± 27 sec in the LMWH group; there was no significant difference between the groups. Patency was significantly increased in the LMWH group (79%) compared to the control group (52%). The weight of thrombotic material in the LMWH group (1.39 ± 0.20 mg per artery) was significantly different compared to the control group (2.19 ± 0.22 mg per artery). In the venous study, 65 veins were divided into three groups (21–23 vessels/group) and treated with systemic saline, heparin, or LMWH. Bleeding times in the conventional heparin group (37 ± 7 sec), the control group (23 ± 3 sec), and LMWH group (22 ± 4 sec) were not significantly different. The patency rates were significantly increased in the heparin (42%) and LMWH (39%) groups compared to the control group (0%). The weight of thrombotic material in each vein was significantly less in the LMWH (1.07 ± 0.24 mg) and heparin (1.78 ± 0.52 mg) groups than in the control group (3.78 ± 0.29 mg). In conclusion, LMWH exerts an antithrombotic effect in small arteries and veins during the most crucial 2 hr following severe trauma without increasing bleeding. The results indicate usefulness of this LMWH in microvascular surgery. © Wiley‐Liss, Inc.
Physiologic alteration of fibrinogen levels: Influence upon patency of microvenous anastomoses
Authors: Cooley Brian C. , Fowler J. David , Gould John S.
Published: March 2007

High baseline levels of plasma fibrinogen have been correlated with increased risk for cardiovascular disease. Since fibrinogen plays a central role in both coagulation and platelet aggregation and is a primary component of thrombi, this study was designed to assess the relationship of circulating fibrinogen concentration and vein anastomotic patency. Subcutaneously injected turpentine was used to increase, and intravenous ancrod (snake venom) to decrease, plasma fibrinogen levels. Rat femoral vein anastomoses were performed, and patency was assessed after 120 min of flow. Rat tail bleeding times were obtained, and blood samples were drawn to determine fibrinogen and plasma protein concentrations, Lee‐White clotting times, and activated partial thromboplastin times (APTT). Increased patency was found in the ancrod group (88%) (P<0.05 vs. controls); turpentine‐treated and control groups were not significantly different (71% and 63%, respectively). The ancrod group also showed significantly prolonged tail bleeding times and APTT. Fibrinogen levels were significantly decreased in the ancrod group (1.73 mg/ml) and elevated in the turpentine group (4.91 mg/ml) vs. controls (2.34 mg/ml; P<0.005). These results indicate that elevated fibrinogen levels, in particular when triggered by an acute‐phase response, do not appear to predispose small vessel repairs toward thrombosis. Furthermore, this study supports the use of ancrod as an anticoagulant for microvascular surgery. © Wiley‐Liss, Inc.
Long‐term results of 1 millimeter arterial anastomosis using the 3M precise microvascular anastomotic system
Authors: Lanzetta Marco , Owen Earl R.
Published: March 2007

The 3M Precise Microvascular Anastomotic System has been tested experimentally in long‐term studies of arteries of 1 mm in diameter for the first time. The device was placed, using a newly described technique, in the infrarenal aorta of 25 rats. At different intervals (2 weeks, 16 weeks, and 1 year), the section containing the 3M Precise Microvascular Anastomotic System was removed and processed for light microscopy and scanning electron microscopy. All the anastomoses were found to be patent. Using a new device to process the material, both light microscopy and scanning electron microscopy at 2 weeks showed a perfect reparative process at the junction site and the presence of a continuous endothelial layer. Media atrophy was responsible for wall thinning within the device. At 16 weeks, the atrophy of the media was even more marked, reducing the vessel wall thickness within the device to one‐third of normal. At 1 year, this atrophy of the media was complete; smooth muscle cells disappeared and were replaced by fibrous tissue. Adventitia was not present over the long term within the device. The continuous endothelial layer, however, was still viable. These long‐term results suggest that scar tissue forms within the device, while a continuous endothelial layer remains viable internal to this. © Wiley‐Liss, Inc.
Development of a new rabbit ear model for the longitudinal study of digital pathophysiology
Authors: Smith Thomas L. , Koman L. Andrew
Published: March 2007

A rabbit ear model has been developed in which arterial pressure, auricular blood flow conductance, and microvascular perfusion can be followed continuously in conscious animals. Conductance is measured with a transit‐time flow probe placed around the auricular artery, arterial pressure is measured with an abdominal aortic catheter, and cutaneous microvascular perfusion is assessed using laser Doppler fluxmetry. Placement of a femoral vein catheter permits administration of vasoactive substances. To date, rabbits have been instrumented for 90 days or longer. Auricular and abdominal arterial pressures were equal, permitting the calculation of auricular artery conductance. Microvascular perfusion as measured by laser Doppler fluxmetry followed changes in overall blood flow. The presence of postsynaptic α2‐receptors was confirmed by determining auricular conductance before and after the administration of intravenous α‐agonists. The development of this unique model will help to advance the understanding of the pathophysiology of human digital thermoregulatory vascular abnormalities. © Wiley‐Liss, Inc.
Microsurgical approach to the abdominal thoracic duct in the rat: Considerations in the collection of lymphocytes
Authors: Frank W. , Stuhldreher D. , Muchnik S. , Shaw M. , Chou B. , Rubenstein M. , Ray P. , Guinan P.
Published: March 2007

In experiments involving the collection of thoracic duct lymphocytes the anatomy of the abdominal thoracic duct in the rat has been further defined. In general, the abdominal thoracic duct lies posterior and to the left of the aorta between the renal arteries and the diaphragm. There are variations in the microsurgical approach to the classically described location of this organ that should be noted by investigators attempting to identify and dissect this Structure. © Wiley‐Liss, Inc.
New rapid technique for renal transplantation in the rat
Authors: Engelbrecht Gert , Kahn Delawir , Duminy Francois , Hickman Rosemary
Published: March 2007

Present techniques for renal transplantation in the rat include a period of 20–25 minutes warm ischemia. Our method combines a recently described sleeve anastomotic technique for the renal artery, conventional end‐to‐end anastomosis of the renal vein, and implantation of the ureter into the bladder. This has resulted in a reproducible ischemic interval of 12–14 minutes. Plasma creatinine and histological features in animals sacrificed from 10 to 30 days after transplantation were within normal limits with no evidence of ischemic damage. A further advantage of the technique is that kidneys can be exchanged between the donor and recipient. It is recommended that this procedure, which reduces the ischemic interval by up to 50%, should be learned and employed in studies of renal transplantation in the rat, especially if such studies include the prior administration of cyclosporine, which may aggravate the effects of ischemia. © Wiley‐Liss, Inc.
Small bowel transplantation in the mouse: Development of a model
Authors: Squiers Elizabeth C. , Kelley Stephen E. , West John C.
Published: March 2007

The rat has been used as a model to study the significance of graft and host interactions in small bowel transplantation (SBTX). A mouse model of SBTX would allow investigators to apply the knowledge of the well‐defined genetics in the mouse to this field of study. Therefore, we have developed a mouse model of heterotopic SBTX using syngeneic C57BL6/J mice. Animals were anesthetized with a combination of ketamine and xylazine. Donor animals underwent midline laparotomy, with isolation of a segment of bowel as an isograft for transplantation to a recipient animal. The bowel was flushed in situ prior to removal of the graft with a Carrel patch of aorta and portal vein. The recipient animal underwent midline laparotomy and preparation of its infrarenal aorta and inferior vena cava for end‐to‐side anastomosis of the graft with 10‐0 nylon. After vascular reperfusion of the graft the ends of the isografted bowel were brought out as stomata. Successful grafts were later assessed for viability by laparotomy or histological examination at the time of sacrifice. Areas of technical difficulty in this model and issues that might improve the experimental results are discussed. This model should allow investigators to apply the well‐defined genetics of the mouse to probe the challenging field of intestinal transplantation. © Wiley‐Liss, Inc.
Free flap failure due to venous occlusion secondary to previous intravenous cannulation: A case report
Authors: Beckingham Ian J. , Wilson Geoffrey R. , McLean Neil R. , Soames James V.
Published: March 2007

A case of failure of a free radial forearm flap is presented. It is surmised that this was due to venous thrombosis in the cephalic vein which showed evidence of recanalization of an old thrombus. The patient had received intravenous erythromycin some months previously. © Wiley‐Liss, Inc.
Management of major penetrating glass injuries to the upper extremities in children and adolescents
Authors: Iconomou Thomais G. , Zuker Ronald M. , Michelow Bryan J.
Published: March 2007

Penetrating glass injuries are a common cause of severe neurovascular damage, both in adults and in children. Frequently, an innocent skin wound disguises the extensive nature of the injuries beneath. Nineteen children and adolescents (ages 3–16 years) with a mean age of 9 years who sustained upper extremity penetrating glass wounds were evaluated retrospectively in order (1) to determine the incidence of unappreciated significant neurologic, musculotendonous, or vascular injury; (2) to provide indications for intraoperative evaluation under anesthesia; and (3) to further define the role of microneurorrhaphy in this population. Twelve patients sustained injuries above the elbow and seven patients injuries distal to the elbow. Above the elbow, the structures injured in order of frequency were the median nerve (75%), the brachial artery (58%), the ulnar nerve (50%), the musculocutaneous nerve (33%), sensory nerves of the arm and forearm and venae commitantes (42% each), the radial nerve (25%), and the chords of the brachial plexus (8%). Distal to the elbow, the ulnar nerve was the most frequently involved (71%), followed by the ulnar artery (57%), the flexor carpi ulnaris (57%), the superficialis and profundus flexor tendons (43%), the median nerve (43%), and the palmaris longus and flexor carpi radialis (14% each). Early exploration is critical to successful management. Vascular repairs and or microneurorrhaphy were necessary in all cases. A detailed follow‐up evaluation to assess the results of these repairs was carried out from 4 to 9 years postsurgery. There were no clinical problems related to the vascular reconstructions. The results of the nerve repairs in this small series of children and adolescents were remarkably good. Sensory modalities and motor function approached normality. Of particular note was the return of intrinsic motor function even in high axillary injuries. Microsurgical reconstruction following penetrating glass injuries to the upper extremities in children and adolescence is a worthwhile procedure, yielding surprisingly good results. © 1993 Wiley‐Liss Inc.
Novel microsurgical model of experimental vascular neointimal hyperplasia
Authors: Tennant Marc , Barker Andrew , Storrie Ann E. , McGeachie John K.
Published: March 2007

Neointimal hyperplasia is a common finding after trauma to blood vessels and also as a primary change in atherosclerosis. In this study we have developed a simple model, using microsurgical techniques, for the initiation of neointimal hyperplasia in the rat. In 24 Wistar rats, a 2 mm‐diameter arteriotomy in the aorta was repaired with a „patch”︁ of iliolumbar vein, using eight evenly spaced 10‐0 Ethilon sutures. The patch overlapped the edges of the arteriotomy, and the sutures fastened the patch to the subjacent aorta. At 2, 6 and 12 weeks after surgery, the venous patch grafts and segments of the adjacent aortae of eight rats were removed. One‐half of the specimens were analyzed by scanning electron microscopy and the other one‐half by light microscopy. All patch grafts were surgically successful. Endothelial cells regenerated to cover the patch within 2 weeks of insertion. By 6 weeks after surgery, neointimal hyperplasia, consisting predominantly of smooth muscle, had developed in all patches to a thickness that was not significantly different from that of the adjacent aorta. These findings are consistent with data from other more complex experimental models of neointimal hyperplasia in the rat. We consider that this venous patch technique is a simple but effective model for the initiation of neointimal hyperplasia in the rat and may easily be used to study the experimental effects of various injurious or therapeutic agents on neointimal hyperplasia. © 1993 Wiley‐Liss Inc.
Hemodynamic comparison of microsurgical closures for longitudinal arteriotomies
Authors: Cipoletti Robert D. , Moneim Moheb S. , Greene E. R.
Published: March 2007

Twenty‐four femoral arteries in 12 rats were used to compare longitudinal and transverse closures in blood vessels ∼ 1 mm in diameter. The closure techniques were applied to a simple longitudinal slit, 1 mm long, and to a longitudinal defect, 0.5 mm wide and 1 mm long. Comparisons were made of the change in pre‐ and postrepair flow velocities, recorded every 5 min using a 20‐MHz pulsed Doppler velocimeter. Maximum reductions in flow velocity (linearly related to volume flow) were 10% and 29% for the longitudinal and transverse repairs, respectively, when applied to the longitudinal slit, and 65% and 19%, respectively, when applied to the larger arteriotomy. An analysis of variance indicates that the differences in the normalization of flow velocities during the immediate postrepair period are significant (P < 0.05). We conclude that optimal flow normalization is achieved by applying the longitudinal repair to the simple slit and the transverse repair to the larger arteriotomy. © 1993 Wiley‐Liss Inc.
”︁Plasmatic imbibition„ in the rat musculocutaneous pedicled venous flap: Enzymatic proof using horseradish peroxidase
Authors: Fukui Akihiro , Maeda Masami , Tamai Susumu , Inada Yuji
Published: March 2007

To determine the reason for survival of a pedicled venous flap in which only a draining vein is preserved, it is important to clarify what kind of blood flow is present in the preserved draining vein. Pedicled venous flaps were prepared on the dorsum of the rat and histologically evaluated using horseradish peroxidase (HRP). HRP was applied between the flap and recipient bed in one group. In the other group, HRP was injected into the femoral vein after the flap was turned over (to prevent contact with the recipient bed). The flaps in these HRP‐treated groups were compared with untreated control groups. HRP applied between the flap and recipient bed was imbibed into the flap and subsequently transferred into the preserved draining vein. HRP that was injected into the femoral vein was also found in the draining vein of the flap. These results suggest that (1) plasmatic imbibition occurs in pedicled venous flaps; and (2) antegrade and retrograde blood flow are present in the draining Vein. © 1993 Wiley‐Liss Inc.
Refinement of the rat crush‐avulsion femoral artery injury model
Authors: Rooks Michael D. , Rodriquez Jorge , McNaughton Mark , Turnidge Kip , Zusmanis Kathy , Hutton William
Published: March 2007

A model for studying arterial crush‐avulsion injuries in the rat is described. The model uses a standardized crush of ∼0.3 joules and a standardized avulsion. The crush is accomplished by gravity acceleration of a 400 g weight over a distance of 7.5 cm. The weight impacts an anvil over the artery distributing the force of the impact over a 10 mm length of the vessel. The avulsion is accomplished by a hemostat attached to a second, 120g weight. Vascular stasis for 90 sec after vessel repair in a 175–225 g rat will consistently result in an 80% anastomotic failure. The model allows evaluation of anticoagulant effects singly or in combination. Agents may be given either systemically by intravenous route or locally by intraarterial route. © 1993 Wiley‐Liss Inc.
Development of a mouse intestinal transplantation model
Authors: Zhong Robert , Zhang Zheng , Quan Douglas , Duff John , Stiller Calvin , Grant David
Published: March 2007

We have recently developed a mouse intestinal transplantation model. The proximal segment of donor jejunum is transplanted into the recipient in a heterotopic position. End‐to‐side anastomoses are performed between donor aorta and recipient aorta and between donor portal vein and recipient inferior vena cava. Mortality rates were initially high due to shock, arterial thrombosis, and postoperative sepsis. Refinements in surgical techniques reduced these complications, resulting in a high rate of success. Important technical factors included (1) minimizing ischemic injuries to the graft in both the donor and the recipient, (2) using an aortic patch and elliptical aortotomy for anastomosis, (3) administering large volumes of crystalloid to maintain normal blood pressure during the donor and recipient surgeries, and (4) using broad‐spectrum antibiotics as postoperative prophylaxis. The mice with isografts had normal intestinal function and histology when they were sacrificed 1 month after surgery. This new model of small bowel transplantation will be a useful tool to study the immunology of intestinal grafting at the molecular level. © 1993 Wiley‐Liss Inc.
Monitoring techniques for the detection of flow failure in the postoperative period
Authors: Neugan Peter C.
Published: March 2007

Free tissue transfer is now a commonly used reconstructive tool. Vascular compromise is still a common complication and salvage rates of compromised flaps have been in the region of 50%. Numerous monitoring techniques have been tried but there is yet no single technique which has enjoyed universal acceptance. This paper reviews the available techniques and indicates where current trends are leading. © 1993 Wiley‐Liss Inc.
Pharmacologic intervention in ischemia‐induced reperfusion injury in the skeletal muscle
Authors: Pang Cho Y. , Forrest Christopher R. , Mounsey Robert
Published: March 2007

This article provides a concise review on the potential causes of ischemia‐induced reperfusion (I/R) injury and pharmacologic intervention in the skeletal muscle. Special emphasis is placed on the recent observation of the acute ischemic preconditioning phenomenon for prevention of I/R injury in skeletal muscle. Finally, the mechanism of ischemic preconditioning and its clinical applications for augmentation of skeletal muscle tolerance to prolonged ischemic insult are discussed. © 1993 Wiley‐Liss Inc.
The medical leech: An old treatment revisited
Authors: Wells Mark D. , Manktelow Ralph T. , Brian Boyd J. , Bowen Vaughan
Published: March 2007

The treatment modality of choice for venous insufficiency after free tissue transfer or replantation remains surgical repair. When this is not technically possible, the use of medical leeches is a useful adjunct to treatment. This paper reviews the history of the use of leeches in medicine, the anatomy and physiology of Hirudo medicinalis, the techniques of leech therapy, and the complications and contraindications. © 1993 Wiley‐Liss Inc.
Complications in head and neck microsurgery
Authors: Al Qattan Mohammad M. , Brian Boyd J.
Published: March 2007

Microvascular surgery plays a vital role in head and neck reconstruction. This paper deals with the complications arising from this form of surgery. They can be classified as general complications, anastomotic problems, and specific problems related to particular donor and recipient sites. © 1993 Wiley‐Liss Inc.
Complications and unsatisfactory results in the microsurgical reconstruction of lower extremities
Authors: Bowen Vaughan , Manktelow Ralph T.
Published: March 2007

Complications and unsatisfactory results in the microsurgical reconstruction of lower extremities were reviewed in a chronological sequence. Perioperative complications were grouped into the following categories: improper patient or donor tissue selection, unsatisfactory choice of recipient site vessels, inadequate exposure of recipient site vessels, improper „insetting”︁ of the free tissue transfer, extralumenal obstruction, and miscellaneous adverse factors. Vascular changes in the limb as a result of free tissue transfer are discussed. Discussion of late postoperative problems includes the long‐term results of soft tissue and skeletal reconstruction. © 1993 Wiley‐Liss Inc.
Experimental microsurgical vein grafts: Quantitative temporal analysis of progressive media fibroplasia
Authors: McDonald James P. , Shaffer John W. , Carter John R. , Field Greg
Published: March 2007

The sequential histopathologic changes in microvenous grafts placed in a microarterial system were studied. In 48 Sprague Dawley rats, a 1 cm segment of epigastric vein was interposed into a defect created in the femoral artery. Grafts were explored at 1, 2, 4, and 12 weeks. After an initial smooth muscle hyperplasia, a progressive fibroplasia of the media was observed. Only small focal areas of intimal hyperplasia were seen. The width of the media was measured with an eyepiece micrometer. A statistically significant (P < 0.01) increase in width from 17 μm at 1 week to 462 μm at 12 weeks was noted. Although this process has been described before, this is the first quantitative assessment. © 1993 Wiley‐Liss Inc.
Colon transplantation: A new microvascular technique
Authors: Plapler Hélio , Cohen Zane
Published: March 2007

This paper describes a new transplantation technique, using the colon instead of the small bowel for intestinal transplantation. With microsurgical techniques, aljogeneic colon transplantation was carried out in rats in a hetero‐topic fashion. The vascular pedicle containing the aortic cuff and the portal vein was anastomosed to the aorta and the inferior vena cava of the host, respectively. The technique has proven reliable and reproducible, and our preliminary results suggest that the colon produces a milder rejection response than transplantation of the small bowel. © 1993 Wiley‐Liss Inc.
Replantation of a multiple digit and circular palm amputation: A case report
Authors: Cai Jinfang , Cao Xuecheng , Pan Jiqing , Hu Jianguo
Published: March 2007

A case of successful replantation of multiple digits and circular palm amputation caused by an industrial punch force is reported. The two‐level amputation was reconstructed by first replanting the severed fingers to the palmar segment and then connecting the palm segment to the hand stump. An arterial crisis was treated with urokinase, and postoperative functional recovery is described. © 1993 Wiley‐Liss Inc.
Percentage of nerve injuries in which primary repair can be achieved by end‐to‐end approximation: Review of 2,181 nerve lesions
Authors: de Medinaceli Luis , Prayon Marina , Merle Michel
Published: March 2007

Primary nerve repair yields better results than secondary reconstruction but is not always possible. We reviewed a series of 2,181 fresh nerve injuries of the upper limb. One nerve only was injured in 41% of the patients; two or more in 59%. One thousand four hundred eighty‐two injuries (68%) were located in the digits. The injured limb segment was lost or beyond repair in 387 cases (18% of all cases). In the 1,794 remaining injuries, primary treatment was accomplished by end‐to‐end suture 1,568 times (87%) and by graft 33 times (>2%) and was impossible in 193 cases (11%). © 1993 Wiley‐Liss Inc.
Congenital pseudarthrosis of the forearm: Treatment of six cases with vascularized fibular graft and a review of the literature
Authors: Mathoulin Christophe , Gilbert Alain , Azze Ronaldo Gorge
Published: March 2007

Six cases of pseudarthrosis of the forearm are reported. One involved only the radius, one the ulna alone, and four both forearm bones. There was associated neurofibromatosis in five cases. All the cases were treated by wide resection and free vascularized fibular graft. In two cases, a single‐bone forearm was created. In all cases, good results were achieved, with moderate forearm shortening. The literature suggests electrical stimulation, corticoperiosteal graft, osteotomy of the involved bone, and free vascularized bone grafting as treatment alternatives. Vascularized free bone grafting appears to be more successful than other treatments. The use of microsurgical sutures permits this treatment in young patients. © 1993 Wiley‐Liss Inc.
Wound closure at the trunk by micro vascular free flap transfer
Authors: Piza Hildegunde , Rath Thomas , Hausmaniger Claudia , Leopold Walzer R.
Published: March 2007

Defects of the thoracic or abdominal wall can be congenital or caused by trauma or tumour resection. There may be other problems, such as infection and irradiation effects. In most cases those defects can be closed by local cutaneous and fasciocutaneous or by muscle and myocutaneous flaps. In some rare instances, the use of pedicled flaps may be limited. The size of the defect, the impossibility of closing the donor site, an impaired blood supply, or poor quality of local tissues represent such limitations. In these cases microvascular flap transfer has enlarged our choice of alternative methods. Advantages of this method are the one‐stage procedure and the wound coverage by well‐vascularized tissue. This is especially beneficial in areas of infected or irradiated tissue. On the other hand microvascular flap transfer requires high technical skill and extensive perioperative and postoperative care. © 1993 Wiley‐Liss Inc.
Histological evaluation of free revascularized iliac crest bone after transplantation for mandibular reconstruction
Authors: Leimbruckner Bernhard D. , Dielert Eckhard , Stock Wolfgang
Published: March 2007

Differing views on the nutritional status of revascularized bone in animal studies and in human transfer have been expressed. Normal viability is reported as well as single cell necrosis and devitalized areas and, finally, necrosis of the complete graft. From 19 patients with revascularized bone transfer into injured recipient tissues, we obtained 32 drill biopsies out of the centre of the graft and near the mandibular stump during the removal of the osteosynthesis plates. The histological preparations were examined for bone viability. In 58% of all patients, there occurred partial necroses in the grafted bone and in 26% single cell necroses; 16% of the transplants maintained normal viability. The areas with disturbed nutrition were found more frequently in peripheral areas than in central regions of the graft (p < 0.05, x2 test). The overall graft failure rate was 6.8%. The results of this clinical study are discussed with particular reference to the technical procedure, the recipient tissue quality, and the design of the graft. The indication for using revascularized bone transfer in difficult local conditions of the recipient tissues has been confinned. The viability of the grafts cannot always be maintained entirely. The particular risk to the viability of the graft in the peripheral regions requires careful technical procedures. © 1993 Wiley‐Liss Inc.
Microsurgery in gaining paediatric vascular access for haemodialysis
Authors: Sanabia Juan , Polo José R. , Morales Maria D. , Canals Maria J. , Polo Jorge , Serantes Angela
Published: March 2007

One hundred and one surgical procedures performed in children for construction and maintenance of vascular accesses for haemodialysis were retrospectively analyzed. There were 86 operations performed to create a new fistula in patients without vascular access or with nonrecoverable failed angioaccess. Fifteen surgical procedures were performed to treat fistula complications. The new fistulas were radiocephalic n = 60 (70%), ulnar‐basilic n = 5 (5.8%), antecubital n = 9 (10.3%), and PTFE grafts n = 12 (14%). Microsurgical techniques were used in all cases, including PTFE graft fistulas. A microscope was used in 56 cases (55.4%) and magnifying loupes (× 2.5 magnification) in the rest of the operations. Early‐failure rate for radiocephalic fistulas was 10%. Cumulative patency rates in radiocephalic fistulas were 79%, 75%, and 70% at 1, 2, and 5 years, respectively. No statistical differences were found from the cumulative patency curve of 730 radial‐cephalic fistulas performed in adults during the same period of time. Radiocephalic fistulas can be constructed in most paediatric cases using microsurgical technique. Elbow fistulas can be the second‐choice vascular access, and PTFE grafts can be reserved for children with exhaustion of autologous veins. Brachial‐jugular PTFE grafts can be used in cases of subclavian vein stenosis. © 1993 Wiley‐Liss Inc.
Dextran's antithrombotic properties in small arteries are not altered by low‐molecular‐weight heparin or the fibrinolytic inhibitor tranexamic acid: An experimental study
Authors: Zhang Baimeng , Wieslander Jan B.
Published: March 2007

In two separate blind, randomized studies, 48 rabbits were divided into five groups. Three treated groups received dextran 70 (0.51 g/kg) as a single injection, dextran 70 combined with low molecular‐weight heparin (LMWH) (560 IU/kg as anti‐FXa and 140 IU/kg as APTT in 3 hr), and dextran 70 plus tranexamic acid (14 mg/kg) following severe arterial trauma (arteriotomylintimectomy). Two control groups received the same amount of saline. The bleeding times from the arteriotomy were recorded, and patency rates and the weight of thrombotic materials were registered 2 hr after reperfusion of the trauma region. The bleeding times in three treated groups, all including dextran, were significantly prolonged compared to the control groups (P < 0.05 or 0.01). The patency rates of treated groups, which were 100% (1 8/18 vessels patent) in the dextran‐treated group, 90% (18/20 vessels patent) in the dextran + LMWH group and 95% 19/20 vessels patent) in dextran + tranexamic acid group, were significantly higher than those of their control groups (55‐67% patent vessels) (p < 0.05 or 0.01). The mean weights of thrombotic materials were significantly reduced in the treated groups compared to the corresponding control groups (p < 0.01). In conclusion, dextran 70 in an ordinary dose exerted such a profound antithrombotic effect (100% patency) in small traumatized arteries that the addiiion of a high dose of LMWH could not further improve patency rates or decrease thrombotic materials but did not prolong vessel bleeding times compared to the single dextran treatment. The addition to dextran 70 treatment of a clinical dose of the antifibrinolytic agent tranexamic acid did not disturb the good antithrombotic effect, suggesting that fibrinolysis enhancement is a less important characteristic of the dextran antithrombotic effect in small traumatized arteries. © 1993 Wiley‐Liss Inc.
Nerve reconstruction with glycerol‐preserved allogenic grafts in the rat
Authors: Wolff K.‐D. , Walter G. , Zimmer C.
Published: March 2007

A variety of materials have been evaluated as potential nerve grafts. To date, none has been shown to be consistently equal with regard to functional outcome when compared to standard autogenous nerve grafts. In this study, nerves stored in glycerol were evaluated for their peripheral nerve regenerative capacity. Femoral nerves were harvested from Fischer rats and stored for a minimum of 100 days in 98% glycerol at 4°C. They were grafted into femoral nerve gaps of Lewis rats. After 3 months, histologic, electrophysiologic, and morphometric (axon diameter) analyses revealed less regenerative response than nerve gaps grafted with fresh, syngeneic controls. The differences disappeared by 6 months, although neither graft technique achieved recovery comparable to unoperated nerves. Immunohistochemical evaluation demonstrated a modest immune response at 3 months, which subsided by 6 months. These findings are encouraging for the development of glycerol‐preserved nerve graft banking. © 1993 Wiley‐Liss Inc.
Comparison of 10‐0 polypropylene and 10‐0 nylon sutures in rat arterial anastomosis
Authors: Chen Long‐En , Seaber Anthony V. , Urbaniak James R.
Published: March 2007

The selection of suture materials is an important factor in further improving the results of microsurgical operations. In this study, two kinds of nonabsorbable suture materials, 10‐0 polypropylene and 10‐0 nylon monofilament, were compared in end‐to‐end anastomosis of 66 femoral arteries of adult rats. Both suture types were of identical size (70 μm needle/28 μm suture) and each artery received eight sutures. The vessels were harvested at various intervals from 2 hr to 180 days postoperatively and were evaluated by pathology, radiology, and tensile strength test. The results show that both sutures are capable of achieving excellent long‐term patency (100%) of anastomosed sites. Polypropylene suture was equivalent to nylon in mechanical integrity of the anastomosis sites but was superior in handling, knotting, and biocompatibility. These physical and biological properties of polypropylene sutures may offer the benefits of diminished early and late complications at anastomosis sites and reduced operation time. Enhancement of contrast against surrounding tissue may make polypropylene a superior alternative to nylon sutures for microsurgical use. © 1993 Wiley‐Liss Inc.
Flexible technique for multiple organ procurement in rats: A training and research tool in transplantation
Authors: D'silva Milbhor , Pirenne Jacques , Bonnet Pierre , Honore Pierre , Meurisse Michel , Lee Sun , Jacquet Nicolas
Published: March 2007

Multiple organ procurement techniques are increasingly popular in many transplant centers. This paper describes a technique for multiorgan unit(s) explantation in rats. The procedure involves in situ preliminary dissection, cold perfusion of the thoracic and abdominal organ units as separate procedures, explantation, and finally the ex situ isolation of various organ units as single and/or multiple organ combination units. The procedure is feasible, allows for flexibility in the separation of combination organ units, and is reproducible. The exercise is provided as a training and research tool for clinical and research transplant surgeons. The technique is also presented as an animal model for clinical organ sharing. © 1993 Wiley‐Liss Inc.
Free vascularized fibula in traumatic long bone defects and in limb salvaging following tumor resection: Comparative study
Authors: Malizos Konstantinos N. , Nunley James A. , Goldner Richard D. , Urbaniak James R. , Harrelson John M.
Published: March 2007

In this retrospective analysis, we present our experience with two groups of patients who had long bone defects secondary to trauma or tumor resection and who were treated with a free vascularized fibular graft for skeletal reconstruction. Both groups were comparable in number and average age of patients, length of bone defect, and mean follow‐up (average 3 years both groups). The number of surgical procedures prior to microvascular grafting was significantly higher for the traumatic defects. Primary bone union in a mean period of 6 months occurred at a higher rate in the tumor patients; the trauma patients had a significantly higher nonunion rate, which required multiple additional surgical procedures. The latter did not, significantly, improve the rate of success in the trauma group. Residual limb shortening was present in one‐half of the patients with traumatic defects. On the basis of this review, it appears that the scarred and relatively avascular soft tissues surrounding the long bone defects secondary to trauma affect the course and the final outcome of the microvascular fibular grafting. A similar procedure applied for limb salvaging after tumor resection is better. © 1993 Wiley‐Liss Inc.
Five year digital replantation series from the frigid zone of China
Authors: Zhang Wen‐De , Zhou Guang‐Hen , Zhao Hu‐Rui , Wei Zhou , Mu Yu‐Ke
Published: March 2007

A series of 208 digital replantations from the frigid zone within the People's Republic of China is presented. The extremely cold climate (often −20M‐0C to −30M‐0C) presents the problem of warming exposed amputated digits prior to replantation without causing further damage. An overall replantation survival rate of 94% is reported, and this includes 45 cases of multiple digit amputation. Longer periods of ischemia seem to be tolerated under these unusually frigid conditions. Problems encountered within the series and suggestions for successful outcomes are discussed. © 1993 Wiley‐Liss Inc.
Clinical and experimental studies of cigarette smoking in microvascular tissue transfers
Authors: Gu Yu‐Dong , Zhang Gao‐Meng , Zhang Li‐Yin , Li Gi‐Feng , Jiang Ji‐Fu
Published: March 2007

Circulatory crisis, attributed to cigarette smoking, in three microvascular cases (two toe transfers, one musculocutaneous flap) is reported. After anticoagulation and antispasm treatment only one transfer survived. Coordinated experimental studies in the rat demonstrated that cigarette smoking delayed anastomotic healing. Five days after anastomoses were performed, endothelial cells completely covered the sutures in the experimental smoking group in only 16–19% of sutures, while the control group had a 75% coverage rate. Mechanisms and characteristics of circulatory crisis caused by cigarette smoking are discussed. © 1993 Wiley‐Liss Inc.
Group fascicular vein grafts with interposition of nerve slices for long ulnar nerve defects: Report of three cases
Authors: Tang Jin‐Bo
Published: March 2007

Group fascicular vein grafts with interposition of nerve slices were designed for reconstruction of three ulnar nerves with defects of 2.5–4.5 cm. The veins were taken from superficial veins in the forearm and reversed to bridge the fascicles in both stumps. Normal nerve slices were sectioned from fascicles in the proximal stump and inserted inside the corresponding vein conduits. Postoperatively, the Tinel's sign was detected across the vein conduits, and electromyography showed reinnervation of intrinsic muscles of the hands. Follow‐up for more than 2 years revealed motor recovery to M4 and sensory recovery to S3–S4 in these three cases. This technique may be a promising alternative to group fascicular nerve grafting for long defects in peripheral nerve trunks. © 1993 Wiley‐Liss Inc.
Retransplantation of the liver in the rat
Authors: Delriviere Luc , Kamada Naoshi , Goto Shigeru , Kobayashi Eiji
Published: March 2007

A successful technique of liver retransplantation in the rat is described. Heterotopic nonauxiliary liver engraftment of a whole liver using cuffed anastomoses is the primary transplant procedure. The graft is implanted in the right hypochondrium and is revascularized by a portal end‐to‐end anastomosis. Venous drainage is via an end‐to‐side anastomosis between the donor infrahepatic vena cava and recipient right renal vein. The graft suprahepatic vena cava is ligated. Biliary drainage is achieved by a double stent anastomosis of the biliary ducts. Total parenchymectomy of the recipient's liver is completed leaving intact the intrahepatic and suprahepatic vena cava. Retransplantation in the orthotopic position can thus be attempted, after removal of the first graft, by cuffed anastomoses between the donor and recipient portal veins, infrahepatic vena cava and a double stent anastomosis of the common bile ducts. Anastomosis between the donor and recipient suprahepatic vena cava is completed with a 7/0 Prolene running suture. In the first group of operations (n = 6), a three week survival rate of 50% after retransplantation was obtained. Using the technical lessons of these preliminary cases, 80% of the second group of operations (n = 5), were successful in the long term. Utilization of this new technique may allow further investigations in different fields of research dealing with liver surgery and transplantation. © 1993 Wiley‐Liss Inc.
A modified technique of micro‐arteriography utilizing dental x‐ray equipment
Authors: Zhang Ling , Wu Feng C. , Moskovitz Martin , Siebert John
Published: March 2007

We report on the use of dental x‐ray equipment for micro‐arteriography in 18 rat arterial anastomoses. Our experience has shown that an exposure of 70 kV, at 7mA, for 0.17 seconds, gives excellent results. This is an easy and useful technique for evaluating the patency and stenosis of microvascular anastomoses. © 1993 Wiley‐Liss Inc.
Microsurgical neurolysis: Its anatomical and physiological basis and its classification
Authors: Millesi H. , Rath Th. , Reihsner R. , Zoch G.
Published: March 2007

Neurolysis is a procedure which has to be performed if the gliding apparatus of a peripheral nerve does not function, and consequently, adhesions and fibrosis develop. The gliding tissue has to provide the ability for the nerve to adapt to the different position of the extremity by longitudinal passive movement. The paraneurium provides movements between the nerve and the surrounding tissue; the interfascicular epineurium provides the possibility of the movement within the nerve. Internal neurolysis is defined as surgery within the nerve if the epifascicular epineurium is completely transected. A classification of different degrees of fibrosis is given with special reference to the procedure which has to be done in each case. Neurolysis is a step‐wise procedure with the aim to decompress the fascicles and which is immediately stopped if this aim is achieved. In very severe cases, if the gliding tissue does not regenerate, a gliding tissue flap to envelope the nerve may solve the problem. © 1993 Wiley‐Liss Inc.
Arteriovenous fistula with a saphenous long loop
Authors: Silveira Luis F. , Patricio Joao A.
Published: March 2007

After radiation, chronic infection or previous operations recipient vessels for free tissue transfer become difficult to find. It may be necessary to locate vessels remote from the area of reconstruction and to construct long venous grafts. Long venous grafts can be compressed in the tissue tunnels that may be required. In this series of patients, an arteriovenous fistula was created with a long saphenous loop 10 to 21 days prior to tissue transfer. The saphenous loops were placed close to the area for reconstruction and when divided at the time of transplantation, provided one artery and one vein. In this series of 12 cases, adequate vascularization was achieved in 10 cases. In the other 2 cases, we believe that maturation of the fistula may have been necessary before proper function. The other advantages of the technique are: the procedure can be carried out under local anaesthesia, ease of positioning of the patient on the operating table, and a reduction in the time taken to perform the tissue transfer. © 1993 Wiley‐Liss Inc.
Primary shortening with secondary limb lengthening in severe injuries of the lower leg: A six year experience
Authors: Betz A. M. , Stock W. , Hierner R. , Baumgart R.
Published: March 2007

Multiple secondary grafting procedures may be necessary in cases of complete or partial amputation of the lower limb if the aim is to preserve the initial limb length. The traditional concept of staged reconstruction often leads to a prolonged hospitalisation and a high complication rate, especially in cases with segmental nerve defects of more than one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a primary shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months after replantation, secondary limb lengthening is started, using an external or internal distraction device. Since 1985, 7 patients presenting with complete or partial amputation of the lower leg had been treated using this concept. The indications, operative technique, complications and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting. © 1993 Wiley‐Liss Inc.
Preventive haemostasis with an inflatable tourniquet for microsurgical distal arteriovenous fistulas for haemodialysis
Authors: Bourquelot Pierre D.
Published: March 2007

The creation of a distal arteriovenous fistula for haemodialysais is made easier by using preventive haemostasis with an inflatable tourniquet. Preventive haemostasis reduces the duration of the surgery and reduces the arterial spasm provoked by the dissection. When microsurgical techniques and preventive haemostasis are used, it is possible to create fistulas even in very small children. © 1993 Wiley‐Liss Inc.