bluuebunny/crossref_metadata_2025 huggingface dataset:
Photographing microsurgery—still and dynamic techniques
Authors: Katzenberg Barbara
Published: March 2007

Photographic documentation has come to play an important role in the teaching of and research in microsurgery. Although microsurgical recording shares with conventional surgical recording such considerations as photographic technique and the maintenance of a sterile field, there are several additional problems peculiar to photographing microsurgery. Setting up the microscope to guarantee sharp focus on the film plane is crucial to obtaining high quality results, and the use of a high‐intensity light source is equally important. The different media of still photography, motion pictures, and video recording all have advantages, and the physician must judge which method best suits his needs.
Revascularization of the heart by laser
Authors: Mirhoseini Mahmood , Cayton Mary M.
Published: March 2007

The possibility of revascularizing the myocardium with high‐energy laser was investigated based on the finding that the laser beam could produce small channels in the tissue of the myocardium that were devoid of debris and scarring. The technique was investigated in 4 groups of 6 mongrel dogs each. In 3 of the groups, the left anterior descending (LAD) coronary artery was ligated above the first diagonal branch and the myocardium was treated with the laser energy according to the protocol of that group. In the fourth control group, the LAD artery was ligated but the myocardium was not subjected to laser treatment. In the first 3 groups, the myocardium was protected by the channels produced by the application of the laser energy. The animals were subsequently sacrificed at various intervals. In the control group, all of the animals died within 20 minutes of ligation of the artery. At autopsy, the epicardial sites of the channels created by the laser were clearly visible and a lack of charring in the channels was demonstrated. The penetration through the endocardial surface could be demonstrated. Microscopically, the channels were patent and endothelialized. It is concluded that the channels created in the myocardium effectively helped to protect the myocardium from acute coronary artery occlusion in this model in dogs.
Revascularization of autotransplanted ovine eyes by microsurgical anastomosis
Authors: Sher Herman
Published: March 2007

Microsurgical techniques are used to anastomose the ciliary and internal ophthalmic arteries and veins of the autotransplanted eyes of sheep to restore the circulation. Microscopic inspection and fluorescein angiography showed early patency of the anastomoses and the return of circulation to the retinal vessels. The applications of such an experimental model are discussed.
A simplified model for heterotopic heart transplantation in rats
Authors: Lee Sun , Lee Donald , Curtis Guy P. , Orloff Marshall J.
Published: March 2007

In a new simplified model, heterotopic heart transplants in rats function normally with only an aortoaortic anastomosis when one of the 5 lobes of the lungs is attached to the transplant. If an attempt is made to remove the remaining lobe of the lung, the heart dilates, fibrillates, and eventually stops beating. Since the surgery is not very complicated, this procedure can be performed by nonsurgeons in an unhurried manner with minimal training.
Survival of a myocutaneous free flap after prolonged ischemia: A case report
Authors: Takayanagi Susumu , Tsukie Tomio
Published: March 2007

A case is presented in which a myocutaneous free flap survived with only superficial marginal necrosis after being subjected to 15 hours of ischemia. The role of hypothermia and perfusion in preserving the flap are discussed.
Use of small diameter synthetic grafts in carotid bypasses in rats
Authors: Young Paul H. , Yasargil M. Gazi
Published: March 2007

Vascular prostheses of expanded polytetrafluoroethylene were tested as microvascular synthetic substitutes in a carotid bypass model in rats. Poor patency rates (28%) were obtained with this material when compared with the rates obtained in homologous arterial grafts (100%). It is concluded that expanded polytetrafluoroethylene is unacceptable for use as a 1 mm vascular conduit.
The effect of temperature on tolerance to ischemia in experimental free flaps
Authors: Cooley Brian C. , Hansen Frederick C. , Dellon A. Lee
Published: March 2007

Extended groin flaps in rats were used to explore the relationship of time and temperature of ischemic storage to the ultimate survival of free flaps. The maximum period of ischemia with 100% survival was found to be six hours for storage at a normothermic range (20‐ 25‐ C) and 48 hours for storage at a hypothermic range (0‐ 5 C). This study confirms the findings of others that cooling of tissue increases the interval of ischemic storage in which composite tissue can withstand and still survive.
Microlymphaticovenous anastomosis for treating lymphedema of the extremities and external genitalia
Authors: Gong‐Kang Huang , Ru‐Qi Hu , Zong‐Zhao Liu , Yao‐Liang Shen , Tie‐De Lan , Gong‐Ping Pan
Published: March 2007

Thirteen patients with secondary obstructive lymphedema of the upper and lower extremities were treated by microlymphaticovenous anastomosis. The immediate and long‐term results have been very satisfactory. An average reduction in the circumference of the affected limb of 6.2 cm was obtained, and subjective symptoms and objective signs were improved. No correlation was established between the quality of the results and the duration of the lymphedema or the number of anastomoses employed in treating it. On the basis of microlymphaticovenous surgery for lymphedema of the extremities, the authors also developed a microlymphaticovenous procedure to treat lymphedema of the external genitalia and applied it clinically in two patients. Good results were obtained in both instances. The operative techniques and four case histories are described, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the factors required for success of the surgery are discussed.
Free vascularized fibular graft for replacement of the radius after excision of giant cell tumor: Case report
Authors: Okada Tadahiko , Tsukada Sadao , Obara Kazunori , Yasuda Yukio , Kitayama Yoshiaki
Published: March 2007

A case is reported in which a giant cell tumor of the distal end of the radius was treated by massive resection and reconstruction with a free vascularized bone graft taken from the fibula. The postoperative course was uneventful. Angiograms made eight weeks after surgery showed patent anastomoses. One year after surgery there was no evidence of recurrence of the tumor, and roentgenograms showed no degenerative changes and bony union with hypertrophy at the junction of the radius and the graft. An excellent clinical result was obtained, and the patient was able to return to his original occupation as an illustrator.
Heparin and small caliber polytetrafluoroethylene grafts in the carotid arteries of rats
Authors: Barry Kevin J. , Scott R. Michael , Keough Ellen M.
Published: March 2007

Polytetrafluoroethylene (PTFE) grafts having an internal diameter of 1 mm were implanted in the common carotid arteries of rats with or without the simultaneous application of various heparin regimens. Graft patency was determined from postoperative angiograms, and grafts that were patent 40 days after surgery were harvested for light microscopic examination. The level of anticoagulation produced by the various heparin regimens was measured in separate groups of rats and found to be clinically therapeutic. All of the grafts from rats that did not receive heparin were occluded at 24 hours. In the two groups of rats that received high doses of heparin, 5 of 10 and 4 of 11 grafts were patent 40 days postoperatively. There were no patent grafts three days postoperatively in the group receiving low doses of heparin. The grafts that were patent 40 days postoperatively had lumens that were completely lined with presumptive endothelial cells. Further laboratory experimentation is needed before PTFE small caliber grafts can be recommended for use in humans.
The applications of the dental microscope: Preliminary report
Authors: Apotheker Harvey
Published: March 2007

The application of a dental microscope to the examination of the oral cavity and teeth, the preparation of cavities and crowns, root canal therapy, and periodontal and oral surgical procedures is discussed. The combined use of the microscope and laser and the microscope and videotape equipment are also discussed.
Anterior temporal anastomosis: A new approach to the problem of extracranial‐ intracranial bypass
Authors: Ploncard Philippe
Published: March 2007

A technique using the branches of the anterior temporal artery as host vessels for extracranial‐ intracranial bypass is presented.
Experimental carotid artery aneurysms in rats:A new model for microsurgical practice
Authors: Young Paul H. , Yasargil M. Gazi
Published: March 2007

A new method for producing experimental arterial aneurysms in rats is described. The aneurysms created by this technique resemble the intracranial aneurysms seen clinically in their gross and histologic appearance. The two types of aneurysms are also similar in the skill and techniques required for their microscopic dissection. Using this model, microsurgical techniques for the obliteration of aneurysms can be rehearsed and refined in the laboratory before they are applied clinically.
Quantitative analysis of plasminogen activator in small arteries by modified fibrin plates
Authors: Jacobs Gary R. , Reinisch John F. , Puckett Charles L.
Published: March 2007

The assay of plasminogen activator at the intimal surfaces of arteries less than 2 mm in diameter is possible using streptokinase‐ treated fibrin plates. Femoral arteries obtained from rats showed a reproducible fibrinolysis at their intimal surfaces that could be quantitated for the analysis of plasminogen activator. Utilization of the assay adjusted to the experimental situation would give a method of evaluating changes in the concentration of plasminogen activator at the intimal surface of small arteries when studied under various research conditions.
Treatment of choanal atresia by endonasal microsurgery
Authors: Maher Amr , Belal A.
Published: March 2007

The available literature on the pertinent anatomic and pathologic considerations of posterior choanal atresia is reviewed and the various surgical procedures used to treat the condition are presented. Ten cases of unilateral choanal atresia are discussed and a modified transnasal reconstructive operation using the surgical microscope is described. The advantages of the new technique are discussed.
The study and clinical application of the osteocutaneous flap of fibula
Authors: Chen Zhong‐Wei , Yan Wang
Published: March 2007

In this article, four cases of free fibular osteocutaneous flap transfer are reported. The advantages of the bone‐attached flap, its microsurgical anatomy, and its design and method of isolation are discussed in detail. Postoperative follow‐up showed success in all four cases with satisfactory functional recovery.
Critical comparison of transcutaneous PO2 and tissue pH as indices of perfusion
Authors: Raskin Douglas J. , Nathan Ross , Erk Yücel , Spira Melvin
Published: March 2007

A critical laboratory evaluation of transcutaneous PO2 monitoring and tissue pH monitoring in lower abdominal island flaps based on the superficial inferior epigastric vessels in rabbits revealed that transcutaneous PO2 values correlate poorly with tissue survival under circumstances of decreased arterial inflow. The inability of the transcutaneous PO2 monitor to accurately predict viability of the flaps in this study is attributed to physiologic changes in the microcirculation and not to instrument error. Tissue pH was, in all instances, a reliable index of the perfusion status of the flaps.
A simplified method for total artirialization of the liver in rats
Authors: Holmin T. , Buchholtz B. , Flati G. , Ivancev K. , Teuscher J.
Published: March 2007

Total arterialization of the liver appears to be a promising clinical method in preventing or reducing encephalopathy after shunting. A new technique for achieving total arterialization of the liver in rats is described and illustrated. This method is fast, simple, and associated with a high patency rate, even in the hands of relatively inexperienced microsurgeons. It can be recommended as an experimental model for additional studies in rats.
Technical aspects of segmental pancreatic grafting in rats
Authors: Squifflet Jean‐Paul , Sutherland David E. R. , Rynasiewicz John J. , Bentley Frederick C. , Florack Gerd , Najarian John S.
Published: March 2007

Four techniques for segmental pancreatic transplantation were used sequentially in rats. The success rate and the incidence and type of technical complications that developed in each group of recipients were determined and attempts were made to improve the microsurgical technique. A strict comparison of the relative merits of the four different techniques was not made, but rather the development of an approach to an original technique that resulted in a high success is rate presented. The various modifications and details of this experience are documented. The various complications, each of which results in a typical postoperative pattern of weight and plasma glucose changes and each of which is preventable by the use of proper microsurgical techniques, are also analyzed.
Intercostal nerve transfer in brachial plexus injuries: An experimental study
Authors: Tomita Yoshitsugu , Tsai Tsu‐Min , Burns John T. , Karaoguz Ahmet , Ogden Lynn L.
Published: March 2007

Eighteen adult mongrel dogs underwent unilateral surgical disruption of the brachial plexus. Twelve animals (Group I) had as a second‐stage procedure transfer of T4 and T5 intercostal nerves and their accompanying vascular bundles to the distal musculocutaneous nerve stump. Six animals (Group II) had restoration of musculocutaneous nerve continuity with conventional interpositional sural nerve cable grafts. Group I animals demonstrated significantly better electromyographic evidence of reinnervation and, comparing appearance and weight of operated and unoperated biceps muscles at the time of animal sacrifice, maintained greater gross weight and more normal overall appearance of muscle. Histologic study of muscle tissue showed no significant difference between the two groups whereas musculocutaneous nerve histology distal to all anastomoses revealed less fibrous tissue and a greater number of healthy‐appearing axons in Group I. It is concluded that vascularized intercostal nerve transfer as performed in this study has theoretical advantages over conventional nonvascularized intercostal nerve transfer but additional investigation is required to make this determination. The superiority of vascularized intercostal nerve transfers over conventional interpositional sural nerve cable grafts has been demonstrated.
Fascicular nerve graft using an empty perineurial tube: An experimental study in the rabbit
Authors: Restrepo Y. , Merle M. , Michon J. , Folliguet B. , Petry D.
Published: March 2007

An experimental model of a free, empty perineurial tube for use as a nerve graft is presented as an alternative to existing methods. The technique is described and the model compared with conventional nerve graft in the sciatic nerve of a rabbit. Results are evaluated with EMG studies, angiography, and histology. The experimental model compared favorably with the standard graft. Further avenues of investigation and clinical use are suggested.
Telescopic anastomosis of the common bile duct in the rat
Authors: Fronticelli C. M. , Bargoni A. , Discalzo L. , Ongaro R. , Ferri Y. , D'Ambrosio E.
Published: March 2007

A telescopic technique for the end‐to‐end anastomosis of the common bile duct in the rat is proposed as a way of reducing the number of sutures without prejudicing the impermeability of the union. Serial histological examinations of the scar process after 10, 20, and 30 days showed that patency was maintained.
Mechanical and metallurgical properties of vascular clips designed for temporary use
Authors: Dujovny Manuel , Kossovsky Nir , Kossowsky Ram , Perlin Alfred , Gatti Emilio Fernandez , Segal Ricardo , Diaz Fernando G.
Published: March 2007

Six commonly used surgical clips (Kleinert‐Kutz, PivotTM Vari‐Angle, Yasargil, Biemer, and Acland) that have been designated by their manufacturer as being suitable for temporary occlusion were studied in terms of their mechanical and metallurgical properties. Opening and closing forces were determined for all of the clips. Significant variations in clip force with respect to blade gap were found in all of the pivot‐type clips. Metallurgical testing showed that all six clips exhibited properties that contraindicate long‐term implantation.
Effect of suture technique on blood velocity waveforms in the microvascular anastomosis of autogenous vein graft
Authors: Lee Bok Y. , Brancato Richard F. , Shaw William W. , Browne Shawn , Thoden William R. , Madden John L.
Published: March 2007

In using autogenous vein grafts in microvascular surgery, maintenance of compliance at the site of anastomosis is of importance in achieving patency. Using high‐frequency, 20 MHz, pulsed Doppler ultrasonography to monitor blood flow velocity through the vein graft, we have evaluated the effects of continuous and interrupted suture technique on anastomotic compliance in vessels less than 1.5 mm in diameter. In 15 dogs, 15 procedures of each technique, using the continuous technique in one limb and the interrupted technique on the contralateral limb, patency rates for both techniques, documented by arteriography, are 100% at a mean follow‐up of 11 weeks. There were no significant differences in the blood velocity profile and pulsatility proximally, distally, and at the graft site between continuous and interrupted technique. This study confirms the suggestion that autogenous vein graft has sufficient elasticity to maintain normal arterial blood velocity waveforms.
The use of microvascular graft as an arterial substitute in the abdominal aorta of the rat
Authors: Zelder Oskar , Werner Heinz Helmut , Jerusalem Christoph R.
Published: March 2007

The purpose of this study was to compare by means of microsurgical techniques a porous with an interiorly smooth siliconized vascular graft. Compatibility and patency of the graft were examined in a long term followup. A microvascular prosthesis with a particular fibrous texture was used. The fibres consisted of polyurethane (PUR), a new prosthetic material. The lumen of the prosthesis measured 1.6 mm; the outer diameter was 2.4 mm. In group A an in‐ and exteriorly microporous graft was applied; in group B the inner surface of the prosthesis was smoothed by a silicon layer. 30 SPFWistar rats were randomized in group A (n = 15) and B (n = 15), and both prosthetic materials were implanted as a substitute for an infrarenal part of the abdominal aorta. Monofile suture material (MirafilR—DR 5) size 10:0 was used for the anastomosis. The mean pressure of the aorta amounted to 108 ± 30 mm Hg. After 4 ± 2 months the total survival rate was 77% (n = 23): in group A, 80% (n = 12); in group B, 73% (n = 11). Cause of death was early thrombosis due to technical mistakes. The following results were obtained by angiography: highest patency—group A, 8; group B, 1; constriction—group A, 6; group B, 9; occlusion—group A, 1; group B, 4; total—group A, 15; group B, 14; 1 angiography technically failed. Arterial substitution in the abdominal aorta of the rat by PUR‐grafts is possible and is a suitable model for further experiments. Prosthetic material with porous structure is significantly better than that with an impermeable smooth inner surface (significance 10%, test by Bross13). The low number of experiments allows only trend information and therefore must be considered as a pilot study, though histopathological findings undoubtly point to the superiority of the porous texture of the vascular prosthesis.
A scanning electron microscopic study of microvascular anastomoses on irradiated vessels: Short‐term effect of irradiation
Authors: De Wilde R. , Boeckx W. , Van Der Schueren E. , Guelinckx P. , Gruwez J.
Published: March 2007

Experiments were carried out to determine the effect of previous irradiation on microvascular arterial anastomoses. The study focused on regeneration of endothelial cells and thrombus formation. Careful examination with scanning electron microscopy (SEM) showed a difference between irradiated animals and a control group. In the irradiated group one can notice a decreased regeneration, a greater amount of fibrin and platelets, and a higher incidence of microthrombi.
Heart and spleen “twin grafts” in rats: IV. Influence of donor spleen cell mass on allograft survival
Authors: Blanchard Jacqueline M. , Tauber Jürg W. , Lazda Velta A. , Mozes Martin F.
Published: March 2007

Heart and spleen twin grafts from LEW to ACI rats may survive permanently, whereas those grafted from ACI to LEW rats do not. This strain difference in graft acceptance was analyzed quantitatively by transplanting one to three ACI spleens into LEW rats in order to compensate for the relatively small size of ACI spleens (Fig. 1). Under these conditions permanent graft survival was not observed in LEW recipients. However, during host splenectomy 3 days after transplantation, a nonimmunological factor was observed. The transplanted ACI spleens showed congestion and infarctions, while in the LEW to ACI transplant model the LEW spleens did not. This observation could be explained by the size of the vascular pedicle in ACI spleens. Although no problem was encountered immediately after completing the anastomoses, allogeneic spleens react by increasing in size, to such an extent that their size exceeds the capacity of the smaller vascular pedicle in ACI rats and results in congestion. Hence, the concept is formulated that early compromise of hemodynamics on a nonimmunological base may determine the fate of ACI spleen graft before immunological factors have a chance to become effective.
Effect of polyglycolic acid microsuture on rat uterine anastomoses
Authors: Lee Sun , Chan Edmund , Demacedo Arthur R. , Bacchi Carlos E. , Wolf Paul
Published: March 2007

In order to observe the effectiveness of polyglycolic acid microsutures (Dexon 10‐0) on rat uterine anastomoses, 40 Lewis rats were subjected to two‐layer (including the mucosa) and one‐layer (avoiding the mucosa) interrupted anastomoses of the freshly severed uteri using Dexon sutures. They were killed at days 7, 14, 21, 30, 60, 90, 180, 270, and 360. There was intensive inflammatory reaction during days 7–14 that gradually subsided, and the inflammatory reaction was limited to the suture sites by days 21–30. Sutures were still detectable at the end of 2 months, but they were no longer recognized at the end of 3 months. As the sutures were completely absorbed, giant cells and granulomatous reactions completely cleared. By days 180, 270, and 360, the rat uteri in both groups were indistinguishable from nonoperated ones. In this observation, it was noted that the use of absorbable microsutures with the mucosa inclusion in the rat uterine anastomoses was equally effective as those without the mucosa, and Dexon microsutures showed no residual effects on the uterine reanastomoses.
Clinical and experimental studies of bone union in reimplantation of digits: A preliminary report on ischemic interval
Authors: Kuwata Noriyuki , Kawai Shinya , Doi Kazuteru
Published: March 2007

The relationship between ischemic interval and bone union in reimplantation of digits was studied clinically and experimentally. In 32 reimplanted digits, the cases in which the bone union delayed had a longer ischemic interval. In experimental study of rats, bone union of the group of which ischemic interval was 12 hours was definitively delayed in comparison with that of the control group.
Relationship between lymphatic and venous pressure in normal and lymphedematous rabbit ears
Authors: Gong‐Kang Huang , Pai HsinYuan‐
Published: March 2007

Studies of lymphatic and venous pressures of normal and lymphedematous rabbit ears reveal the end pressure of lymphatics to be higher than the venous pressure. Massage of the related rabbit ear increases the lymphatic pressures and can markedly raise the side and end pressures within the lymphatic wall. The venous pressures are not much affected by massaging the rabbit ear. Fluctuations in lymphatic pressure are observed with the naked eye which are associated with spontaneous and intrinsic rhythmic contraction of lymphatics. During the contraction of lymphatics the lymphatic pressure is much higher than the venous pressure. All the facts point to the conclusion that the microlymphaticovenous anastomosis for treating lymphedema has a bright future.
Replantation of a completely amputated penis by the microsurgical technique: A case report
Authors: Yamano Yoshiki , Tanaka Hiroyoshi
Published: March 2007

A case is reported of a 43 year old who performed a self amputation of his penis. Reimplantation was successfully performed.
Energy metabolism and histomorphological findings in replanted rat hind limbs using various conservation methods
Authors: Eisenhardt H. J. , Isselhard W. , Prangenberg G. , Pichlmaier H. , Klein P. J.
Published: March 2007

Using various storage and conservation methods, we examined amputated and subsequently replanted limbs for their ischaemia tolerance level by investigating the changes in the adenylphosphocreatine system and glycolysis cycle. After replantation, amputated limbs that had been stored at room temperature (21.0 ± 1.5°C) for 2 hours were examined 14 days after operation. The adenosine triphosphate level of the skeletal muscle was reduced to 51% and the creatine phosphate to 77% of that of the control group. The glycogen was 13% of the normal value. The biochemical findings correlate with the histomorphological findings. After 2 hours ischaemia, the cross striations of the skeletal muscle and nuclear staining remained intact. There is a breakdown of the biochemical systems after 4 hours of ischaemia. They are no longer intact and the ischaemic limb does not recover. Histologically, muscle necrosis can be observed.
Effect of cigarette smoking on experimental microvascular anastomoses
Authors: Yaffe Batia , Cushin Brian J. , Strauch Berish
Published: March 2007

Cigarette smoking has been shown to cause cutaneous vasoconstriction, a decrease in digital blood flow, impaired wound healing, and it was implicated as a cause of failure of microvascular anastomoses in replanted digits. The subject of the following study was to assess the effect of cigarette smoking on experimental microvascular anastomoses. Twenty Sprague‐Dawley male rats weighing 200 to 250 grams were divided into groups of ten. Both the experimental and the control groups were acclimatized to a Maddox/ORNL rat smoke inhalation exposure system for six days prior to operation. At this time they were anesthetized and bilateral femoral artery end to end anastomoses were performed by two surgeons, using standard microsurgical techniques. After a recovery period of 24 hours, both groups were started on a smoking/sham‐smoking regime for 12 to 13 days. After this time they were anesthetized again, the femoral artery anastomoses were checked for patency in vivo and excised for histological evaluation. Five cm3 of blood was drawn from each animal to be analyzed for the presence of nicotine and its metabolites, and the rats were sacrificed. All the anastomoses in both groups were patent at the time of exploration and no histological difference could be demonstrated between the two groups. The radioimmunoassay of nicotine and cotinine showed large amounts in the smokers, and none in the nonsmokers.
A microsurgical technique for simultaneous pancreas and renal transplantation in the rat
Authors: Nolan Michael Stephen , Lindsey Nigel Jonathan , Ingram Nicholas Paul , Herold Alice , Slater David Norman , Fox Miles
Published: March 2007

A successful technique of simultaneous pancreatico‐renal transplantation into the streptozotocin‐induced diabetic rat is described employing a sutureless cuff technique for three of four vascular anastomoses. Reversal of the diabetic state was uniformly observed within 24 hours postoperatively and near‐normal renal function was evidenced by 50 days postoperatively. The technique is reliable and reproducible and represents the first report of successful combined transplantation into the diabetic rat.
The ring technique for end‐to‐side microvascular anastomosis
Authors: Weinrib Harry P. , Cook John Querin , Penn Richard D.
Published: March 2007

The ring technique for end‐to‐side microvascular anastomosis employs a resorbable polyglycolic acid ring to prevent stenosis and spasm at the anastomotic site. In 20 rats, the ring technique was compared with the conventional technique for constructing end‐to‐side anastomoses between the femoral (0.9‐1.1 mm) and superficial epigastric (0.3‐0.4 mm) arteries. The ring technique proved superior to the conventional end‐to‐side technique both in speed of execution and in patency at 3‐4 weeks (100% vs 70%). Grossly and microscopically, the ring was completely resorbed at 3 wk.
Automatic milking apparatus for the insufficient venous drainage of the replanted digit
Authors: Kotani Hironobu , Kawai Shinya , Doi Kazuteru , Kuwata Noriyuki
Published: March 2007

An automatic milking apparatus composed of a finger attachment and a pump to push out the air was devised in order to perform the forced drainage from replanted digits with insufficient venous drainage. Seven replanted digits with insufficient venous drainage after replantation were applied, and remarkable improvement was found in five digits. An interesting case is reported in which a replanted digit without venous anastomosis survived as a consequence of applying the milking apparatus. The advantages of our milking apparatus are also discussed.
Liver revascularization with the left gastric artery following portocaval shunt in rats: Technique and preliminary results
Authors: Vassanelli P. , Marchetto R. , Marini P. , Fiore D.
Published: March 2007

The technique of liver arterialization with the left gastric artery after portocaval shunt in the rat is described. The operation was carried out with three different modalities, and the best results were obtained when suturing was carried out after enlargement of the arterial caliber (0.4‐0.5 mm external diameter), advantage of a vessel bifurcation. Eighty percent of the anastomosis were patent without any anticoagulant treatment 1 month after surgery. Preliminary results show the positive effect of liver arterialization compared to treatment with portocaval shunt alone.
Implantable pulsed doppler cuff for long‐term monitoring of free flaps: A preliminary study
Authors: Parker Paul M. , Fischer Joseph C. , Shaw William W.
Published: March 2007

High‐frequency (20 mHz) ultra‐sonic Doppler in a pulsed mode rather than continuous mode allows blood flow detection in small arteries using a 1‐mm crystal embedded in a silastic cuff. The “probe factor”; used to determine flow was first established in an in vitro system and found to be reliable. The probe was then tested in five dogs on the saphenous artery and found to be highly responsive to hemodynamic changes in the pedicle. Finally, in 15 longterm studies of island flaps and free flaps, the probes were implanted to obtain daily readings and then removed at 7 days. Except for some dogrelated problems and technical errors, the system produced reliable flow data in the percutaneous cable. It is anticipated that such immediate and direct information on the pedicle blood flow would be useful in monitoring flaps.
Organization and implementation of a community hospital microsurgical service for the management of amputation injuries
Authors: Mirza M. Ather , Korber Kenneth E.
Published: March 2007

The genesis of a voluntary referral system with the establishment of a microsurgical replantation center in a community hospital is described. Specific hospital and emergency care protocols are outlined, along with the percentage distribution of peripheral hospitals utilizing this service. Over the initial 6‐year period, a success rate greater than 85% has been achieved in those cases that have satisfied the criteria for revascularization and replantation.
New small‐caliber antithrombotic vascular prosthesis: Experimental study
Authors: Miyake Hidenori , Handa Hajime , Yonekawa Yasuhiro , Taki Waro , Naruo Yoshito , Yamagata Sen , Ikada Yoshito , Iwata D Eng, Hiroo , Eng D , Suzuki Masakazu
Published: March 2007

Vascular prostheses with the inner diameter smaller than 1 mm were implanted to the common carotid artery of rats, and their patency was examined. Four types of tubes were prepared for this purpose in Experiment 1: polyethylene (PE), poly‐(acrylic acid)‐grafted polyethylene (PE‐AA), polyacrylamide‐grafted polyethylene (PE‐AAm), and poly(vinyl alcohol) (PVA) tubes. Comparative studies made using nonsuture anastomosis revealed that the PE‐AAm and PVA tubes were antithrombotic, although disconnection was noted at the anastomotic sites within 1 week and 1 month, respectively. Thereafter in Experiment 2, the PVA tubes were implanted to the common carotid artery of 20 rats using conventional anastomosis. Neither anticoagulants nor fibrinolytic agents were used in both series of experiments. Patency of the PVA tubes was 80% after 1 week and 70% after 1 month. In patent cases after 1 month, the luminal surfaces of the prostheses and the host arteries were examined using scanning electron microscopy. The lumen of the arteries and anastomotic sites was covered with endothelial cells, while the lumen of the PVA tubes was free from thrombi and there was no neointima formation. So far, there has been reported no manmade material that has completely antithrombotic property in vivo. However, our studies disclosed that PVA is antithrombotic and one of the most promising materials for the inner surface of small vascular prostheses.
Free transplantation of venous network pattern skin flap: An experimental study in rabbits
Authors: Ji Shu Yun , Chia Shu Lan , Cheng Hsu Hsi
Published: March 2007

Free skin flaps using rabbit ear to replace rabbit scalp have been accomplished using only arteriovenous and venous‐venous anastomosis, without arterio‐arterial anastomosis. The technique produced excellent graft survival in 30 of 33 rabbits. Without the vascular anastomosis control grafts did poorly. The mechanism of flow reversed revascularization is discussed.
Scanning electron microscopy studies of needle and suture damage in rat carotid and femoral arteries
Authors: Longa Enrique Zea , Weinstein Philip R. , Chater Geoffrey
Published: March 2007

Using the scanning electron microscope (SEM), we compared the areas of endothelial disruption 45 minutes after penetration of rat femoral and carotid artery walls with 75‐ and 100‐μ taper point and taper cut microsurgical needles, with and without restoration of blood flow. Four experimental groups were designated: needle puncture only, single loose, suture loop, end‐to‐end anastomosis, and end‐to‐side anastomosis. The vessels were perfused with normal saline, immersed in 3% buffered glutaraldehyde, and mounted under slight tension to simulatephysiological wall distention before SEM examination. Endothelial craters at vessel puncture sites were measured on SEM photomicrographs at 300 × magnification. All vessels were patent when examined. Crater diameters averaged less than double the needle size. Although taper cut needles produced craters that were 25% larger (P < 0.05), vessel penetration was easier than with the taper point needle and bleeding times were the same. Suture loop produced craters that were 36% larger (P < 0.05) than needle puncture alone. Craters were 20% larger when blood flow was restored and 50% larger inthe femoral than in the carotid artery. Although craters seen after end‐to‐end anastomosis were not significantly larger than those after end‐to‐side anastomosis, interrupted sutures appeared to cause more endothelial damage than continuous sutures. These results suggestthat the use of cutting needles, passage and tying of sutures, vessel distention by blood flow, and suturing of more muscular and less elastic vessel walls (femoral artery) may increase endothelial disruption but do not reduce patency.
A new microvascular clamp for the production of experimental ischemia
Authors: Stark Ron H. , Sanger James R. , Matloub Hani S.
Published: March 2007

A new microvascular clamp was developed from inexpensive and readily available materials. This clamp, when properly applied, can provide many hours of vessel occlusion with minimal damage to the vessel intima. This clamp has important applications in producing prolonged experimental ischemia without significant vessel damage and thrombosis. This clamp produced less vessel damage when compared with a standard microvascular clamp for prolonged periods of clamping.
Kidney and spleen twin grafts in rats: Unidirectional graft acceptance in unsuppressed ACI recipients
Authors: Blanchard J. M. , Tauber J. W. , Welsh T. J. , John E.
Published: March 2007

In previous studies, we have shown that vascularized spleen grafts can facilitate the acceptance of simultaneously implanted hearts, especially if host splenectomy is done 3 days later. 1 The present study shows that the same protocol works not only for hearts but also for kidneys. A total of 59 renal allografts were carried out in various combinations between LEW and ACI rats. The recipients were submitted to bilateral nephrectomy at the time of graft implantation and host splenectomy 3 days later. Graft function was assessed by survival time of the animals. In addition, BUN, creatinine, and hematocrit were measured in selected individuals. The following observations were made: (1) LEW kidneys were rejected at 92 ± 65 days while ACI kidneys failed at 17 ± 1.4 days (p < 0.025). (2) Control animals without simultaneous syngenic functioning spleen implant rejected their LEW kidneys at 30.6 ± 24.3 days (p < 0.005). (3) Eleven rats never rejected their LEW kidneys (four single, seven twin grafts). (4) BUN, creatinine, and hematocrit differed significantly in rats with functioning kidneys compared to those in end stage renal failure (p < 0.0005, p < 0.0025, and p < 10 −7 respectively). It is concluded that the presence of the donor spleen can facilitate the acceptance of a simultaneous kidney graft to various degrees, depending on the strain combination.
Microlymphaticovenous anastomosis for lymphedema of the breast
Authors: Huang Gong‐Kang , Hu Ru‐Qi , Liu Zong‐Zhao
Published: March 2007

On the basis of microlymphaticovenous anastomosis for treating lymphedema of the extremities, the authors developed a microlymphaticovenous procedure to treat congenital lymphedema of the breast and applied it clinically in two patients. The immediate results have been fairly good. The breast and its nipple had been reduced in size and to a nearly normal level. The results are maintained after a half year of follow‐up. The fundamentals and techniques of the operation are described and the two case histories are reported. The cases presented here appear to be the first successful clinical attempts to treat lymphedema of the breast by microlymphaticovenous anastomosis. The clinical character of congenital lymphedema, the indication of the microlymphaticovenous anastomosis, and the factors required for success of microlymphatic surgery are discussed.
Microlymphaticovenous anastomosis for treating scrotal elephantiasis
Authors: Huang Gong‐Kang , Hu Ru‐Qi , Liu Zong‐Zhao , Pan Gong‐Ping
Published: March 2007

Scrotal elephantiasis can be physically disabling and physchologically distressing to the victim. Ablative procedure has been used in its treatment and has achieved limited success. The authors developed a microlymphaticovenous procedure to treat elephantiasis of the scrotum and applied it clinically in three patients. The immediate and long‐term (13–24 months) results have been very satisfactory. The scrotum size was dramatically reduced to a nearly normal level, and subjective symptoms and objective signs were improved. The operative techniques are described, the three case histories are illustrated, and the advantages of microlymphaticovenous anastomosis, the selection of patients, and the factors required for success of the surgery are discussed.
Microvascular repair following local crush and avulsion vascular injury
Authors: Cooley Brian C. , Hansen Frederik C.
Published: March 2007

A model has been developed demonstrating intimal damage resulting from a combined crush and avulsion injury to the femoral artery of the rat. Revascularization after traumatization is accomplished with microvascular nastomosis of the severed ends. Vascular patency rates at 2 and 7 days postoperatively are low (0–25%) in comparison with control groups (90–100%). A high correlation is found between patency tests performed at 20 minutes and at 2 days after blood flow re‐establishment. Systemically administered heparin improves traumatized‐vessel patency dramatically.
Application of Kunlin's technique in vascular micro‐anastomosis: Experimental and clinical study
Authors: Fossati Enrique , Asurey Néstor , Irigaray Alberto
Published: March 2007

Vascular microanastomosis of vessels that presents marked discrepancy in size can be performed without difficulty by making a longitudinal incision of the end of the smallest vessel, forming a kind of „spatula,”︁ and joined to the vessel of greater diameter.
History of (MICRO) vascular surgery and the development of small‐caliber blood vessel prostheses (with some notes on patency rates and re‐endothelialization)
Authors: Hess Frits
Published: March 2007

The historical development of vascular surgery is reviewed from ancient times (Ruphus of Ephesus, Aëtius of Amida) to recent developments (sutured anastomosis by Carrel). Attempts to anastomose blood vessels by means of nonsuturing technique, using a ring or short tube of diverse materials called prostheses, were undertaken at the start of this century and continued until shortly after World War II. With the advent of modern polymeric materials, prostheses of different types, sizes, structures, and fabrics have been used to substitute for blood vessels, both experimentally and clinically. Recently, blood vessel prostheses with small (1–1.5 mm) internal diameters became available and have been implanted experimentally. Patency rates, biophysical and structural properties, the re‐endothelialization and the neointima formation of several types of microvascular prostheses are briefly reviewed.
A hemodynamic evaluation of cuffed microarteriorrhaphy
Authors: Bell Lawrence D. , Blair William F. , Pedersen Douglas R. , Gabel Ronald H.
Published: March 2007

A cuffing technique and a standard interrupted suturing technique of microarteriorrhaphy were compared in the rat femoral artery. The comparison was based on hemodynamic variables, which were measured by 20‐MHz pulsed ultrasound Doppler velocity meter (PUDVM) method. The hemodynamic variables included measured blood velocity and vessel lumen diameters, and calculated volumetric flows. Measurements were completed at 5‐, 10‐, and 20‐minute intervals after vessel repair. Data from 26 experimental animals were suitable for analysis, with 15 animals in the standard repair group and 11 animals in the cuffed group. All variables were statistically similar prior to the surgical procedure, indicating that the study groups were appropriate for comparison. The measured lumen diameters were not statistically different at any time interval (P = .06). However, the velocities and the volumetric flow were statistically different (P < .05) between groups at all time intervals. These values returned toward normal preoperative values over time. The cuffing technique used in this study was not as efficacious as the standard technique of microarteriorrhaphy, when evaluated by 20‐MHz PUDVM‐derived hemodynamic criteria.
Microarteriorrhaphy: Blood flow after wound healing
Authors: Blair William F. , Pedersen Douglas R. , Joos Karen , Green E. R. , Bondi David
Published: March 2007

The present study tests the hypothesis that early wound healing effects blood flow after experimental microarteriorrhaphy. Hemodynamic variables were measured in the rat femoral artery prior to and 3 weeks after both interrupted and continuous microarteriorrhaphy techniques. The hemodynamic variables (blood velocities, lumen geometry, and calculated blood flow) were measured by 20‐MHz pulsed ultrasonic Doppler velocity meter (PUDVM) methods. The control values (N = 22) and the 3 weeks postoperative values, for both the interrupted (N = 11) and continuous groups (N = 11), were not statistically different (P > .01). The average calculated blood flows were as follows: control group 10.85 ± 1.45 cc/min, interrupted group 12.01 ± .92 cc/min, and continuous group 8.50 ± 1.45 cc/min. Three weeks of wound healing after microarteriorrhaphy did not significantly change blood flow variables compared to preoperative values.
A new method for venous interposition grafts using fibrin glue
Authors: Sugiura K. , Nakatsuchi Y. , Yagi R. , Sugimoto Y.
Published: March 2007

We developed a new technique of venous interposition graft where the principle of sleeve anastomosis was applied at the proximal suture site and fibrin glue was used at both suture sites to prevent leakage. An advantage of this procedure was a reduction in the number of stitches, which reduced operative time and obtained good vascular healing. Since in an animal experiment a high patency rate of 97% was obtained, we applied the procedure to a clinical case with complete amputation at the PIP joint level of a long finger. Good recirculation was seen on angiography 6 weeks postoperatively.
New disposable microvascular clamp
Authors: Smahel Jiri , Laszczower Max
Published: March 2007

A new design for a plastic microvascular clamp is described. The clamp consists of two flat blades, with eyes permitting application and removal of the clamp with cross‐forceps. Closure is effected by the elasticity of a rubber ring placed around the blades, obviating the need for an articular joint or a spring mechanism. The new design simplifies production of the clamp, which is intended to be disposable, i.e., for once‐only use.
A new technique for anastomosing veins to small‐caliber arteries
Authors: Orbay Toygun , Imhof Hans Georg
Published: March 2007

A new technique of arteriovenous anastomosis is presented which lessens the complication of intravascular turbulence and thrombosis seen with elongated and narrow anastomotic segments. The axillary artery and jugular vein were anastomosed in 10 ZBZ‐Cara rats using microsurgical techniques. The jugular vein was prepared as a tubular structure facilitating two end‐toend anastomoses rather than the customary end‐to‐side technique. Angiographic patency was demonstrated at 3 weeks in 10/10 rats. Two of ten anastomotic segments were considered quite narrow; however, angiographic demonstration of flow was excellent.
A new experimental model for microanastomosis between vessels of different diameter
Authors: de Carolis Vicente , Sepulveda Sergio
Published: March 2007

A new model for microvascular anastomosis between vessels of different diameter is described in the aorto‐iliac region of the rat. The model consists of reversing the distal end of one iliac artery toward the aorta to perform an end‐to‐end or end‐to‐side microanastomosis, with 2:1 diameter ratio. The technique and the advantages of this model are presented and discussed.