bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthotopic knee grafts in rats: A model for growth plate transplantation
Authors: Manfrini Marco , Randolph Mark A. , Andrisano Angelo , Weiland Andrew J.
Published: March 2007

A model for orthotopic whole knee transplantation in syngeneic Lewis rats is presented. The donor knee was isolated on the femoral vessels 1 cm superior and inferior to the knee joint. A minimal muscle cuff was left attached to ensure adequate circulation to the graft via the popliteal vessels. The graft was transplanted to the recipient animal and secured in an orthotopic position by two intramedullary Kirschner wires. The graft pedicle was anastomosed to the recipient's femoral vessels and the muscular elements sutured. Preliminary results are reported, and future implications on growth plate autograft transplantation are discussed.
Surgical correction of severe knee pterygium
Authors: Garsman Gary M. , Bennett James B. , Cain Thomas E.
Published: March 2007

Knee flexion contracture secondary to a severe pterygium is a disabling condition. Full surgical correction has not been possible because of the sciatic nerve and its terminal branches. Our technique to obtain full correction is to divide the nerve near the neuromuscular junction and bridge the defect with multiple sural nerve cable grafts. Microscopic technique is used.
IgG Antisperm antibodies attached to sperm do not correlate with infertility following vasovasostomy
Authors: Newton Robert A.
Published: March 2007

The sperm of 12 men postvasovasostomy was tested for antisperm antibodies by means of a mixed antiglobulin reaction (MAR) test. Agglutinating antibodies were found in 58% of these patients: 50% of the men whose partners became pregnant and 75% of those whose partners did not become pregnant. No significant difference in the level of antibody attachment could be found between the fertile group and the infertile group. Damage to the testis and epididymis following vasectomy seems more likely to interfere with subsequent fertility following vasectomy reversal.
Successful replantation of a bitten‐off nose by microvascular anastomosis
Authors: Tajima Sadao , Ueda Koichi , Tanaka Yoshio
Published: March 2007

A case is presented of a nose bitten off by a dog and successfully replanted by artery‐to‐artery and artery‐to‐vein anastomosis. In the absence of vein‐to‐vein anastomosis, the clinical course suggested that artery‐to‐vein anastomosis was useful for venous drainage, although the extent to which this contributed to the survival is not known.
Effect of phosphoenolpyruvate and adenosine triphosphate on rabbit skeletal muscle after ischaemia: Preliminary biochemical study
Authors: Khazanchi Rakesh Kumar , Knight Kenneth R. , Angel Michael F. , Pederson W. Christopher , Coe Serena A. , McC. O'brien Bernard
Published: March 2007

The present study examined the effect of phosphoenolpyruvate (PEP) and adenosine triphosphate (ATP) on rabbit skeletal muscle flap survival after warm ischaemia.

Two muscle flap models, rectus femoris pedicle flap and latissimus dorsi free flap, were subjected to a total ischaemia of 4 hours at 37°C and 20°C, respectively. Immediately prior to revascularisation, the muscles were infused with either Hanks' balanced salt solution (BSS) or Hanks' BSS containing 200 μmol PEP and 6.6 μmol ATP. Quantification of muscle damage was determined by measuring the plasma levels of creatinine kinase (CK), lactate dehydrogenase (LDH), lactate, potassium, and phosphate at 0, 2, 24, and 96 hours after revascularisation. Infusion of PEP/ATP compared with Hanks' BSS alone significantly decreased the efflux of CK in both rectus femoris (P< 0.025) and latissimus dorsi muscles (P< 0.05) and of LDH in the rectus femoris muscle (P< 0.01). No significant changes were observed, however, for the plasma levels of lactate, potassium, and phosphate. From this study it was concluded that PEP and ATP partially protect skeletal muscle from ischaemia and reperfusion injury.
Arterialization of liver transplants in rats: I. Application of the tissue perfusion monitor in hemodynamic studies
Authors: Lee Sun , D'silva Milbhor , Dennis Rick , Glassford Edmund , Moossa A. R.
Published: March 2007

This study demonstrates the use of the tissue perfusion monitor in the investigation of arterialization (using an arteriovenous fistula) of the heterotopic partial liver transplant. An index of peak perfusion rate was introduced as a reliable and accurate measure of the index of delivery rate of blood to the liver. Results revealed a significant (P <.01) difference between arterialized and nonarterialized liver grafts when compared with their respective recipient host livers. Arterialization of grafted livers raised the index of peak perfusion rate to levels that were comparable to host livers. Arterialization also had a significant effect (P <.01) on the host liver, whose values dropped by 74.26% when compared with the normal liver. Surprisingly, host values of the nonarterialized group fell by 61.54%. At this point, explanations for this phenomenon are speculatory. An extensive review of the literature exposes the variability in the observations of the role and usefulness of arterialization in hepatocellular function.
Strength of microvascular anastomoses: Comparison between the unilink anastomotic system and sutures
Authors: Gilbert Ralph W. , Ragnarsson Rafn , Berggren Anders , Östrup Leif
Published: March 2007

The Unilink system, a mechanical anastomotic device, was compared with standard suture techniques in terms of anastomotic strength under conditions of uniaxial loading. Twenty‐five rabbits underwent Unilink and suture anastomosis of both carotid arteries and facial veins. Animals were sacrificed at 1 hour (five animals), 2 weeks (10 animals), and 16 weeks (10 animals), and all vessels were tested by constant loading in a material testing machine. The maximum load required to disrupt the anastomosis as well as the site of vessel failure were recorded.

All 100 anastomoses were fully patent as evaluated by clinical testing. At 1 hour and 2 weeks, the Unilink arterial anastomoses were consistently and significantly stronger than the sutured anastomoses. At 16 weeks the sutured arterial anastomoses were significantly stronger than Unilink. The Unilink anastomoses, however, remained approximately 50% stronger than unoperated normal vessels. No statistical differences were observed in the strength of venous anastomoses at any of the intervals tested. There were no statistical differences in the sites of failure of the vessels under loading (i.e., at the anastomosis or proximal or distal to it) between the two techniques.
An animal study of different treatments to prevent postoperative pelvic adhesions
Authors: Graebe Robert A. , Cornelison Terri Lynn , Pan Sie‐Bin , Haseltine Florence P. , De Cherney Alan H. , Oelsner Gabriel
Published: March 2007

A study was designed to test various high‐molecular‐weight solutions in the prevention of postoperative intraabdominal adhesions. The bicornuate rat uterus was used as the surgical model, and 80 mature white female rats underwent surgical injury of the right uterine horn. The rats were randomly divided into 5 groups: groups A, B, and C received 5 ml intraperitoneally of chondroitin sulfate, sodium carboxymethylcellulose, and 32% dextran 70, respectively; group D was treated with microsurgical repair; and group E, the control, received no therapy. The animals were killed postoperatively, and the adhesions were scored. Significantly better results in adhesion prevention were demonstrated in the sodium carboxymethylcellulose group vs. the other groups, except in group A where the difference was not significant.
Tubulation for peripheral nerve gap: Its history and possibility
Authors: Suematsu Noriaki
Published: March 2007

A large gap in peripheral nerve will not allow effective regeneration unless a grafting conduit is used to bridge the defect. Conventionally, nerve tissue has been used as such a conduit in nerve reconstruction; however, results from techniques using these grafts are often unsatisfactory. A number of recent investigations have indicated that nerve fibers will regenerate through a nonneural tube. The purpose of this review is: 1) to provide an overview of the various tubulation techniques previously reported for peripheral nerve gap repair; 2) to investigate new possibilities for enhancing the regenerative capacity of nerves following these tubulation techniques by drawing from technical innovations in microsurgery and recent progress in immunology and neurobiology. The interposed graft thus may perform a more positive role, not merely as a pathway for deregenerating axons, but as a source for neuronotrophic factors and neurite‐promoting factors, which would nurture and guide the neurons and axons. Such modifications in graft materials may lead to clinical applications of tubulation of nerve defects that would result in an improvement in clinical results.
Heel reconstruction with an iliac osteocutaneous free flap in a child
Authors: Shenaq Saleh M. , Dinh Tue A.
Published: March 2007

We report a case of heel reconstruction in a 13‐month‐old child in one stage. An iliac crest osteomyocutaneous free flap based on the deep circumflex vessels was transferred using microsurgical techniques. The apophysis of the os calcis was replaced with a portion of the iliac epiphysis to allow normal growth of the heel. At age 2 years, the patient is walking normally and wearing regular shoes of equal size. Gait analysis reveals normal ambulation.
Effect of heparinized irrigating solutions on patency of experimental microvascular anastomoses
Authors: Zinberg Ephraim M. , Choo Daniel I. , Zotter Leslie Ann
Published: March 2007

The effect of five different irrigating solutions on patency of four different types of microvascular anastomoses was studied. The solutions used were lactated Ringer's without heparin and four lactated Ringer's solutions with varying concentrations of heparin ranging from 10,000 units/liter to 100,000 units/liter. These were tested on four different anastomotic models in the rat: 1) end‐to‐end femoral arterial anastomosis; 2) end‐to‐side arterial bypass graft; 3) end‐to‐end venous anastomosis; and 4) end‐to‐side venous bypass graft. There were statistically significant differences in patency rates among the solutions only in the end‐to‐end venous anastomosis group. In these, significantly higher patency was achieved with heparinized lactated Ringer's solution at 20,000 units/liter. The use of higher concentrations of heparin in these solutions resulted in decreasing patency rates and appears to be contraindicated.
Sequential changes of noradrenaline content of vein grafts in rats: Quantitative estimation by high‐performance liquid chromatography using electrochemical detection
Authors: Hukki Jyri , Attila Martti , Haikala Heimo , Castren Maaret , Lähteenmäki Tapani , Smitten Karl V. , Waris Timo
Published: March 2007

Supradiaphragmatic inferior vena cava was transplanted end‐to‐end into the abdominal aorta of 11 ‐week‐old rats of the same inbred strain and same litter using microvascular technique. The grafts were removed 3 days, 4,8,16, and 35 weeks postoperatively, and their noradrenaline (NA) content was estimated by high‐performance liquid chromatography using electrochemical detection. The amount of NA was significantly lower (P <.001) in all vein grafts as compared to nontransplanted vena cava. The substantial decrease of NA in the vein grafts throughout the observation period indicates a persistent denervation of the transplant.
Regeneration of the rat sciatic nerve after different conditioning lesions: Effects of the conditioning interval
Authors: Arntz Craig , Kanje Martin , Lundborg Göran
Published: March 2007

Regeneration of the rat sciatic nerve was studied after a crush lesion (test lesion) on nerves previously subjected to a conditioning lesion. The test lesion was made approximately 30 mm proximal to the conditioning lesion. The period between the conditioning lesion and the test lesion was varied. Regeneration was measured by the pinch test. The conditioning procedure increased the rate of axonal elongation and decreased the initial delay. Conditioning intervals between 14 hours and 4 days were sufficient to increase the regeneration distance significantly, but only until day 4. If the conditioning interval was prolonged to 7 or 14 days, the conditioning effect persisted until day 6. A conditioning effect also was produced by transaction of the sciatic nerve and by local compression produced with a silicone tube. The results of this study demonstrate that the type of injury and the conditioning intervals are important determinants in producing the conditioning effect in the rat.
Comparison of sciatic nerve regeneration through silicone tubes and nerve allografts
Authors: Gibson Karen L. , Daniloff Joanne K.
Published: March 2007

Sciatic nerve regeneration through implanted silicone tubes was compared to allogenic nerve grafting in 30 adult female Sprague‐Dawley rats. Regeneration was assessed at 10, 24, and 90 days post‐transection. Axonal regrowth through the implanted neural prostheses was evaluated with electromyography and histologic examination.
Complications from silicon‐polymer intubulation of nerves
Authors: Merle Michel , Lee Dellon A. , Campbell James N. , Chang Peter S.
Published: March 2007

Three cases are reported to illustrate the potential danger of silicon—polymer intubulation of nerve for either nerve repair or following neurolysis. Since silicon‐polymer intubulation of nerve is now a proven model for producing chronic nerve compression, its use clinically may be contraindicated where neural regeneration is the desired goal.
Comparison of two‐point discrimination testing devices
Authors: Crosby Page M. , Lee Dellon A.
Published: March 2007

In order to provide hand therapists and physicians with information regarding instruments for testing two‐point discrimination we evaluated 20 noninjured and 18 nerve‐injured patients using the three‐prong Aesthesiometer™, a paper clip, and a Disk‐Criminator™. Two‐point discrimination was tested by means of a randomized order for the two different discrimination tests and the three different testing devices. The measurement for either moving or static two‐point discrimination, when obtained with the three‐prong Aesthesiometer™, was consistently less sensitive than with the Disk‐Criminator™, and the correlation coefficient was the least between these two testing devices. The Disk‐Criminator™ measurement had the smallest standard deviation among the three testing devices. In terms of desirability of the testing device tip geometry, translation of interprong distance to numerical rating scale, and facility of alternating between one‐ and two‐prong testing techniques, the paper clip was judged to be the least favorable and the Disk‐Criminator™ to be the most favorable test device.
Interpretation of cutaneous pressure threshold (Semmes‐Weinstein monofilament measurement) following median nerve repair and sensory reeducation in the adult
Authors: Imai Haruo , Tajima Tatsuya , Natsuma Yaemi
Published: March 2007

Semmes‐Weinstein nylon monofilaments are used to evaluate recovery of cutaneous pressure threshold in adults recovering from median nerve repair at the wrist level. Of the 46 patients studied, 22 received a program of sensory reeducation. The nylon monofilament measurements accurately described the improvement in recovered sensation following nerve repair. There was a statistically significant better recovery (lower threshold) in patients receiving sensory reeducation, which was present in those less than 30 years old (P <.003) as well as those greater than 30 years old (P <.05). However, normal thresholds were not recovered in these patient populations.
Results of median nerve repair in children
Authors: Tajima Tatsuya , Imai Haruo
Published: March 2007

Seven children ranging in age from 1 to 13 years (mean 8 years) were evaluated at a range of B months to 15 years (mean 4.7 years) following group fascicular repair of the median nerve at the wrist following a sharp transection of the nerve. At the follow‐up evaluation, they were measured with Semmes‐Weinstein nylon monofilaments, moving and static two‐point discrimination, and were judged for the presence or absence of paresthesias in their hands. The children did not receive sensory reeducation in the postoperative period. All children recovered to normal levels of moving and static two‐point discrimination and were free from disabling paresthesias. These results are contrasted with a group of similar nerve injuries in adult patients treated in the same way and over the same period of time. It is concluded that the capacity for peripheral neural regeneration and cerebral plasticity in children is such that excellent recovery of functional sensation in the hand can occur without the need for sensory reeducation.
Use of prolonged sympathetic blockade as an adjunct to surgery in the patient with sympathetic maintained pain
Authors: Hobelmann Charles F. , Lee Dellon A.
Published: March 2007

Twenty patients with sympathetic maintained pain (SMP) underwent surgery to treat an associated nerve injury. In each patient, an axillary catheter technique was used to maintain anesthesia and sympatholysis for up to 4 days following surgery. In no instance was the SMP exacerbated by the operation. The use of prolonged sympathetic blockade as an adjunct increases the margin of safety in surgery for these patients when nonoperative measures cannot relieve the pain or restore function.
The free fascial forearm flap
Authors: Ahmed Taher Ismail , Ismail Ahmed
Published: March 2007

The unpleasant appearance of the donor site after harvesting a forearm flap limits its use in many centers. In this paper, the author records his experience with a modification of the standard fasciocutaneous forearm flap. Such modification involves the utilization of the fascial component of the flap sparing the skin of the forearm, which is closed as a longitudinal line. This fascial forearm flap (FFF) was used as a free flap in eight cases. All the flaps survived well, and the donor site appearance was excellent. The fascial forearm flap advantages and limitations are discussed with recommendations for further utilization of other fascial flaps.
Laser doppler monitoring of replants using a small prism probe
Authors: Lowdon Ian M. R. , Bruce Toby E. , Ecker Jeff , Seaber Anthony V. , Urbaniak James R.
Published: March 2007

Eighteen patients admitted to Duke University Medical Center for upper limb replantation or revascularization were studied. A small laser Doppler flow prism probe and a cutaneous temperature probe were attached to the distal pulp of replanted digits. Measurements were recorded hourly for the first 3 postoperative days. In the successful cases, the mean laser Doppler flow measurement was 1.76 units (lower 97% confidence limit 0.5 units) and the mean temperature was 34.1M‐0C (lower 97% confidence limit 32M‐0C). In 4 patients with vascular compromise, the laser Doppler flow correctly identified the problem. The reduced size of the new laser Doppler probe makes monitoring of distal pulp flow technically easier while maintaining accuracy.
Experimental study on the behavior of a transplanted vascular pedicle
Authors: Hung L. K. , Leung P. C. , Cheng G. L.
Published: March 2007

The transparent chamber technique of the hamster cheek pouch was utilized to observe the behavior of a transplanted vascular pedicle within a relatively adverse environment. Observations included direct visualization with intravital microscopy, histology, scanning electron microscopy, and alkaline phosphatase staining for vascular endothelium. The results supported the phenomenon of vascular sprouting from the transplanted vascular pedicle.
Comparative functional study of dexon and nylon microsutures in rat uterine anastomoses
Authors: D'silva Milbhor , Durfee Raphael , Wolf Paul , Lee Sun
Published: March 2007

Forty‐two female Wistar rats were used in a long‐term study designed to evaluate the functional sequelae of employing 10‐0 Dexon “S” and nylon microsutures in uterine anastomoses. Functional criteria used were the number of fetuses and live births, during and after pregnancy, respectively. Results indicate that the rats from both control and experimental groups were likely to have identical litter sizes for the first 3 deliveries (P > 0.01). An unexplained observation was the finding of a larger litter size for the experimental group rats at the fourth delivery as compared to its control counterpart (P < 0.01). Also explicit is the propensity for the right uterine horn to bear a larger number of fetuses than its counterpart (P < 0.01). Finally, neither suture was associated with a larger number of fetuses (P > 0.01). It was concluded that 1) uterine anastomosis did not prove detrimental to the functional outcome, 2) none of the sutures proved functionally superior, and 3) nylon was more likely to be associated with foreign body and inflammatory responses.
Effects of neurite‐promoting factors on rat sciatic nerve regeneration
Authors: Khouri Roger K. , Chiu David T. W. , Feinberg Joseph , Tark Kwan C. , Harper Alice , Spielholz Neil
Published: March 2007

Neurite promoting factors (NPF), fibroblast growth factor, and laminin were instilled inside autologous venous nerve conduits (AVNC) interposed across a 1 cm gap in the rat sciatic nerve. Axonal regeneration was measured electrophysiologically and histologically and was compared to control AVNC and autologous nerve grafts (ANG) in 45 rats. By 1 month, the AVNC group with NPF recovered an average nerve conduction velocity twice that of the ANG group (24 m/sec vs. 12 m/sec). The gastrocnemius muscle action potential of NPF grafts was twice that of the control AVNC and was similar to the ANG (1.63 mV vs. 0.87 mV). In subsequent months, the advantage of NPF disappeared; these grafts were grossly reduced to fibrous bands. Histological examination of these grafts at 5 months revealed a florid intraluminal fibrovascular proliferation, which appeared to be “choking off” the regenerating axons. It is suggested that more refined mixtures of NPF should be instilled inside AVNC so that the improved axonal regeneration is maintained while the late inhibitory fibrosis is avoided.
Evaluation of axonal specificity of the regenerating rat sciatic nerve using a fluorescent labeling technique
Authors: Shenaq Saleh M. , Mendelow Michael , Shenaq Jihad M. , Spira Melvin
Published: March 2007

A double‐labeling technique using fluorescent compounds, i.e., diamidino yellow and true blue, is described, with the divided rat sciatic nerve model. Tibial and peroneal fascicles were transected, and each freshly cut nerve end was placed in a vial containing either the true blue or the diamidino yellow label. After a 10–15 day survival period, animals were systemically perfused with fixative, and the lumbar enlargement and dorsal root ganglia corresponding to sciatic nerve roots were removed. Serial sectioning and examination with ultraviolet fluorescence microscopy and counts of the labeled cells were performed. Diamidino yellow in labeled cells was found localized to the nucleus, whereas true blue was found localized to the cytoplasm and nucleolus (control group n = 5). Intermixing of these pools was noted, with yellow cells seen among blue labeled cells following nerve autograft repair of a 1 cm segment of the rat sciatic nerve (experimental group n = 5). Double‐labeled cells displaying a yellow nucleus and a blue cytoplasmic label were also seen. We believe that the double‐labeling technique described, using the fluorescent retrograde tracers diamidino yellow and true blue, is a useful monitoring method for assessing the specificity of regenerating axons in the rat sciatic nerve.
In search of the “perfect” anastomosis
Authors: Guity Afrassiab , Young Paul H. , Fischer Vernon W.
Published: March 2007

Forty‐five end‐to‐side microvascular anastomoses were completed in rat carotid arteries of 0.7–0.8 mm diameter (anastomosing the distal end of the left common carotid to the side of the right common carotid). For comparison both 10‐0 and 11‐0 sutures were utilized in different anastomotic techniques: interrupted, direct‐continuous, and diagonal‐continuous sutures, plus total mural thickness vs. partial mural thickness (piercing only the adventitia and outer media, excluding the intima). Anastomoses were evaluated for patency and scanning electron microscopic appearance after 10 to 12 weeks. The results indicate complete patency in all anastomoses. Ultrastructural observations revealed nearly normal intimal appearance in the partial medial technique and only minimal evidence of intimal injury in the other techniques. It is concluded that 100% patency can be obtained regardless of suture size or anastomotic technique. The most important factor in anastomotic patency is the operator's technical skill.
Effects of normovolemic hemodilution on blood flow in the Rabbit ear
Authors: Frost‐Arner Lieselotte , Aberg Magnus , Brueckner Uwe B. , Wieslander Jan B. , Messmerm Konrad
Published: March 2007

The effect of isovolemic hemodilution using dextran‐60 on arterial blood flow in the rabbit ear was investigated. The animals were anesthetized and an electromagnetic flow probe was applied around the central artery of the ear. Isovolemic hemodilution was performed during a 15 min exchange period. Two degrees of hemodilution were investigated [8.5 and 17 ml dextran‐60/kg body weight (b.w.)] and compared with a nontreated control group. The two levels of hemodilution induced reductions in hematocrit to 29 and 21%, respectively, from the control level of about 40%. In all groups, blood pressure maintained constant levels throughout each experiment, which lasted 240 min. In the controls, ear artery blood flow was unchanged or decreased slightly during the experiment. The lower level of hemodilution caused a slight increase of blood flow after 4 h. In the group treated with 17 ml/kg b.w. dextran, blood flow gradually increased after 90 min following hemodilution. After 240 min, flow rates had increased to two‐ or threefold the initial rate in this group. Although other possibilities exist, the increased blood flow following hemodilution may be interpreted as reflecting a decreased resistance to flow in the tissue due to the decreased viscosity of the blood.
Morphological studies of cellular responses to experimental arterial grafts
Authors: Kischer C. Ward , Weinstein Philip R. , Spall Richard , Brendel Klaus
Published: March 2007

Cross‐carotid microvascular bypass grafts 2–3 mm in diameter were implanted using microsurgical techniques for end‐to‐end anastomosis in four dogs. One autograft control and one of three denatured human umbilical artery xenografts (HUAG) were patent at 5 weeks. One of the other two denatured HUAGs had thrombosed at 1 week, and the other was occluded at 5 weeks. Host and graft vessel specimens were evaluated histologically as well as with transmission electron microscopy after sacrifice. Results indicate that failure of reconstitution of a true endothelial layer, presence of a subintimal myofibroblast population, increased collagen deposition of the muscularis, and occlusion of the adventitial and mural microcirculation were observed in both the early and late nonpatent vessels but not in the patent specimens. Evidence for myointimal cell proliferation was present in both patent and occluded grafts. A cohesive intimal layer was observed in both patent cases. Microvascular occlusion, due to an excess of endothelial cells, of new vasa vasorum in one case seems related to increased fibrosis, which could have resulted in graft stenosis. The surgical procedures and subsequent morphological analyses were adequate and sufficient for use in a longterm study of the possible causes of graft failure.
Wound healing at the site of microvascular anastomosis: Fibrin‐stabilizing factor XIII administration and its effects
Authors: Isogai Noritaka , Ueda Yoshio , Kurozumi Nozomu , Kamiishi Hiroshi
Published: March 2007

Factor XIII has recently been recognized to play an important role as a fibrinstabilizing factor to accelerate the wound healing process. We made an attempt to analyze the effect of how Factor XIII affects the results of the healing process at the site of a microvascular anastomosis. The strong fibrin stabilizing property of plasma Factor XIII maintained its high activity when administered intravenously and was effective for wound healing in a low‐activity state made by subcutaneous administration of carbon tetrachloride. The enhanced network formation of the Factor‐XIII‐injected group was indicated by the accelerated maturation of the fibrin structure at the anastomotic site, exhibited both qualitatively and quantitatively. Stimulation and acceleration by Factor XIII of the healing process at the site of microvascular anastomosis were observed. It is therefore suggested that clinical use of Factor XIII may enhance the microvascular repair process. Details of the analysis using scanning electron microscopy (SEM) and a computerized graphic analyzer system (CGAS) are reported.
Influences of laser pulse duration and anastomotic disruption on laser‐assisted microvascular anastomoses (LAMA)
Authors: Jacobowitz Israel J. , Wang Su , Basu Samir , Baumann F. Gregory , Marini Corrado , Cunningham Joseph N.
Published: March 2007

The success rate of laser‐assisted microvascular anastomosis (LAMA) can be influenced by many factors, including the parameters of the laser technique used. This study examined the effects of laser pulse duration and the occurrence of anastomotic disruption immediately following first repair attempts on the incidence of aneurysm formation and the patency rate in LAMA. Fifty transected rat femoral arteries in 25 rats were anastomosed with three stay sutures and welded with a CO2 laser at a power of 80 mW. In each rat, the laser was applied in the form of 45 pulses of 0.2 sec duration to one femoral artery (group 1) and in the form of 15 pulses of 0.6 sec duration to the contralateral femoral artery (group 2). Comparison of group 1 with group 2 showed that overall rates of aneurysm formation (30% vs. 17%) and patency rates (92% vs. 96%) did not differ significantly (P < 0.05) at 3 weeks post‐operatively. However, disrupted vessels in both groups had a significantly higher incidence of subsequent aneurysm formation than nondisrupted vessels (54% vs. 0% in group 1, P < 0.05; 43% vs. 6% in group 2, P < 0.06; groups 1 and 2 pooled, P < 0.001). These findings indicate that changes in laser pulse duration such as those tested do not affect the aneurysm and patency rates of LAMA. The results demonstrate, however, that disruption after laser welding plays a significant role in subsequent aneurysm formation.
Assessment of microvascular clamping injury of rat aorta by histochemical examination of oxidoreductases
Authors: Remes Veikko A. , Von Smitten Karl A. , Waris Timo H. , Raekallio Jyrki A.
Published: March 2007

To assess clamping injury to the rat abdominal aorta, the activities of two oxidoreductases, lactate dehydrogenase (LD) and succinate dehydrogenase (SD), were estimated histochemically at various points in time after clamping the aorta for 30 min (group A) or 60 min (group B) with two kinds of microvascular clips. Areas of depressed LD and SD activity were found 3 days after surgery in group A and 1 day and 3 days after surgery in group B. The random, intermittent occurrence of the changes in enzyme activity within the time groups pointed to a mild trauma induced by the clips. At 1 week and thereafter, no changes in enzyme activities were observed in the aortic wall. Two different patterns of depressed enzyme activity were observed: One was a narrow zone without activity throughout the medial layer, and the other consisted of a broader area of depressed activity in the outer parts of the media. Occluding the aorta with a mosquito clamp led to tissue destruction and loss of enzyme activity in the injured area. This study shows that enzyme histochemistry provides nonquantitative methods to detect and localize microvascular injury and that the injury caused by the microvascular clips was mild and reversible.
Development and perspectives of experimental pancreas transplantation in the Rat
Authors: Timmermann Wolfgang , Schang Thomas , Stoffregen Clemens , Schubert Gerhard , Thiede Arnulf
Published: March 2007

Whole organ pancreas transplantation in the rat was first described by Sun Lee in 1972. Since that time the basic technique has been modified in several ways and this model can now be used for a variety of experiments. Various techniques for transplantation and representative results of functional and immunological experiments are summarized.
Metabolic effect of pancreas transplantation on long‐term diabetic rats
Authors: De Macedo Arthur , Lee Sun
Published: March 2007

Thirty‐six male Lewis rats rendered diabetic using alloxan received syngeneic pancreaticoduodenal grafts. Seven days prior to and 7, 30, and 90 days posttransplantation, the animals were housed in metabolic cages for periods of 48 hours. During this time, body weight, water intake, food intake, urine output, and fecal output were recorded every 24 hours. Blood sugar, plasma insulin, glucosuria, and proteinuria were determined at 3‐month intervals prior to the transplant and at monthly intervals posttransplantation. These parameters were also concurrently recorded for diabetic control rats. Pancreaticoduodenal transplantation produces immediate relief of hyperglycemia, glucosuria, polyuria, polyphasia, and polydypsia, resulting in good health of the animals until the time of sacrifice. A significantly increased insulin level was also recorded. The transplanted animals showed a weight gain reflecting that of a normal growth curve.
Effect of pancreas allografts on the ultrastructure of sciatic nerves in diabetic Rats
Authors: Scott Michael H. , Lee Sun , D'Silva Milbhor , Chang Cheng‐Ming , Allen Jennifer , Yancey Diane , Moossa A. R.
Published: March 2007

In a long‐term study using cyclosporin‐A (Cy‐A) as immunosuppressant in a dose of 10 mg/kg/day, pancreas‐duodenum was transplanted from Brown Norway donors to alloxan‐diabetic Lewis rats (n = 190). The pancreas transplants (PT) were performed after 1, 3, 6, 9, 12, and 15 months of diabetes. Recipient rats were sacrificed between 3 and 12 months of graft retainment. The mean axonal cross‐sectional area and relative percentage of small, medium, and large myelinated fibers was evaluated. Also studied were unmyelinated fiber, ovoid body, and glycogen inclusion densities. Control rats consisted of non‐diabetic rats (n = 36), similar rats receiving Cy‐A (n = 42), diabetic rats (n = 103), and diabetic rats receiving Cy‐A (n = 45). It was found that PT had a beneficial effect on the axonal cross‐sectional area of myelinated nerves, the relative percentage of the various sizes of nerve fibers, and the ovoid body density, especially so in early diabetes. The effects in late diabetes were less spectacular. PT did not prove beneficial to the glycogen inclusion and unmyelinated fiber densities.
Effect of pancreatic allografts on vascular basement membrane thickness in the diabetic Rat
Authors: Scott Michael H. , Lee Sun , D'Silva Milbhor , Chang Cheng‐Ming , Yancey Diane , Allen Jennifer , Moossa A. R.
Published: March 2007

Diabetic Lewis rats received pancreaticoduodenum allotransplants from Brown‐Norway donors. Cyclosporine A (Cy‐A) was used in a dose of 10 mg/kg/day for immunosuppression. These transplanted rats (n = 190) were compared with nondiabetic Lewis rats (n = 36), nondiabetic Lewis rats receiving 10 mg/kg/day Cy‐A (n = 42), diabetic rats (n = 103), and diabetic rats receiving 10 mg/kg/day Cy‐A (n = 45). The percentage area of periodic acid‐Schiff (PAS) positive basement membrane (BM) of rectus muscle microvasculature was compared in each of the groups. It was found that the percentage area of PAS positive BM increased markedly over 15 months of uncontrolled diabetes. Cy‐A did not have a significant effect on either normal or diabetic skeletal muscle vascular BM. Rats with established diabetes showed some reversal in the percentage area of PAS positive BM, when pancreas transplantation was performed at 9, 12, and 15 months of diabetes. Pancreas transplantation may appear beneficial even after the development of BM thickening of skeletal muscle vascular BM.
Arterialization of the liver. II. Systemic pressure gradients in rats following variously sized arteriovenous fistulae
Authors: Glassford Edmund , D'Silva Milbhor , Ghorab Hussein , Bai San , Un Lee Sang , Moossa A. R. , Lee Sun
Published: March 2007

Four groups (I, II, III, and IV) of six Wistar rats each were studied to elucidate the blood pressure changes following creation of arteriovenous fistulae (AVF) of diameters 1, 2, and 3 mm (groups II, III, and IV, respectively). Group I comprised normal rats with no AVF. Blood pressures were recorded in the carotid and femoral arteries, the femoral and portal veins, the right atrium, and the inferior vena cava (IVC) at renal vein (RV) and common iliac vein (CIV) levels. We found that AVF size did not disturb baseline carotid arterial or portal venous pressures (P > 0.01), but that femoral arterial pressures fell increasingly (P < 0.01). On the other hand, right atrial pressure and that of IVC at RV and CIV levels rose substantially with increasing diameters of AVF (P < 0.01). It was concluded that an AVF of 1 mm diameter least upset the normal blood pressures in the vessels examined.
Arterialization of the liver. III. influence of systemic and portal pressure gradients following heterotopic partial liver transplantation
Authors: D'Silva Milbhor , Pirenne Jacques , Glassford Edmund , Mayer David , Bai Sang , Gittes Ruben F. , Lee Sun
Published: March 2007

An acute study was designed to compare blood pressures across a heterotopically transplanted partial liver graft using arterialized and nonarterialized models. Eight partial liver transplants (PLT) were done in each group, using Wistar rats. The data gathered from them are the basis for the results obtained herein. Whereas there was no significant difference (P > 0.01) in inflow, outflow, or the pressure difference across the PLT between nonarterialized and arterialized groups, host portal venous pressures were significantly higher (P < 0.01) in the arterialized group. A 1 mm arteriovenous fistula (AVF) was used to arterialize the PLTs in this study. It was proved that arterializing a PLT using a 1 mm AVF did not alter the pressure difference across the transplanted liver compared with the situation in the nonarterialized setting.
Soft tissue coverage of the hand with a free digital fillet flap
Authors: Idler Richard S. , Mih Alexander D.
Published: March 2007

A free digital fillet flap was used to achieve soft tissue coverage of the ulnar border of the hand in a 38 year old man with an industrial fan blade injury to the dominant hand. The use of a digital fillet flap from an unsalvageable ring finger allowed for a one‐stage procedure avoiding donor site morbidity or need for additional reconstructive surgery.
Union memorial hospital experience with replantation: Patterns of change
Authors: Redfern Anne B.
Published: March 2007

The experience with replantation of amputated or devascularized parts of the upper extremity distal to the wrist was reviewed for 1976‐1980 and again in a similar way for 1986‐1989. Comparisons between the two groups were made to look for similarities and differences. Analysis of this experience may help treating physicians, patients, and third‐party payers to make decisions about management of these injuries.
Microvascular anastomoses in replanted fingers: Do they stay open?
Authors: Schmidt David M. , McClinton Michael A.
Published: March 2007

Replantation of fingers is a well established procedure following traumatic amputation. Several studies have documented the functional results of replanted digits. Studies have not documented the long‐term (>5 yrs) patency of the microvascular anastomosis in the replanted digit. Duplex imaging, a combination of B‐mode ultrasound and bidirectional Doppler ultrasound has been shown to visualize vessels 1 mm in diameter. Color enhancement of the ultrasound image is now possible.

We evaluated 18 patients with 24 replanted fingers to assess vascular patency. A minimum of five years follow‐up was required for inclusion in the study group. Examination showed a patent anastomosis in every case and a Digital‐Brachial Index within normal limits in 71% of the digits. Microvascular anastomoses in vessels as small as 1 mm in diameter remain open as long as 11 years following completion. The sophisticated techniques of color enhanced Duplex imaging makes long‐term evaluation of these procedures possible in a non‐invasive and accurate fashion. The use of such imaging modalities will have an important role in the evaluation of replanted digits and microvascular procedures in general.
Digital replantation in children: A long‐term follow‐up study
Authors: Ikeda Kazuo , Yamauchi Shigeki , Hashimoto Fumio , Tomita Katsuro , Yoshimura Mitsuo
Published: March 2007

This paper reports a series of 14 cases of digital replantation in children who had had a total of 17 digits traumatically amputated. All but two digits survived, for an overall success rate of 88%. The length of follow‐up was between 3 and 14 years (average 8 years). Sensory recovery of all digits was satisfactory. The mean growth rate of replanted digits relative to contralateral digits was 86%. Twelve cases had an excellent result, and one case had a good result. Digital replantation in children is recommended when feasible.
Treatment of migraine headache in a postoperative microsurgical patient
Authors: Poon Sharon L. , Lineaweaver William C. , O'Keefe Philip J. , Alpert Bernard S.
Published: March 2007

Immediately following a double‐toe transfer to her hand, a 40‐year‐old woman developed a severe migraine headache unrelieved by narcotics. Medical consultation was obtained, and available medical treatments were discussed in relation to their possible effects on the patient's recent microvascular procedure. Intravenous steroids were administered, with resolution of the headache. This case illustrates an approach to the management of medical problems in which treatment options are weighed against their possible microsurgical effects.
Microvascular grafts: Effect of diameter discrepancy on patency rates
Authors: Monsivais Jose J.
Published: March 2007

This study examined the effects of diameter discrepancy between interpositional vein grafts within a range of 0.25 to 2 mm. One hundred rats underwent isolation of a 10 mm segment of the femoral artery, from which a 4 mm segment was removed. Venous grafts measuring 8 ± 2 mm were interposed. The rats were categorized by their graft to artery diameter ratios. Patency was assessed upon completion and 4‐6 days postoperatively. All surgical specimens were submitted to the pathology department for microscopic evaluation. Results showed Group I: graft to artery ratio 1:1, patency rate 90% (18/20); Group II:ratio 0.75:1, patency rate 80% (16/20); Group III:ratio 0.5:1, patency rate 60% (12/20), Group IV: ratio 0.25:1, patency rate 20% (4/20); Group V:ratio 2:1, patency rate 60% (12/20). It is concluded that 1:1 venous graft to artery ratios are optimal. When this is impossible, diameter discrepancies should be at least 0.75:1 for acceptable patency rates to be attained in microvascular grafting.
Human nerve xenografting in nude mouse: Experimental study of graft revascularization
Authors: Duprez Karine , Bour Christian , Merle Michel , Duprez Adrien
Published: March 2007

In the nude mouse, the congenital absence of T lymphocytes makes it possible to implant human nerve grafts without rejection or iatrogenic modifications (by immunosuppression) of human and murine tissues. Medial antebrachial cutaneous nerves were harvested from human cadavers 1–18 hours after death. These nerve grafts were implanted using different techniques in nude mice. All the grafts were macroscopically and microscopically revascularized 3 days after implantation. The modifications in time of this vascularization could be studied with precision through the use of repeated biopsies. The absence of human blood group antigens on the neovessel endothelium suggested a murine origin for angiogenesis. In situ DNA hybridizations with human and mouse DNA confirmed this origin. The topography of the revascularization (maximal in the perineurium and endoneurium) and the almost complete absence of human cells other than Schwann cells in the grafts at the peak of angiogenesis (26 days after grafting) suggested that Schwann cells had a determining role in graft vascularization. The irradiation of the nerve grafts with a dose of 30 grays before implantation did not modify significantly their histologic appearance compared to the control group, whereas an irradiation of 60 grays led to massive lesions. The neurotization of murine axons led to chimerical structures of normal histologic appearance, with vascularization similar to that observed in nonneurotized nerves. Through chimerism (human Schwann cells, murine vessels and axons) this model makes it possible to dissociate the respective role of the host and of the nerve graft in angiogenesis and suggests the existence of growth factors produced by the human Schwann cells.
Re‐use of the recipient vessels of a microvascular transplant
Authors: Gordon Leonard , Levinsohn David
Published: March 2007

Three cases are described in which a second microvascular free flap, transplanted after a delay of several months, was provided perfusion by re‐using the recipient vessels of the first flap in end‐to‐end fashion. In each patient, healing of the second flap was uneventful, and both transplants continue to survive. Prior to harvesting the second transplant, a careful intraoperative examination was performed in which the vascularity of the original transplant was assessed. In each case, recipient vessel re‐use represented the least risky of several options. The results of the present series suggest that vascularization from the transplant bed or surrounding tissues proceeds despite the fact that, initially, the only source of blood for the free flap flows through a single axial vessel. This single vessel can therefore be divided without loss of the transplant as long as the transplant bed has already provided vascularization to the flap. In our opinion, the timing of the second procedure and the quality of the transplant bed are the key factors in the survival of the transplants.
Improved survival in a replantation model containing ischemic muscle
Authors: Concannon Matthew J. , Dooley Thomas W. , Puckett Charles L.
Published: March 2007

The effectiveness of superoxide dismutase and allopurinol was evaluated in preventing reperfusion injury in Sprague‐Dawley rats utilizing a limb replantation model after 6 hours of warm ischemia. Immediately prior to reperfusion of the replanted limb the animals received (intravenously) either a single bolus of superoxide dismutase (16,000 units/kg), a single bolus of allopurinol (45 mg/kg), both agents, or only control solutions. In the rats that received only control solutions, 30% of the limbs survived the ischemic insult. The group that received both superoxide dismutase and allopurinol had a 75% limb survival (P = 0.005). The animals that had only superoxide dismutase or allopurinol had 58% and 60% of the replanted limbs survive, respectively. This study suggests that the administration of superoxide dismutase and allopurinol may be helpful in the prevention of reperfusion injury in skeletal muscle in an acute injury setting (without pretreatment) and may thereby improve limb salvage after a significant ischemic period.