bluuebunny/crossref_metadata_2025 huggingface dataset:
Free flap survival improved by prostacyclin analogues
Authors: Frick Andreas , Baumeister Rudiger G. H. , Wohllaib Ulrich
Published: March 2007

Free flap transplantations and replantations of extremities are threatened by venous occlusion in the postoperative course. In rats, free autogenous groin flaps were transplanted to the neck using microsurgical techniques. On the first postoperative day, the draining vein of the flap was temporarily clamped. In the control group there was always a total loss of the flaps by haemorrhagic necrosis. The intraarterial flap perfusion by lloprost during the clamping was able to diminish the ischaemic effects; 80% of the flaps survived. The systemic application of lloprost by intravenous infusion reduced the ischaemic effects in a similar way. Serious complications such as intraabdominal bleeding or bleeding in the donor area were seen after intravenous administration. Cicaprost had a similar protective effect on flap ischaemia after intravenous infusion. Flap survival was comparable to lloprost. Severe complications seemed to be less. Prostacyclin analogues were able to diminish damage of secondary ischaemia caused by venous occlusion. © 1993 Wiley‐Liss Inc.
Correction of hypoplastic thumb by free transfer of metatarsal bone: A case report
Authors: Schneider W. , Reichert B. , Pallua N. , Meyer H.
Published: March 2007

A new form of correction of hypoplasia of the thumb is presented in a case of grade 3 thumb hypoplasia. The distal half of the second metatarsal together with its epiphyseal plate was used to lengthen the first metacarpal bone and improve thumb function. This method represents a promising alternative to pollicization in this type of thumb hypoplasia. © 1993 Wiley‐Liss Inc.
Further clinical use of the interposition arteriovenous loop graft in free tissue transfers
Authors: Angel Michael F. , Chang Bernard , Clark Norman , Wong Lesley , Ringelman Paul , Manson Paul N.
Published: March 2007

The use of an arteriovenous fistula (AVF) to afford vascular access for free tissue transfer is described in 11 consecutive patients from a 1 year period. The leg was the site of pathology in six cases, and a reversed saphenous AVF to the femoral vessels was created. In the remaining five cases, those in the head and neck and arm regions, the recipient vessels varied. The mean patient age was 37.7 years, and ten of 11 patients were male. Etiologies of defect were automobile accidents in six cases, neoplasm in three, and gunshot wound and electrical injury in one patient each. Mean ischemia time was 113 ± 15 min. Mean length of AVF was 27.3 ± 2.1 cm. All flaps survived. AVF was a useful technique in the current study. Several maneuvers were undertaken to minimize the risk of thrombosis. All patients were given aspirin prior to AVF creation. Patients received dextran 40 in the postanastomosis period for 5 days. Finally, every effort was made to create the AVF between large vessels, especially in the leg, to maximize blood flow. © 1993 Wiley‐Liss Inc.
The cephalic vein in microsurgery
Authors: Hallock Geoffrey G.
Published: March 2007

A working knowledge of the venous anatomy is seldom emphasized but is an essential element in all microvascular procedures. The cephalic vein has been chosen here to serve as a model, since it is an important source for both afferent and efferent flow for flap transfers as well as in limb replantations. The better known, lower extremity superficial veins, especially as a source for long vein grafts, are not necessarily the best option. The cephalic vein represents the most versatile of the large superficial veins of the upper extremity and has numerous roles in microsurgery other than as a viable alternative for vein grafts. © 1993 Wiley‐Liss Inc.
New skeletal muscle model for the longitudinal study of alterations in microcirculation following contusion and cryotherapy
Authors: Smith Thomas L. , Curl Walton W. , Smith Beth Paterson , Holden Martha B. , Wise Thomas , Marr Albert , Andrew Koman L.
Published: March 2007

This preliminary report describes the use of a rat model developed to study in vivo the effect of anesthesia, contusion, and cryotherapy on skeletal muscle microcirculation by use of an implanted chamber. The diameters of arterioles and venules within the chamber were determined by photomicroscopy in the contusion study and by compound videomicroscopy in the anesthesia study; microvascular perfusion was determined by laser Doppler fluxmetry (LDF). Combined ketamine and xylazine anesthesia significantly reduced (P < 0.05) arteriolar and venular diameters by 32.4% and 37.8%, respectively, and average LDF measurements by 36.1%. Contusion significantly increased arteriolar diameters over baseline values (P < 0.05); cryotherapy did not alter arteriolar diameters but increased venular diameters (P < 0.05). It is hypothesized that this increase in venular diameter may, by increasing the surface area available for reabsorption, explain one mechanism by which cryotherapy decreases the edema of contusion. Use of this model should help to advance the understanding of microcirculatory dynamics following contusion and cryotherapy. © 1993 Wiley‐Liss Inc.
Effect of denervation on endothelium‐derived relaxing factor‐dependent relaxation in the rat cremaster muscle
Authors: Gazdag Andre , Chen Long‐En , Hagen Per‐Otto , Seaber Anthony V. , Urbaniak James R.
Published: March 2007

Endothelium‐derived relaxation mediated primarily by endothelium‐derived relaxing factor/nitric oxide (EDRF/NO) is essential in the maintenance of vascular tone. However, little is known about the effects of denervation on EDRF‐mediated relaxation in the microcirculation after reimplantation. Using intravital videomicroscopy in the rat cremaster model, this study assessed the effect of acute and chronic denervation of the muscle, produced by severing the genitofemoral nerve, on EDRF‐mediated vasorelaxation. The results demonstrated that acetylcholine‐induced EDRF relaxation (10−6M) significantly relieved norepinephrine‐induced vasoconstrtction in small arteries (40–80 (μm diameter) in both the acute and chronic denervated muscles. There was no significant difference in the relaxant response between the denervated or innervated controls in each group or between the acute or chronic groups. This relaxation was prevented by methylene blue (10−4 M). These findings suggest that EDRF‐mediated relaxation in the microcirculation is not dependent on tissue innervation. Thus the use of potent endothelial dependent agonists may be of use in cases of vasospasm postreimplantation. © 1993 Wiley‐Liss Inc.
Effect of hypertension on arterial structure and wound repair at the microvascular anastomosis site using stroke‐prone spontaneously hypertensive rats (SHRSP)
Authors: Isogai Noritaka , Fujii Shunichiro , Tsukahara Takahiro , Kamiishi Hiroshi
Published: March 2007

Different processes of microvascular wound healing under hypertension in comparison to normotension have been suspected. To explore these differences at the site of anastomotic wound repair, we performed microvascular anastomoses of the femoral arteries in 12‐week‐old, stroke‐prone hypertensive rats (SHRSP) whose maximum blood pressure reached 238 mm Hg and in normotensive age‐matched Wistar Kyoto (WKY) rats. Morphologic changes under hypertension were examined via light microscopy. The arrangement and number of endothelial cells were examined using the en face silver staining technique. The plasma activity levels of factor XIII were also measured in each group. Transitional healing at the microvascular anastomosis site was evaluated via scanning electron microscopy. The extent of endothelial migration over the exposed media around the needle holes was determined using a computerized graphic analysis system. Histologic cross sections demonstrated a thickened media, with altered shape and arrangement of the smooth muscle cell nuclei in SHRSP arteries compared with WKY arteries. En face silver staining showed small and spindle‐shaped endothelial cells with an irregular cell arrangement and distribution in SHRSP arteries relative to WKY arteries. Factor XIII was increased 36% over baseline in SHRSP rats post‐operatively; this was significantly higher than the increase in WKY rats (P < 0.05). Although both SHRSP and WKY arteries had similar wound healing responses to microvascular anastomosis, endothelial cell migration over the exposed media was significantly accelerated in the SHRSP rats. © 1993 Wiley‐Liss Inc.
Long‐term evaluation of nerve regeneration in a biodegradable nerve guide
Authors: Den Dunnen Wilfred F. A. , van der Lei Berend , Schakenraad Jeff M. , Blaauw Engbert H. , Stokroos Ietse , Pennings Albert J. , Robinson Peter H.
Published: March 2007

Nerve regeneration using artificial biodegradable conduits is of increasing interest. The aim of this study is to evaluate the regeneration and maturation of a nerve after long‐term implantation (2 years) of a biodegradable poly‐L‐lactide/poly‐e‐caprolactone (PLLA/PCL) copolymeric nerve guide in the sciatic nerve of the rat. After harvesting, we evaluated both the regenerated nerves and the controls, using light microscopy, transmission electron microscopy, and morphometric techniques. Remnants of biomaterial were still present after 2 years of implantation, but the foreign body reaction was very mild at this stage, due to the rounded shapes of the polymer debris. Morphometric analysis showed significant differences between the regenerated nerve and the normal sciatic nerve: the number of myelinated fibers is higher, and the mean fiber diameter of the myelinated fibers in the regenerated nerve is smaller. In conclusion, the results demonstrate that the new PLLA/PCL nerve guide can provide optimal conditions for regeneration and maturation of damaged nerves. © 1993 Wiley‐Liss Inc.
Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants
Authors: Bos K. E. , Besselaar P. P. , van der Eyken J. W. , Taminiau A. H. M. , Verbout A. J.
Published: March 2007

Seven patients with congenital Boyd type II pseudarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow‐up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three operations). Union was successful in all patients although three required further surgery. At follow‐up all patients were able to walk without external support. The results were classified as good in two cases and fair in five cases.

The postoperative period was, however, often complicated by stress‐fracture and nonunion. Leg length discrepancy and valgus deformity are still unsolved problems in some cases. It seems probable that a primary reconstruction at an early age will prevent many of these subsequent problems. © 1993 Wiley‐Liss Inc.
Patency and healing of microvascular prostheses: A review of 10 years of experimental work in groningen
Authors: van der Lei B. , Robinson P. H.
Published: March 2007

From 1982 onwards, in Groningen, The Netherlands, we have worked on the experimental evaluation and development of microvascular prostheses in rats and rabbits. In this review article a systematic overview of this experimental work is presented and the results are discussed with regard to the literature to come to a current state of the art on (experimental) microvascular grafting with prosthetic conduits. © 1993 Wiley‐Liss Inc.
Neither desferrioxamine nor lipoic acid enhances the cold ischaemic tolerance of epigastric free flaps in rats
Authors: Werker Paul M. N. , Kon Moshe , Green Colin J. , Franken Ralph J. P. M. , Overgoor Max L. E.
Published: March 2007

This study was designed to test the ability of pre‐ and postischaemic administration of desferrioxamine (DFX), a combination of a preischaemic single passage perfusion with hypertonic citrate solution (HCA) and postischaemic administration of DFX, and pre‐ and postischaemic administration of lipoic acid (LA) to enhance the cold (0°C) ischaemia tolerance in epigastric free flaps in inbred rats. The ischaemic intervals varied between 0 and 120 hr. The area of flap survival 2 weeks after revascularisation as a percentage of original flap size was recorded as an exponent of ischaemic tolerance. None of the treatment regimens was able to increase flap area survival. Histologically, there were no major differences between the different treatment regimens. © 1993 Wiley‐Liss Inc.
Vein graft conduits versus conventional suturing in peripheral nerve reconstructions
Authors: Heijke Guda C. M. , Klopper Pieter J. , Dutrieux Richard P.
Published: March 2007

Positive results of tubulization in peripheral nerve reconstruction have been established in animals by many investigators. Clinically, tubulization by means of a venous tubulus is accepted as a reliable technique, but histological results are not known and functional analysis is limited. The aim of this investigation was to study the histological effect of venous tubuli in peripheral nerve reconstruction.

In 20 rabbits the saphenous nerves were transected and anastomosed. In ten rabbits (series 1) a venous tubulus was placed around the nerve suture. In another ten rabbits (series 2) a venous tubulus was sutured over a 3 mm nerve gap. Conventional suturing was done in ten contralateral saphenous nerves (series 3, controls). Epineurial stitching was performed. The healing was studied after 3 months and after that histological analysis was performed by means of monoclonal antibody staining.

The results of our experiments show that covering a nerve anastomosis with a venous tubulus did not enhance healing in comparison to the conventional end‐to‐end anastomosis, but in contrast evoked extensive fibrous tissue, thereby hampering regeneration of axons. © 1993 Wiley‐Liss Inc.
Addressing the ideal requirements by free flap phalloplasty: Some reflections on refinements of technique
Authors: Joris Hage J. , De Graaf Floris H.
Published: March 2007

Ideally, in phalloplasty one should aim at 1) a one‐stage procedure that can be predictably reproduced, 2) creation of a competent neo‐urethra to allow for voiding while standing, 3) return of both tactile and erogenous sensibility, 4) enough bulk to tolerate the insertion of a prosthetic stiffener, and 5) a result that is aesthetically acceptable to the patient. We consider 6) minimal scarring or disfigurement, and 7) no functional loss in the donor area further requirements for any ideal procedure. Thanks to ongoing refinements, microsurgical free flap phalloplasty techniques lead to the best results, both functionally and cosmetically. These refinements are presented and discussed, as are our experiences applying them. © 1993 Wiley‐Liss Inc.
Late salvage of a ”︁free flap„ phalloplasty: A case report
Authors: Noordanus Robert P. , Joris Hage J.
Published: March 2007

Three weeks after radial forearm free flap phalloplasty, a 28‐year‐old female‐to‐male transsexual presented with ischaemia of the neophallus. A salvage procedure was started 7 hours after onset of ischemia. Thrombectomy of the arterial pedicle did not result in venous return of the arterial inflow. Perfusion of the flap with streptokinase restored venous return. Flap perfusion was confirmed by intraoperative direct angiography of the neophallus. Six months after this salvage procedure, the flap is doing well and tactile sensibility has occurred. © 1993 Wiley‐Liss Inc.
”︁Impossible„ reversed radial forearm free flap in microsurgical reconstruction
Authors: Bauland Constantmn G. , van Twisk Reinier , Bos Michael Y. , Nicolai Jean‐Philippe A.
Published: March 2007

The reversed radial forearm free flap is described and patient histories are presented to illustrate its unique reconstructive versatility. The valvular orientation of the deep and superficial forearm veins should theoretically oppose the reversed flow in this flap, but the venous flow is not compromised. In comparison to the anterograde forearm free flap the vascular pedicle is longer and the donor defect generates less functional and cosmetic complications because it is located on the proximal forearm. In a review of the literature anatomical details of the venous drainage are presented. Different opinions on reverse flow in forearm flaps are discussed and a new theory is proposed. © 1993 Wiley‐Liss Inc.
Salvage of a through‐knee amputation level using a free fillet of sole flap
Authors: van der Wey Leo Peter , Polder Theo W.
Published: March 2007

A young adult male sustained a compound crural fracture with a 15 cm defect of tibia and fibula, and an extensive soft‐tissue loss of the lower leg and knee joint. A free fillet of sole flap was raised on the amputated foot and transferred to the soft‐tissue defect around the femoral condyles in order to prevent an above‐knee amputation. Intact vascularisation and sensation of the flap were secured by microsurgical anastomoses of the popliteal and posterior tibial vessels and the sciatic and tibial nerves. The patient was rehabilitated rapidly with a prosthesis. At the 12‐month follow‐up, he demonstrated excellent „foot”︁ sensibility, stable soft‐tissue coverage of the stump, and an optimal functional result. © 1993 Wiley‐Liss Inc.
Micro‐Anastomosis of 0.3‐0.4 mm vessels after cold ischemia using a rat model of toe‐to‐thumb transplantation
Authors: Chaopricha Werayudth , Chen Long‐En , Seaber Anthony V. , Bossen Edward , Urbaniak James R.
Published: March 2007

Anastomoses of vessels of less than 0.5 mm in diameter remain a challenge from the technical aspect. Clinically such anastomoses are necessary for replantation of the distal digit in adults and whole digits in children. Survival data for replantation of these parts after prolonged ischemia have not yet been reported. Since a rat foot has an anatomic structure similar to the human hand, we used 40 rats as models of toe‐to‐thumb transplantation to study the survival rates of transplanted toes after various periods of cold ischemia (4°<C) of the amputated part. While a 100% success rate was achieved following immediate transplantation of the amputated digits (control group), the survival rates were 87.5, 75, 75, and 62.5% after transplantation of digits cooled for 24, 48, 72, and 96 hours, respectively (groups 2–5). No exact ischemic time limit was demonstrated. The results suggest that, in this model, optimal digital replantation results are achievable even after a 24 hour period of cooling preservation. © 1993 Wiley‐Liss Inc.
Circumferential choledochoplasties with autologous venous and arterial grafts
Authors: Flati Giancarlo , Flati Donato , Porowska Barbara , Rossi Giorgio , Francavilla Sandro , Santoro Emanuele , Carboni M.
Published: March 2007

Circumferential choledochoplasties with vascular grafts have rarely been attempted either experimentally or in clinical practice.

In this study, choledochoplasties using autologous venous and arterial grafts were performed in rats. Sixty‐four rats were randomly selected into five treatment groups: A) venous interpositional graft replacement of a choledochus gap without a stent; B) venous graft with prolene stent; C) venous graft with polyethylene stent; D) arterial graft; E) a control group with simple resection between ligatures in the choledochus.

The operative mortality in treatment groups B, C, D, and E, was 0, and 13% in group A. At 12 weeks follow‐up, all the rats in group E had died, whereas, 52.2% (P <.05) of the rats in group A, 30% of the rats in group B, 57% of the rats in group C, and 92.8% of the rats in group D survived treatment.

Surviving animals were sacrificed at 3 months for further examination. The morphology and caliber of the common bile duct of these rats were normal in 25% of the rats in group A, 33% of the rats in group B, 25% of the rats in group C, and 84.6% of the rats in group D.

Proximal dilations were found in the rats presenting with abnormal morphology. The dilations were less marked in the group treated by arterial choledochoplasties.

Laboratory and clinical cholestatic parameters were within normal ranges in the presence of common bile duct dilations less than four times the normal duct caliber. Electron microscopic examination of the venous and arterial graft at 3 months follow‐up revealed a fibrous ring composed of collagen fibers, fibroblasts, and remnants of elastic fibers. Regenerated ductal epithelium encompassed both types of grafts. Epithelialization was more pronounced in venous grafts as compared to arterial grafts. Biliary epithelium was able to colonize the venous grafts and resume cell specialization and function as in normal biliary epithelium.

The most satisfactory results were obtained using venous grafts with stents or by using arterial grafts. © 1993 Wiley‐Liss Inc.
Results of reconstruction of the facial nerve
Authors: Ferreira Marcus Castro , Besteiro Julio Morais , Tuma Paulo
Published: March 2007

The results of surgical treatment for facial paralysis are still difficult to compare as there is no universal scoring method. The purpose of this communication is to review the results of reconstruction of the extratemporal facial nerve with nerve grafts using our own evaluation system. Fifty‐nine patients were operated on during the period 1981–1991. They had lacerations or other trauma to the face which resulted in loss of continuity of the facial nerve or branches.

Three groups were considered: (a) 12 patients had injuries involving the trunk and extending up to the main branches of the facial nerve; (b) 32 patients had parotid laceration or contusion on the parotid area with resulting nerve defects extending from a main branch up to distal branches; and (c) 15 patients had injuries on the distal branches: frontal, zygomatic, or mandibular.

The sural nerve was used as the graft in all instances. The grafting procedure was performed from three weeks to six months after the trauma.

The method of evaluation compares the normal with the paralyzed side. A score is given of 0 (no motion), 1 (weak motion), or 2 (strong motion), for each of six voluntary contractions: forehead, closure of eyelids and lips, traction, elevation, and depression of the lips. The assessment of involuntary mimic actions was done while observing blinking, speaking, smiling, and laughing. Mass movements were scored negatively. The numbers were recorded and the ratio between the paralyzed and normal side gave an estimate of the lack of symmetry. Differences between the preoperative and postoperative scores showed that improvement had been achieved by surgery. Nerve grafting provided a significant improvement of function in patients with traumatic injuries to the extratemporal facial nerve. © 1994 Wiley‐Liss, Inc.
Free flap reconstruction of tumors involving the cranial base
Authors: Besteiro Julio Morais , Aki Fabio Ezo , Ferreira Marcus Castro , Medina L. R. , Cernea C.
Published: March 2007

The authors describe their experience in treating 24 patients who underwent resection of tumors involving anterior, middle or posterior cranial fossa with immediate reconstruction. All were reconstructed with free flaps, 15 rectus abdominis, 4 radial forearm, 3 latissimus dorsi, 2 great omentum, and one scapular flap.

There was one latissimus dorsi flap loss due to arterial thrombosis in a heavily irradiated patient.

Three patients presented with a temporary cerebrospinal fluid leak, one of them with meningitis which resolved after intravenous antibiotics and continuous lumbar drainage.

Fifteen patients were followed (mean 2 years). Five died of recurrence. Four presented local recurrence. Six patients are alive with no signs of recurrence.

Free flaps, especially the rectus abdominis flap and the latissimus dorsi, are versatile flaps and may be easily positioned to cover several structures or anatomical surfaces. © 1994 Wiley‐Liss, Inc.
Replantation of digits: Factors influencing survival and functional results
Authors: Zumiotti Arnaldo , Ferreira Marcus Castro
Published: March 2007

Immediate survival and functional results were studied in 60 finger replants performed from 1980 to 1990. The follow‐up ranged from 1 to 5 years with the mean of 2 years and 8 months. The survival rate achieved was 70% and was not related to the patient's age, the mechanism of injury, the level of amputation, the total ischemia time, the number of arteries and veins repaired or the type of vascular reconstruction. Sensory return was related to the mechanism of amputation and the total active motion was strongly correlated with the level of amputation.

Of the 16 digits that had only one artery anastomosed, there were 10 survivals (62.5%), and in 15 digits with anastomosis of two arteries, the success rate was 86.66% (P = 0.1244). The success rate in those cases in which vascular grafts were employed was 62.96% (P = 0.4161). In replantations with one, two or three veins anastomosed, the survival rate was 50%, 79.16% and 100%, respectively (P = 0.1324). © 1994 Wiley‐Liss, Inc.
Vascularized fibular graft for management of severe osteomyelitis of the upper extremity
Authors: Mattar Rames , Azze Ronaldo J. , Ferreira Marcus Castro , Starck Regina , Canedo Antonio Carlos
Published: March 2007

The authors analyzed 14 patients with severe osteomyelitis of the upper extremity between 1985 and 1992, managed with the vascularized fibular graft. Eleven radii, two humeri and one ulna were reconstructed. Bone loss after resection ranged from 6 to 12 cm (mean 8.14 cm). Follow‐up ranged from 8 months to 7 years and 10 months (mean 3 years and 3 months). The therapeutic applications of the vascularized fibular graft in severe bone infections of the upper extremity were discussed and the good results of this surgical procedure established it as a good option for treatment. Morbidity at the donor site was minimal. © 1994 Wiley‐Liss, Inc.
CO2 Laser nerve welding: Optimal laser parameters and the use of solders in vitro
Authors: Menovsky Thomas , Beek Johan F. , van Gemert Martin J. C.
Published: March 2007

To improve the welding strength, an in vitro study was performed to investigate the bonding strength of CO2 laser nerve welding (LNW), with and without the use of human albumin solution, dried albumin solution, egg white, fibrinogen solution, fibrin glue, and red blood cells as a solder. Fifteen different combinations of laser power (50, 100, and 150 mW) and pulse duration (0.1 to 3 s) were used with a spot size of 320 μm. The results have been compared to suture, fibrin glue, and laser‐assisted nerve repair (LANR). The strongest welds (associated with whitening and caramelization of tissue) were produced at 100 mW with pulses of 1.0 s and at 50 mW with pulses of 3 s. The use of a dried albumin solution as a solder at 100 mW with pulses of 1 s increased the bonding strength 9‐fold as compared to LNW (bonding strength 21.0 ± 8.6 g and 2.4 ± 0.9 g, respectively). However, positioning the nerves between cottons soaked in saline for 20 minutes resulted in a decrease of the bonding strength (9.8 ± 4.5 g). The use of a 20% albumin solution and egg white, both at 50 mW with pulses of 3 s, resulted in a bonding strength of, respectively, 5.7 ± 2.1 g and 7.7 ± 2.4 g. Other solders did not increase the bonding strength in comparison to LNW. The substantial increase in bonding strength for some solders suggests that it is worthwhile to investigate the dehiscence rate and nerve regeneration of solder enhanced LNW in an in vivo study. © 1994 Wiley‐Liss, Inc.
Experimental study of cryopreserved allogeneic transfer of vessel: Preliminary report
Authors: Takeishi Meisei , Hirase Yuichi , Kojima Tadao
Published: March 2007

It has long been known that the antigenicity of tissues is depressed when they are kept at a very low temperature. In this study, Lewis rats and Brown Norway (B.N.) rats were used because these species are significantly dissimilar at the major histocompatibility complex (MHC) Femoral arteries were harvested from Lewis rats, frozen while lowering the temperature in a stepwise fashion to −70°C. After three weeks of cryogenic storage, the arteries were transplanted into Lewis and B.N. rats. At various times from the first to the twelfth week after surgery, grafted vessels were observed, and pathological and electron microscopic studies were carried out. The vessels were found to be in good condition at the end of the 12 week observation period. These results strongly suggest that prolonged cryopreservation of vessels makes allotransplantation without immunosuppression possible. © 1994 Wiley‐Liss, Inc.
New and reproducible technique for experimentally induced middle cerebral artery stenosis
Authors: Derugin Nikita , Roberts Timothy
Published: March 2007

A reproducible technique has been developed to create reversible middle cerebral artery (MCA) stenosis in the cat. Under pentobarbital anesthesia, the right eye was enucleated, MCA dissected and a suture looped around the vessel. A short segment of thicker suture was set horizontally on the MCA. The looped suture was then tied and the segment suture removed, resulting in partial stenosis. The knot could be easily removed, restoring blood flow.

Perfusion and diffusion‐sensitive magnetic resonance (MR) images were obtained over the next 6 hours to document cerebral blood flow abnormalities and developing ischemic changes, respectively. Laser‐Doppler was performed to further document reduced flow through the ipsilateral hemisphere following MCA stenosis. Histopathologic sections were assessed for ischemic damage.

Our results show this to be a reliable model of MCA stenosis and reperfusion, which is suitable for the evaluation of acute cerebral perfusion abnormalities resulting from arterial stenosis. © 1994 Wiley‐Liss, Inc.
Use of latissimus dorsi flap for reconstruction with prostheses after tumor resection
Authors: Ikeda Kazuo , Tsuchiya Hiroyuki , Shimozaki Emi , Tomita Katsuro
Published: March 2007

Five latissimus dorsi musculocutaneous flaps (LD flap) were used for reconstruction with prostheses after resection of tumors between 1984 and 1991 in our hospital. Bony structures were reconstructed with prostheses and in three cases autoclaved autobone grafts were also needed. The prostheses and adjacent grafts were then wrapped by the LD flaps. Tumor sites included one humerus, two thighs, and two knees. All but one case healed primarily. The sole case of infection was successfully treated with debridement and irrigation. Due to the LD flaps' plentiful blood supply, we believe infection of the prosthetics can be avoided and good clinical results can be achieved using the flap with autoclaved autograft prosthetic composite reconstruction. © 1994 Wiley‐Liss, Inc.
Experimental study of the osteogenic capacity of periosteal allografts: A preliminary report
Authors: Liu Jian Yin , Wang Dan , Cheng Hsu Hsi
Published: March 2007

A total of 16 rabbits were used in this investigation. Beijing long‐eared white rabbits served as donors and immunologically incompatible Chinchilla rabbits as recipients. Periosteal flaps were stripped from the femurs of 8 donor rabbits and implanted into the muscles of both thighs of 8 recipients. Revascularization of the grafts was done only on the left side. Immunosuppressants were administered orally beginning the day of surgery. The animals were observed for 1–4 months. A series of radiography, histomorphology, fluochrome labelling, and electron microscopic examinations were performed. The results demonstrated that all of the revascularized periosteal allografts had new bone formation (8/8), while the non‐revascularized periosteal allografts had none (0/8). The difference in the rate of new bone formation between the two groups was statistically significant. © 1994 Wiley‐Liss, Inc.
Arteriovenous shunt as a method of restoring venous drainage in rabbit ear replantation
Authors: Lin Hua , Posner Martin A. , Yue Tong , Liu De‐Cheng
Published: March 2007

An arteriovenous (AV) shunt as a method of restoring venous drainage during replantation was examined by use of the rabbit ear model. The results were compared to ears replanted using one vein (1:1) or two veins (2:1) for venous drainage. The success rate for AV shunt replantations was found similar to that of replantations with a 1:1 ratio, but lower than that of ears with a 2:1 ratio. Postoperatively, ears replanted using an AV shunt or a 1:1 ratio revealed more swelling and lower tissue oxygenation than ears with a 2:1 ratio. After 10–14 days, all ears that survived were similar in appearance, regardless of method of replantation. Microscopic venules crossing the replanted interface appeared at seven days following surgery in all groups. The authors conclude that the AV shunt method offers an alternative to venous anastomosis when vein‐to‐vein reconstruction cannot be established. © 1994 Wiley‐Liss, Inc.
Invaginated vein graft as nerve conduit: An experimental study
Authors: Benito‐Ruiz Jesus , Navarro‐Monzonis Angel , Piqueras Adelina , Baena‐Montilla Pablo
Published: March 2007

Vein grafts have been used for nerve repair in experimental and clinical studies. However, some concerns about their collapsability and the presence of valves which could block axonal growth have been put forth. We propose a modification to eliminate these potential problems by turning the vein inside out, obtaining an “invaginated” vein graft.

We performed an experimental study on 61 adult Wistar rats, divided into 3 groups: control (non‐operated) (n = 11); immediate repair, with 3 subgroups: invaginated vein graft (n = 10), vein graft (n = 10), and nerve graft (n = 10); and delayed repair, with 2 subgroups: invaginated vein graft (n = 10) and nerve graft (n = 10). Delayed repair was performed 3 to 4 weeks following division of the nerve. Electromyographical (EMG) assessment was performed in all operated animals at 2, 4, and 6 months after immediate reconstruction, and at 1 and 4 months after delayed repair. At the end of the study, all nerves were excised and a morphometric analysis was performed. We conclude that vein grafts are as useful as nerve grafts in immediate and delayed nerve repair, as there were no significant functional or histologic differences. We found no significant differences between invaginated vein grafts and non‐invaginated vein grafts. However, electrophysiological results were slightly superior in the former. Regenerated axons were small, grouped in minifascicles with thin myelin sheaths. The venous adventitia did not interfere with axonal growth. © 1994 Wiley‐Liss, Inc.
Electrophysiological evaluation of the effects of naftidrofuryl on skeletal muscle reinnervation in the rat
Authors: Pécot‐Dechavassine Monique , Mira Jean‐Claude
Published: March 2007

The effects of naftidrofuryl on the reinnervation of the rat gastrocnemius muscle after its denervation by localized freezing of the sciatic nerve were tested with electrophysiological techniques. Daily intraperitoneal injections of 30mg/kg of naftidrofuryl do not increase the rate of axonal regeneration since early signs of reinnervation appeared as in controls around the 10th day after surgery. However, axonal sprouting is markedly increased since the percentage of muscle fibers with polyneuronal innervations was almost twice as high as in controls at the 15 and 21 day postoperative stages. The promoting effects of naftidrofuryl on polyneuronal innervation which gives rise to a redundant innervation during the first period of reinnervation constitutes an improvement of motor function which might be efficient for treatment of nerve injury and neuropathies. © 1994 Wiley‐Liss, Inc.
Comparative study of intraarterial and intravenous anticoagulants in microvascular anastomoses
Authors: Rooks Michael D. , Rodriguez Jorge , Blechner Mark , Zusmanis Kathy , Hutton William
Published: March 2007

Using a rat femoral artery crush‐avulsion model previously described by the authors (Rooks et al.: Microsurgery 14:130–134, 1993), we analyzed the relative efficacy of intraarterially delivered anticoagulants against similar systemically administered intravenous anticoagulants with double blinded experimentation. The model uses a standardized crush of approximately 0.3 J and a standardized avulsion. This is followed by vascular stasis for 90 seconds after vessel repair. All rats were limited to 175 to 225 gm in weight to control vessel size. Urokinase, heparin sodium, and dextran (40,000 Dalton) were evaluated in this study. A statistically significant (p‐value = 0.02) increase in urokinase efficacy was found with intraarterial delivery. (Patency rate increased from 40% to 100%.) No advantage to intraarterial delivery was evident with either dextran or heparin. There was a dose related improvement in patency with heparin that was unaffected by delivery route. (Patency increased from 30% to 80% with a statistical p‐value of 0.018.) © 1994 Wiley‐Liss, Inc.
Healing of a severe microarterial trauma: An experimental study
Authors: Zhang Baimeng , Wieslander Jan B.
Published: March 2007

A severe microarterial trauma (arteriotomy/intimectomy) was introduced to the central arteries of rabbit ears. Twenty‐one patent vessels, 3 at each interval of 2 hours, 1, 3, 7, 14, 30, and 90 days after reperfusion were taken for light and scanning electron microscopy studies. These vessels remained patent at all time intervals. A physiological “in vivo” perfusion technique with fixation fluid of normal temperature (37°C), pressure (120 mm Hg) and osmolarity (300 mOsm) was used to ensure fixed relaxed vessels. The endothelial, internal elastic, and part of the medial layers of vessel walls were removed following intimectomy. The inner surface of the intimectomy region was irregular and partly covered with thrombotic materials between 2 hours and 3 days postreperfusion. Endothelialization of the traumatized region was first observed at 3 days and was completed between 7 and 14 days. Intimal hyperplasia developed during this period and had not diminished in thickness by 30 or 90 days. The trauma and healing process of the arteriotomy/intimectomy are similar to the healing of vascular anastomoses and virtually identical to the clinical trauma of vessel avulsion, but neointima formation is more pronounced and engages vessel walls far outside the intimectomy site. © 1994 Wiley‐Liss, Inc.
Reconstruction of radial half hand by using combined transplantation of pedicled phalanx, free toe, and island flap
Authors: Li Xiaojun , Wang Van , You Ruoxu , Luo Linjie
Published: March 2007

Combined transplantation of (1) a residual proximal phalanx flap of the thumb with a fascial pedicle, (2) a reversed island flap based on the posterior interosseous artery, and (3) a free second toe was successfully used to reconstruct the radial half of the hand in a patient who had experienced loss of the second metacarpal bone and index finger, a defect to the shaft of the third metacarpal bone, and dry gangrene of the thumb, two‐thirds of the radial dorsal skin and the first web space of the left hand. The reconstructive result was satisfactory and took advantage of each tissue flap. The operation was relatively simple and was completed in one stage. We believe the procedure provided good recovery of function and appearance at an appropriate cost. © 1994 Wiley‐Liss, Inc.
Island skin flap with neurovascular pedicle from the dorsum of the index finger for reconstruction of the thumb
Authors: Shi Shao‐Min , Lu Yu‐Pu
Published: March 2007

This paper describes the successful reconstruction of badly injured thumbs in nineteen patients with transposition of a neurovascular pedicle island flap from the dorsum of the index finger. The flap has a consistent arterial supply (the first metacarpal artery), good sized veins, and terminal branches of the superficial radial nerve. Five patients had either palmar, dorsal, or circumferential loss of soft tissue from the thumb. Twelve patients had acute traumatic amputations requiring distal thumb reconstruction, and two patients had distal amputations with late reconstruction. In both immediate and late reconstruction, we maintained length and skin coverage with good circulation and sensation. This one‐stage operation requires less postoperative care than many other procedures currently in use and may be employed in a wider variety of cases. © 1994 Wiley‐Liss, Inc.
Use of a vena comitans as a vein graft in digital replantation
Authors: Qattan Mohammed M. Al , Boyd J. Brian
Published: March 2007

The use of a vena comitans as a vein graft is demonstrated in a case of successful thumb replantation in which the ulnar artery was already exposed in the distal forearm for associated injuries. © 1994 Wiley‐Liss, Inc.
Fifty consecutive free flaps in a new microsurgical unit
Authors: Waris T. H. , Kaarela O. I. , Teerikangas H. E. , Raatikainen T. K.
Published: March 2007

Fifty free flap operations in 49 patients were performed in Oulu University Central Hospital during a three year period. The patients' ages ranged from 15 to 83 years; mean 41 years. The indication for the operation was malignant tumor in 19 cases, benign tumor in one case, trauma in 28 cases and congenital anomaly in 2 cases. The radial forearm flap was used in 36 cases; latissimus dorsi in 7 cases; lateral arm, rectus abdominis, and fibula in two cases; and second toe in one case. Forty‐nine of the fifty flaps were successful (98%); two venous thromboses were successfully revised. Starting microsurgery in a new unit is demanding but also rewarding due to the good results. © 1994 Wiley‐Liss, Inc.
Digital amputations and their reconstruction: Reconstructive surgery of the fingers
Authors: Julvea J. Gustavo Garcia
Published: March 2007

Reconstructive surgery of the fingers has been greatly modified and improved by the introduction of microsurgery. Fifty‐three cases, in the past five years, of hand mutilation due to an amputation and the reconstructive techniques used have been reviewed. In the majority of the secondary reconstructions, three fundamental methods have been combined: (1) medialisation of the digits, (2) prolongation of the digits from “nearby” transpositions (remainders of proximal fingers), and (3) transfers from foot to hand. Beginning with this analysis, a classification of the procedures according to the defect to be reconstructed can be developed. Finally, the results in relation to the procedures applied have been analysed and technical observations that derive from these are pointed out, both for the donor foot as well as for the reconstructed hand.
Effect of basic fibroblast growth factor and α‐melanocytic stimulating hormone on nerve regeneration through a collagen channel
Authors: Laquerriere Annie , Peulve Pascal , Jin Olivier , Tiollier Jérôme , Tardy Michel , Vaudry Hubert , Hemet Jacques , Tadie Marc
Published: March 2007

An experimental study on the rat sciatic nerve was performed to evaluate nerve regeneration through a collagen guide and to study the effects of α‐melanocytic stimulating hormone (α‐MSH) and basic fibroblast growth factor (b‐FGF) in accel erating axonal elongation. After transection, nerves were repaired over a 7 mm gap using a placental collagen type IV guide. The channel was filled with either a b‐FGF solution or an α‐MSH solution or was produced with b‐FGF incorporated into the guide. Four weeks later, only groups in which b‐FGF had been injected or incorporated displayed a significant somatosensory evoked potential response. Histological and quantitative analysis of nerve fibres confirmed the existence of nerve continuity in groups receiving an α‐MSH solution or a channel containing b‐FGF. These results demonstrate that α‐MSH in solution and b‐FGF incorporated into a collagen type IV channel enhance peripheral nerve regeneration. However, at 4 weeks, only b‐FGF (3 ng) restores functional activity.
Technique for experimental surgery: Simple cautery for experimental microvascular surgery
Authors: Gahankari Diupkuma Rramesh
Published: March 2007

A simple and safe method of themocoagulation of small vessels, particularly useful in an experimental microsurgical laboratory, is described. This thermocautery can be readily prepared, and the vessels can be cauterized as close as 0.5 mm from the origin.
Major mandibular reconstruction with vascularized bone grafts: Indications and selection of donor tissue
Authors: Chen Yueh‐Bih Tang , Chen Hung‐Chi , Hahn Liang‐Hiunn
Published: March 2007

Free vascularized bones have been shown by many specialists to exhibit specific capabilities of reconstructing a major mandibular defect and can solve problems that may be insoluble by other methods. Nevertheless, absolute indications for using vascularized bone for major mandibular reconstructions have not been sufficiently well delineated to convince people of always considering vascularized bone for major mandibular reconstructions as a first option. Based on our experience with 55 major mandibular reconstructions, we might delineate the absolute indications for using free vascularized bone for major mandibular reconstructions explicitly: (1) osteoradionecrosis of mandible or on irradiated tissue bed; (2) hemimandibular reconstruction with a free end facing the glenoid fossa; (3) long segment mandibular defect, especially across the symphysis; (4) inadequate skin or mucosal lining; (5) defects demanding sandwich reconstruction; (6) inability to obtain secure immobilization on the reconstructed unit; (7) failure of reconstruction by other methods; (8) near total mandibular reconstruction. Selection of donor tissue should be according to (1) the amount of tissue deficiencies, (2) composition of the defect, (3) design and placement of the flap, (4) irradiation on the recipient site or not, (5) which vessels to be used, (6) which flap has the appropriate vessel length (7) skin color and texture of the donor tissue, (8) how many osteotomies required to simulate the curvature of the resected mandible (9) speed of bony union, (10) feasibility of future osseointegration. We have used three kinds of vascularized bones (iliac bone, fibula, scapula). lliac bone was most frequently used, and has always been our first choice, since it can carry good quality bone, a large skin flap, and ample soft tissue. The fibula has the merit of being less bulky and good for simultaneous intraoral lining, but the contour is more rigid and the bony height is insufficient. The scapula bone is rarely used at present because of its relative inconvenience. © 1994 Wiley‐Liss, Inc.
Fibula osteoseptocutaneous flap for mandible reconstruction
Authors: Yim Kenneth K. , Wei Fu‐Chan
Published: March 2007

The fibula free flap has become an established flap for mandible reconstruction when vascularized bone is desirable. Recreating mandibular contour, providing soft tissue coverage, and restoring masticatory function are equally important in mandible reconstruction, and these can be provided by the fibula osteoseptocutaneous flap. This article is a summary of the anatomy, indications, and operative technique of the fibula osteoseptocutaneous flap accumulated from 49 consecutive mandible reconstructions. © 1994 Wiley‐Liss, Inc.
The place of the iliac crest in vascularized oromandibular reconstruction
Authors: Boyd J. Brian
Published: March 2007

The iliac crest is reevaluated with respect to the rapid evolution of vascularized mandibular reconstruction. With more flaps to choose from, indications for the crest have become more specific—playing to the strengths of this particular transfer. Ideally, defects should exclude soft tissue and occupy lateral segments of the mandibular arch—up to and including a complete hemimandible. The composite flap is capable of reconstructing external skin with ease, but the color match leaves something to be desired. Mucosal defects are less well handled. The flap can replace soft tissue bulk as well as mandibular height following through‐and‐through excisions in the region of the chin. Where donor site cosmesis is of paramount importance, the iliac crest is simply the best flap available. © 1994 Wiley‐Liss, Inc.
Vascularized metatarsal transfer in mandibular reconstruction
Authors: Macleod A. M.
Published: March 2007

Adequate reconstruction of the mandible when associated with a mucosal deficit requires an osteocutaneous component in which the skin is closely associated with the bone. A curve in the bony framework to simulate the curvature of the mandible is required when the defect is in the anterior segment. The second metatarsal and toe osteocutaneous flap can provide such a mandibular mucosal replacement and has been used successfully for eighteen years. © 1994 Wiley‐Liss, Inc.