bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcutaneous Po2 monitoring for assessing viability and predicting survival of skin flaps: Experimental and clinical correlations
Authors: Serafin Donald , Georgiade Nicholas G. , Mullen R. Y. , Lesesne Carroll B.
Published: March 2007

Rectangular skin flaps based on the right superficial epigastric vessels were designed on the groins of 36 rats. Preoperative control, intraoperative, and postoperative readings of oxygen tension (Po2) were made atproximal, central, and distal sites on the flaps with a transcutaneous Po2 (tcPo2) monitor under various conditions of oxygen inspiration. The results of this experimental work indicated that the tcPo2 monitor was useful in continuously and rapidly measuring changes in oxygen concentration in skin flaps in a noninvasive fashion. The monitoring demonstrated that the response time of the flaps to changes in the concentration of inspired oxygen was rapid (less than 15 seconds). The monitoring also was valuable in assessing viability of the flaps, in predicting flap survival, and in detecting any systemic factors influencing oxygen transport, such as pneumonia. As a result of the experimental series, tcPo2 monitoring was used clinically to evaluate 18 flaps in 16 patients. As in the experimental series, the clinical measurements were significant and reproducible. They demonstrated that the tcPo2 monitor provides safe, reliable monitoring of peripheral oxygenation in the microcirculation that is rapid, continuous, and totally noninvasive. It is concluded that simultaneous tcPo2 measurements at control and flap sites provides a continuous record of the status of a flap that can improve the postoperative management of the surgical patient.
The operating microscope. V. Maintenance and cleaning
Authors: Hoerenz Peter
Published: March 2007

Editor's Note: This is the fifth and last article in a series by Mr. Hoerenz on the basic principles and handling of the operating microscope. The first article, on optical principles, illumination systems, and support systems, appeared in Journal of Microsurgery 1:364–369, 1980. The second article, on individual parts, handling, assembling, focusing, and balancing, appeared in Journal of Microsurgery 1:419–427, 1980. The third article, on accessories, appeared in Journal of Microsurgery 2:22–26, 1980. The fourth article, on documentation, appeared in Journal of Microsurgery 2:126–139, 1980.
Microsurgical urology: A silicone cover to protect the ureter from induced retroperitoneal fibrosis in rats
Authors: Wagenknecht L. V. , Langendorff H. M. , Schäfer H.
Published: March 2007

Retroperitoneal fibrosis was induced in 30 rats by placing a paraffin pellet containing 5 mg of phenol‐mandelic acid behind the left ureter. In an additional 15 rats, the left urinary tract was transposed into a silicone sheath before the pellet of phenol‐mandelic acid was placed behind the ureter in an attempt to protect the urinary tract from retroperitoneal fibrosis. In all 30 animals without the sheath, hydronephrosis of the left side occurred, and in the 15 animals with the sheath, lateral and anterior displacement of the left tract occurred, but function was not impaired. It is concluded that the silicone‐sheath technique may represent a new therapeutic approach to retroperitoneal fibrosis.
Long‐term results with autogenous microvascular grafts in various experimental models in rats
Authors: Carmignani Giorgio , Belgrano Emanuele , Puppo Paolo , Cichero Andrea , Sanna Alberto
Published: March 2007

Autogenous arterial and venous grafts were used to bridge defects in the femoral arteries, aortas, and renal arteries of 40 Wistar rats in an effort to determine the feasibility of using such grafts in the treatment of renovascular hypertension. The long‐term results indicated that arterial grafts would be the most suitable in such a situation, but further study is needed before the technique can be applied clinically.
Reduced vascular trauma after temporary occlusion with modified biemer and yasargil clips
Authors: Dujovny Manuel , Munoz Guillermo , Nelson Debra , Langhi Roberto , Fein Jack M. , Ba Nir Kossovsky
Published: March 2007

The Biemer and Yasargil microvascular clips that are currently available commercially can traumatize the vascular endothelium. In an effort to resolve this problem, both clip designs were structurally modified by changing the length, width, and surface of the clip blades in various ways. Also, the occlusion force of the clips was set at either 15 or 30 g. Studies on the carotid arteries of 140 rats showed a correlation between the structural and mechanical alterations of the clips and the degree of endothelial trauma produced by temporary occlusion for 1 hour. The most favorable results were obtained with a Biemer clip that had long, wide, smooth blades and an occluding force of 15 g.
A lower trapezius myocutaneous free flap in facial reconstruction: A case report
Authors: Maruyama Yu , Yoshimura Yoko , Sawada Yukimasa , Fujino Toyomi
Published: March 2007

The free transfer of a myocutaneous flap is the procedure of choice in the reconstruction of facial defects. A case is reported in which a lower trapezius myocutaneous free flap was successfully transferred with microneurovascular anastomoses to repair a facial defect. The advantages of the lower trapezius myocutaneous flap also are discussed.
Experimental arterial aneurysms: Modification of the production technique
Authors: O'Reilly Gerald V. , Utsunomiya Ryuichi , Rumbaugh Calvin L. , Colucci Ba Vincent M.
Published: March 2007

Vein pouches obtained from the external jugular vein were used to create experimental aneurysms on the carotid arteries of 13 rabbits and the abdominal aortas of 18 rabbits. Eighteen of these vein pouch aneurysms were grafted onto a linear incision in the artery; 13 of the aneurysms were grafted onto an elliptical incision. In 4 of the rabbits in which the vein pouch was grafted onto an elliptical arteriotomy in the carotid, a new approach for producing an intracranial aneurysm was attempted by relocating the aneurysm segment to the subarachnoid space at the cranial vertex. The results indicate that the aneurysms grafted onto an elliptical arteriotomy had a higher patency rate than the aneurysms grafted onto a linear arteriotomy in both the aortic and carotid models. Also, the attempt to produce an intracranial model demonstrated that short‐term patency of the aneurysms could be achieved and that a two‐stage approach to creating such aneurysms would be more appropriate than a one‐stage approach.
Continuous suture technique in microvascular end‐to‐end anastomosis
Authors: Man Daniel , Acland Robert D.
Published: March 2007

A refined technique for continuous suturing of end‐to‐end anastomoses is presented along with a study in which the continuous‐suture technique was compared with the standard interrupted‐suture technique in end‐to‐end anastomoses in the femoral arteries of 20 rats. The results of this comparative study demonstrate that the two techniques had equal patency rates, but that the continuous‐suture technique required less than 50% of the time necessary to perform end‐to‐end anastomosis with interrupted sutures.
Preserved arterial grafts in microvascular surgery
Authors: Cruz Norma I. , Blanco Gumersindo , Cestero Herman J.
Published: March 2007

The patency rates of arterial grafts preserved by immersion in 70% alcohol and arterial grafts preserved by ficin digestion and dialdehyde tanning were compared with the patency rate of fresh autogenous vein grafts in 5‐mm defects in the femoral arteries of 50 rats. The overall patency rate for the fresh vein grafts was 90%. The patency rate at 2 weeks for the alcohol preserved arterial grafts was 40%; the patency rate for the dialdehydetanned arterial grafts at 2 weeks was 30%. The difference between the rates for the fresh vein grafts and the alcohol‐preserved and dialdehyde‐tanned grafts was statistically significant (P < 0.01 and P < 0.001, respectively). At 2 months there was no statistically significant difference in the rates between the autogenous vein grafts and the preserved arterial grafts, probably because of recanalization of grafts that had occluded primarily. From the data, it is concluded that fresh autogenous vein grafts are still superior to preserved arterial grafts in microvascular surgery.
Heart and spleen twin grafts in rats. II. Delayed host splenectomy
Authors: Tauber Jürg W. , Blanchard Jacqueline M.
Published: March 2007

Simultaneous auxiliary transplantation of the spleen has been shown to delay and attenuate the rejection of cardiac grafts in rats.1 In the experiments reported here, 144 such twin grafts in Lewis and ACI rats were explored in an attempt to determine whether removal of the host's spleen would further facilitate graft survival in this model. Thus, 87 rats were submitted to host splenectomy at various time intervals after implantation of the twin grafts. After considerable technical problems were overcome, it was found that this additional maneuver induced permanent ( >5 months) survival in 64% of Lewis‐to‐ACI twin grafts. The important requirement for this success was timing; delaying host splenectomy for 3 to 5 days after implantation of the twin graft was mandatory.
The effects of storage media and perfusion on osteoblast and osteocyte survival in free composite bone grafts
Authors: Berggren Anders , Weiland Andrew J. , Östrup Lelf T. , Dorfman Howard
Published: March 2007

Twenty‐two adult mongrel dogs were used to investigate the effects of storage alone and storage and perfusion in 3 different storage media on the survival of osteocytes and osteoblasts in free bone grafts revascularized by microvascular anastomoses. Evaluation of the grafts at 2 weeks demonstrated that storage in chilled (+ 5°C) physiologic saline or Collins‐Terasaki solution resulted in greater survival of osteocytes and osteoblasts than did storage in chilled BGJb solution or in room temperature air. No beneficial effect could be detected from perfusing the bone grafts with their storage media. On the contrary, deleterious effects were noted at the sites of the anastomoses, with thromboses of vessels secondary to endothelial damage.
Experimental aortocaval fistulae in rats
Authors: Mickle J. Parker , Menges James T. , Day Arthur L. , Quisling Ronald , Ballinger William
Published: March 2007

The technique for creating a distal, high‐flow aortocaval fistula in rats is described in detail. This reliable, inexpensive model lends itself easily to radiologic study and experimental manipulation and may be useful in studying the histologic and pathologic effects of the detachable balloon technique technique in treating arteriovenous fistulae in humans.
A sensory innervated latlsslmus dorsi musculocutaneous free flap: Case report
Authors: Dabb Richard W. , Conklin William T.
Published: March 2007

The latissimus dorsi musculocutaneous free flap has been shown to be a useful tool in reconstructive surgery. Sensory innervation of the vascular territory of the latissimus dorsi is presented. This anatomic principle is applied in a free transfer of a latissimus dorsi musculocutaneous flap for reconstruction of the volar area of a foot following a severe frostbite injury.
A microscope for use in dentistry
Authors: Apotheker Harvey , Jako Geza J.
Published: March 2007

A microscope designed to be used in dentistry, and its associated equipment and instrumentation are discussed.
A one‐suture end‐to‐side microvascular sleeve anastomosis: Preliminary report
Authors: Katz Denis C. , Rose Franklin A. , Erk Yucel , Spira Melvin
Published: March 2007

A new technique is presented for end‐ to‐ side anastomosis of vessels smaller than 0.5 mm in diameter. This technique employs a “sleeve” or “telescoped” method of joining the vessels, which has previously been used in end‐to‐end anastomoses.
Demonstration of autonomic nerves in transplanted arteries in rabbits
Authors: Wada Hidetoshi
Published: March 2007

Histochemical and cytochemical studies were performed on the autonomic innervation of normal and transplanted femoral arteries in rabbits. These arteries appear to have both adrenergic and cholinergic innervation. Adrenergic reinnervation was apparent in the transplanted arteries shortly after the grafting procedure, however, the innervation decreased or disappeared with time.
A new microvascular surgical clip system
Authors: Ueba Yasuo , Sudo Yasuaki , Yanase Yoshiaki
Published: March 2007

A new microvascular clip system has been designed that consists of 3 sets of different sized clips, an applicator, and an approximator. The basic clip is a one‐piece design consisting of two blades extending from an annular base. Its construction is simple and durable. The blade closing force is predetermined for each size clip and is set at pressures that are nontraumatic to blood vessels. The tips of the applicator allow the clip to rotate through a wide arc. Two basic clips can be used with the approximator to form a double clip.
Treatment of congenital pseudoarthrosis of the tibia by a free vascularized fibular graft: Case report
Authors: Usami Fumiaki , Iketani Masayuki , Hirukawa Michio , Fujikura Kunio , Furuya Masahiro , Kikuchi Tatsuyuki
Published: March 2007

A free vascularized fibular graft was used to treat a case of congenital pseudoarthrosis of the tibia in a 5‐year‐old girl. Four weeks after the surgery, x‐ ray films revealed remarkable callus formation at the proximal junction of the graft and tibia. Seventeen months passed before union at this junction was complete. Union at the distal junction, on the other hand, took only 12 weeks. It was noted that the fibular graft enlarged in diameter rapidly, and at 17 months was the same size as the recipient tibia.
A method for quantitative analysis of lumen changes in microvascular anastomoses
Authors: Cook Allan F. , Grossman John A. I. , Herpy Eloise S. , Dinner Melvin I.
Published: March 2007

This report describes a technique for quantitating changes in the wall and luminal area of a vessel after a microvascular anastomosis. This method can be used as a standard technique for assessing luminal changes, and therefore the degree of patency, when experimentally evaluating new materials and new techniques in microvascular surgery.
The effects of preservation on microvascular vein grafts in rats
Authors: Razaboni Rosa M. , Greco M. Alba , Harper Alice D. , Shaw William W. , Ballantyne Donald L.
Published: March 2007

Segments 15 mm in length were excised from the femoral veins of rats and preserved by refrigeration at 4 C in lactated Ringer's solution for periods up to 21 days. The findings show that veins can be preserved for up to seven days and successfully grafted to recipients. Although there was some success in preserving vein segments for more than seven days, a high rate of thrombosis occurred after implantation in the recipients. It is generally accepted that damaged endothelium causes thrombosis. The light and electron microscopic observations in this study, however, suggest that the condition of the endothelium may not be the only important factor in the patency of small vessels. A thickened and prominent elastic lamina may also play a role in keeping the lumen open.
Experience with free composite tissue transplantation based on the deep circumflex iliac vessels
Authors: Satoh Tetsuo , Tsuchiya Masamitsu , Kobayashi Masafumi , Nomoto Sakae , Yasuwaki Yoshiyuki , Harii Kiyonori , Moriwaki Masayuki
Published: March 2007

Eight free iliac osteocutaneous flaps and three vascularized iliac bone grafts based on the deep circumflex iliac vessels were transferred in 11 cases of large skin and bone or bone defects. Seven of the eight osteocutaneous flaps took successfully. The eighth demonstrated partial necrosis. There was complete bone union in ten cases, and no union in one case as a result of persistent infection. Based on this experience, we conclude that free osteocutaneous flaps based on the deep circumflex iliac vessels have the following advantages over free osteocutaneous flaps based on the superficial circumflex iliac vessels: the pedicle is long (5 to 7 cm); the nutrient vessels are large (artery: 2.2 mm; vein: 2.5 mm); the anatomic course of the vessels is constant; and there is a large amount of bone available.
Comparison of end‐ to‐ end and telescoped arterial anastomoses in renal transplantation in rats
Authors: Choi Hyung K. , Phd Nicholas Stowe , Novick Andrew C.
Published: March 2007

The telescoped microvascular anastomosis was compared with the standard end‐ to end technique in the renal arteries of rats both in situ and in orthotopic kidney transplantation. The telescoped technique was easier to perform, required fewer sutures, allowed the transplantation to be done with a reduced period of ischemia, and was equally effective in terms of arterial patency. The telescoped arterial anastomosis appears to be a useful technique for simplifying orthotopic renal transplantation in rats.
Renal transplantation in hamsters
Authors: Dubols Michèle A. , Dubols Michèle A. , Haertig Alain G. , Küss René
Published: March 2007

Hamsters have never before been used for experimental kidney transplantation. An original anesthetic and microsurgical protocol is presented for renal transplantation in hamsters based on a series of 152 orthotopic renal transplantations. The operation is performed with the animal under general anesthesia of acepromazine and sodium thiopental. A left nephrectomy is followed by left renal orthotopic transplantation. The transplantation is performed in the following order: anastomosis of the renal artery and aorta, anastomosis of the renal vein to the inferior vena cava, and implantation of the ureter in the bladder. The survival rate after contralateral nephrectomy was 71% in 45 female hamsters. Male hamsters should not be used because of a high risk of severe periureteral stenosis caused by fibrosis secondary to necessary dissection of the large seminal vesicles. The prevention of hypothermia in hamsters is mandatory.
Stenosis following end‐ in‐ end microarterial anastomosis: An angiographic comparison with the end‐ to‐ end technique
Authors: Wieslander Jan B. , Åberg Magnus
Published: March 2007

Thirty end‐ to‐ end (ETE) and 30 end‐ in‐ end (EIE) microvascular anastomoses were performed in the central arteries of the ear or the saphenous arteries of 30 rabbits (diameters: 0.8– 1.2 mm). The anastomoses were then examined angiographically at varying intervals postoperatively. The ETE anastomoses caused no stenosis in the majority of vessels, while the EIE anastomoses generally resulted in considerable stenosis. This was most marked one hour postoperatively, with the average luminal area in crosssection being 22% of the luminal area of the vessel. With time the stenosis in the EIE anastomoses gradually became less pronounced, but even after 90 days the cross‐ sectional luminal area was only 63% of the luminal area of the vessel. In a second series, EIE anastomoses were performed in five femoral arteries (diameter: 1.7– 2.0 mm) and five renal arteries (diameter: 2.0– 2.7 mm). The EIE technique was found to cause less pronounced stenosis in the larger vessels. In a third series, five EIE anastomoses were performed in the central arteries of the ear according to the technique of Lauritzen and compared with five EIE anastomoses performed according to the technique of Meier. The Meier technique was more difficult to perform but produced less stenosis.
The strength of microvascular anastomoses— an experimental evaluation in rats
Authors: Davis Clinton B. , Smith Bruce M. , Hagen Per‐Otto , Urbaniak James R.
Published: March 2007

To determine the longitudinal strength of microvascular anastomoses during early healing, the left femoral arteries of 56 rats were divided and anastomosed with six interrupted sutures of 10– 0 nylon. The right femoral arteries served as unoperated controls. The vessels were then harvested immediately, or 3, 7, 14, 21, 28, or 120– 150 days after surgery. The crosssectional surface area was measured and the force required to pull the vessels apart (burst strength) was determined with a tensiometer. Fifty‐ four of the 56 anastomosed vessels were patent at the time of harvest. All of the operated vessels ruptured at the site of anastomosis when the sutures pulled through the vessel wall. The mean burst strength of the anastomosed vessels was 44% of the contralateral unoperated controls immediately after surgery and did not significantly increase for four to five months. It was concluded that early mobilization of replanted parts is not limited by the strength of microarterial anastomoses.
Efforts to enhance survival of limb allografts by prior administration of whole blood in rats using a new survival end‐ point
Authors: Black Kirby S. , Hewitt Charles W. , Woodard Terry L. , Adrig Lynda M. , Litke David K. , Howard Edwin B. , Achauer Bruce M. , Martin Donald C. , Furnas David W.
Published: March 2007

Injecting whole blood into the recipient before surgery can significantly prolong renal transplant survival in rats. Therefore, experiments were performed in rats to study the effects of prior administration of whole blood on the survival of limb allografts. Tests to quantitate survival of the allografts included monitoring the internal temperature of the leg, assaying serum creatine kinase levels, and testing for alloantibodies. Lewis recipients of (BN × LEW)F1 limb transplants that received 1 ml of BN or (BN × LEW)F1 whole blood before surgery had mean survival times that were longer compared with controls as measured by a 10 F change in temperature. In a test‐ retest experiment, decline of temperature proved to be a reliable quantitative determination of limb allograft survival since a difference of only 5.6% was observed in the mean number of days of graft survival between two separate groups of control Lewis recipients. Moreover, combined data demonstrated that control Lewis recipients of (BN × LEW)F1 limb allografts averaged 24.0 days of graft survival based on a 10 F decline in temperature with a 95% confidence interval of ± 6.3 days. It is concluded that prior administration of whole blood can produce significant prolongation of survival in organ transplantation, but it is not as effective in enhancing survival of limb allografts. It is also concluded that internal temperature measurement of limb allografts is an easy, effective, and quantitative method of monitoring rejection.
Microsurgical removal of anterolateral spinal lesions
Authors: Avman Nurhan , Özkal Ertuǧ , Erdoǧ Ahmet
Published: March 2007

Lateral and anterior lesions of the cervical spine have posed many technical problems for the neurosurgeon, and a number of approaches have been advocated to solve these difficulties. Microsurgical techniques combined with hemilaminectomy and facetectomy have improved results in cases of anterolateral lesions of the spine. This technique has been especially helpful in treating lesions in the cervical area because it permits exposure of the vertebral artery and the dissection of lesions from the wall of an intact artery.
Clinical and experimental microsurgery in China: An historical note
Authors: Lee Sun , Jun Shu
Published: March 2007

Despite a slow begining, experimental microsurgery in China may now be on its way to developing a sound research effort to complement the advances made in clinical microsurgery. The development and advances made in both clinical and experimental microsurgery in China since 1946 are reviewed. The experimental and clinical efforts of Professor Wang Suy Hwa and Drs. Yang Dong Yue and Gu Ye Dong in this development are discussed.
Recovery of sensation in replanted digits— time of recovery and degree of two‐point discrimination
Authors: Yamauchi Sigeki , Nomura Susumu , Yoshimura Mitsuo , Ueno Tatsuya , Iwai Yoshinobu , Shimamura Kouji
Published: March 2007

Even if good motor function returns in a replanted digit, if no useful sensation returns, the digit cannot be considered fully functional. In such cases sensory reconstruction with nerve grafts may be necessary, but it is difficult to determine the optimal time for such surgery. Therefore, we studied 37 replanted digits in which the palmar digital nerves had been severed bilaterally and anastomosed at the replantation procedure. Our findings indicate a correlation between the time at which sensation returned to the digits and the degree of two‐point discrimination (2PD) that returned. In digits in which sensation returned less than four months after replantation, a 2PD of less than 15 mm returned in more than 50% of cases, but when more than four months passed before the return of sensation, a useful degree of 2PD seldom returned. We believe, therefore, that if the recovery of sensation in a replanted digit has not been satisfactory by four months after replantation, reconstructive surgery should be considered.
A retractor for microsurgical access to the clivus in rats: Instrumentation note
Authors: Motti ENRICO D. F. , Landolt Alex M.
Published: March 2007

The preparation of a simple device to facilitate transclival surgery in rats is described.
Direct microvascular monitoring with implantable ultrasonic doppler probes
Authors: Pinnella John W. , Spira Melvin , Erk Yucel , Freed Debow , Hartley Craig J.
Published: March 2007

A method for constructing high‐frequency pulsed Doppler ultrasonic microprobes is described. Such probes were constructed and implanted on the femoral arteries of 14 rats. All of the probes gave excellent signals during the early postoperative period and all probes were found to be functional when retrieved one month after implantation. We feel that high‐frequency pulsed Doppler microprobes have important advantages for microvascular monitoring.
Microsurgical one‐stage repair of hypospadias with a rectangular transverse dorsal preputial vascularized skin flap
Authors: Carmignani Giorgio , Belgrano Emanuele , Gaboardi Franco , Farina Furio Pirozzi
Published: March 2007

A microsurgical technique for one‐stage repair of hypospadias using a rectangular transverse dorsal preputial island skin flap is presented. The use of optical magnification, atraumatic technique, and microsurgical instruments allows a vascularized preputial skin flap to be raised and isolated on the dorsum of the penis and then rotated ventrally and tubulized into a neourethral channel. The meatus of the new urethral channel lies at the tip of the glans. Cover for the penis is simply obtained and does not require a longitudinal row of sutures. The need to remove the distal stenotic portion of the urethra and to correct any degree of chordee is outlined and emphasized. Good cosmetic and functional results demonstrate the efficacy of such a technique.
A Method for testicular denervation in rats
Authors: Kullendorff C. M. , Ivarsson H. , Ekelund M. , Holmin T.
Published: March 2007

A successful method for microsurgical denervation of the testes in rats is described. Testes were unilaterally denervated in 15 animals. Thirteen untreated and two sham‐operated rats served as controls. With the animal under ether anesthesia, the spermatic vessels on either side were exposed with the aid of microsurgical technique and an operating microscope. The area was then dyed with two to three drops of 1% Toluidine blue. With utmost precaution the nerves were separated from the vessels and resected. A biopsy specimen from the epididymal fat pad of each side was removed and assayed for norepinephrine content. The denervation procedure was considered successful if the norepinephrine content of the denervated fat pad was less than 11% of that of the contralateral fat pad. The denervation procedure was successful in 13 of 15 animals. No recognizable side effects from the use of Toluidine blue were observed.
The reapplication of microvascular clamps after venous anastomosis: An experimental study
Authors: Fossati Enrique , Harashina Takao , Fujino Toyomi
Published: March 2007

Albino rats were used to determine the effects of the reapplication of microvascular clamps in veins after anastomosis. The results demonstrate that, if necessary, microvascular clamps can be reapplied either proximal, or both proximal and distal to a venous anastomosis for up to 30 minutes, thus allowing a suture to be redone or the lumen to be explored with no loss of patency.
A Comparison of hemostatic agents in microvascular surgery
Authors: Achauer Bruce M. , Black Kirby S. , Grosmark Douglas M. , Hayamizu Terry F.
Published: March 2007

The hemostatic abilities of oxidized cellulose, gelatin powder, microfibrillar collagen, and expanded polytetrafluoroethylene cuffs were compared on anastomoses of the femoral vessels in rats. The intraoperative hemostatic time and patency were recorded. Vessels that were patent intraoperatively were examined at various intervals postoperatively to determine patency and to detect the development of abnormalities, and specimens for examination under a scanning electron microscope were obtained. Microfibrillar collagen was found to be superior in maintaining patency and in ease of use. The PTFE cuffs demonstrated the shortest hemostatic times, but they produced distortion of the vessels several weeks after surgery. The authors conclude that microfibrillar collagen is the best overall hemostatic agent and have continued to use it experimentally and clinically with no complications.
Japanese reconstructive microsurgery today
Authors: Nakamura Junji
Published: March 2007

The results of a survey of 310 members of the Japanese Society of Reconstructive Microsurgery on the present status of reconstructive microsurgery in Japan is reported.
Cross‐hand replantation: Preliminary case report
Authors: Kutz Joseph E. , Sinclair Stewart W. , Rao Venkat , Carlier Alain
Published: March 2007

A 38‐year‐old man had his left hand avulsed and the middle third of his right upper extremity irretrievably injured in a mine accident. The right hand was replanted onto the left forearm. The operative procedure is summarized and problems associated with such a procedure are briefly discussed.
Comparison of efficacy of thrombolysin, streptokinase, and urokinase in a femoral vein clot model in rats
Authors: Cooley Brian C. , Jones Mark M. , Dellon A. Lee
Published: March 2007

A venous clot model in rats was used to compare the ability of locally infused thrombolytic agents to lyse clots. Urokinase and a combination of streptokinase and human plasminogen (Thrombolysin) proved to be equally effective in lysing clots. In comparison, streptokinase alone was not as effective a thrombolytic agent in this model.
The histopathology of microvascular anastomosis: A study of the incidence of various tissue changes
Authors: Chow S. P.
Published: March 2007

The histopathologic changes caused by microvascular anastomosis were studied in 178 femoral arteries of rats. While in all vessels the tissue surrounded by the suture loops at the anastomosis showed the strangulating effect of the suture with the process of repair being evident on the endothelial and adventitial surfaces, there were certain differences in the changes between patent and thrombosed vessels in the areas adjacent to the anastomosis. A study of the incidence of various tissue changes showed that endothelial integrity is important for patency of the anastomosis.
Vascularized fibular grafting for treatment of aseptic necrosis of the femoral head–preliminary results in four cases
Authors: Fujimaki Arihisa , Yamauchi Yasuo
Published: March 2007

Vascularized grafting with segments of fibula was performed in four men with aseptic necrosis of the femoral head. The patients were restricted to relatively young individuals in whom the necrosis seemed to be confined to two‐thirds or less of the femoral head and in whom the outer shell of the femoral head appeared relatively well preserved. The operative technique is described, and the interim results from follow‐up ranging from one year, two months to three years, eight months are reported. Three of the four hips became asymptomatic after surgery with x‐ray films showing no progression of the necrosis or deformity. In one hip, however, mild pain, bony absorption, and some progression of the deformity persisted. Although the final results in these four cases remain to be seen, vascularized fibular grafting will find a place in the treatment of early avascular necrosis of the femoral head.
Immediate total scalp and skull reconstruction
Authors: Smith P. J. , Morgan B. D. G. , Crockard H. A.
Published: March 2007

A patient who required excision of a large basal cell carcinoma was left with a scalp defect measuring 23 cm × 23 cm, associated with an underlying bony defect of 18 cm × 16 cm with a similar dural defect. Simultaneous reconstruction of all three layers was performed using a large free latissimus dorsi flap, titanium strips, and lumbar fascia. A satisfactory cosmetic and functional result was obtained using this technique.
Dorsalis pedis free flap to close extensive palate fistulae
Authors: Chem Roberto Corrěa , Franciosi Luiz Fernando N.
Published: March 2007

A study of the dorsalis pedis free flap and the procedure used to raise it, including a discussion of its difficulties, is presented. Three cases are reviewed in which it was used with encouraging results.
Is a crossover to the contralateral side by nerve transplants a satisfactory source for reinnervation of a muscle transplant? an experimental study in the rectus femoris muscle of the rabbit
Authors: Frey M. , Gruber H. , Freilinger G.
Published: March 2007

In ten rabbits the nerve branch to the left rectus femoris muscle was prolonged to the contralateral side by a nerve graft. Three months later the distal end of the transplant was connected to the transsected nerve branch to the right rectus femoris muscle. Nerve biopsies were taken from the muscle nerve, the nerve graft at the time of grafting and from the distal end of the nerve graft immediately before nerve suture in the second operation. Six months after the second operation the final assessment of muscle function and of the histology of the muscle and of the muscle nerve was performed. The functional results of the rectus femoris muscle reinnervated by a crossover nerve graft ranged between 6% and 56% of a normal standard muscle and seemed to be insufficient to justify a clinical use for muscle transplant reinnervation in the extremities. The histological findings also confirmed the basic possibility of elongating a motor nerve by nerve grafts, but the second nerve suture, the interposition of a long nerve graft, and the obviously changed reflex system probably caused a moderate and unpredictable muscle function.
A microvascular surgical practice disc for beginners
Authors: Lee Sun , Coppersmith Ward J.
Published: March 2007

In order to assist beginners in microsurgery in practicing microvascular suturing without the use of an animal model, we devised an apparatus composed of a Lucite disc with Lucite cylinders attached to either side. On the one side, a piece of rubber glove can be attached for practice of either continuous or interrupted suturing. On the other side, four slots in the cylinder permit suture material or simulated blood vessel to be placed and held for practice in tying knots or end‐to‐end anastomosis. The disc apparatus is very inexpensive, durable, and easily obtained.
A portable microvascular laboratory for the office
Authors: Sukoff Michael H. , Salibian Arthur , Arick Thomas P.
Published: March 2007

Regular exercises in microsurgery are mandatory for the microsurgeon to develop and maintain skill. Not all microsurgeons have access to a hospital or university laboratory in which to perform such microsurgical procedures. The authors describe a simple model for a portable microvascular laboratory that can be set up in an office.
Thumb reconstruction with an iliac bone graft and a dorsalis pedis flap transplant including the extensor digitorum brevis muscle for restoring opposition: A case report
Authors: Tamai Susumu , Fukui Akihiro , Shimizu Toyonobu , Yamaguchi Takeshi
Published: March 2007

A method for thumb reconstruction with an iliac bone graft and a dorsalis pedis flap transplant, including the extensor digitorum brevis muscle for restoring opposition, is presented. This case involved a 21‐year‐old man with a traumatically absent right thumb at the metacarpal base. Thumb reconstruction by means of an iliac bone graft with immediate transfer of a dorsalis pedis neurovascular sensory free flap, including the extensor digitorum brevis muscle to restore the opponens pollicis muscle, was carried out. After a period of six months he had gained satisfactory opposition of his newly reconstructed thumb to the ring finger, with evidence of contraction of the muscle on electromyograms.
Stereomicroscopy as a diagnostic aid in evaluating the viability of island flaps: An experimental study
Authors: Ballantyne Donald L. , Razaboni Rosa Maria , Converse John Marquis
Published: March 2007

This study entailed direct stereomicroscopic observations of rat abdominal island flaps and the sequence of vascular events that occurred during and after occlusion by clamping of the individual femoral vessels for varying time intervals of up to 16 hours. The vascular changes and the status of the circulation in the flap vasculature, including the timing of complete hemal stasis and resumption of flow, following the application and subsequent release of the vessel clamp were observed and correlated with flap viability and behavior. This study also included a grading system of the vascular changes observed under a stereomicroscope. From these findings, it is suggested that in vivo stereomicroscopy may serve as a new and simple clinical tool for the early diagnosis of thrombosis at the site of microvascular anastomosis of a free flap transfer and may define time limits during which the anastomosis can be successfully corrected and the flap salvaged.
End‐to‐side anastomosis of the vein: A technical innovation
Authors: Harashina Takao
Published: March 2007

A new technique for easier end‐to‐side anastomosis of veins is presented. By applying a few traction sutures to the edge of the venotomy and tenting the venous wall, thereby keeping the venotomy open, end‐to‐side anastomosis of the vein can be easily performed.
Efficacy of polyglycolic acid (Dexon) microsutures in peripheral nerve anastomoses in the rat: 1. Epineural suture
Authors: Lee Sun , deMacedo A. R. , Chan E. , Wolf Paul , Han Keith , Li Shuj‐J.
Published: March 2007

The efficacy of polyglycolic acid (Dexon) microsuture in peripheral nerve repair was studied using 84 and 28 reanastomoses of freshly severed rat sciatic nerve employing Dexon and nylon 9‐0 interrupted epineural suture technique. Animals were sacrificed and sutured portions of the nerves were histologically examined. There were almost identical suture reactions by day 7, except that the intensity of polymorphonuclear (PMN) and macrophage infiltrate in the nylon‐sutured nerves was far greater than in the Dexonsutured group. Although the intensity of the nylon‐suture reaction subsided considerably after day 21, the lymphocytes, macrophages, and plasma cells surrounded the suture as long as the sutures remained in the nerves up to 12 months postoperatively. The Dexon‐sutured nerve segments showed disappearance of the inflammatory cells as soon as the sutures were completely absorbed. The Dexon sutures were still detectable at months 1 and 2 but not after month 3.
The external ring method of microvenous anastomosis: A new experimental concept
Authors: Weinrib Harry , Schenck Robert R. , Sadr Bahman
Published: March 2007

A new method of microvenous anastomosis has been devised using a rigid ring around the anastomotic circumference. Only four sutures are used in the anastomosis and these are tied around the ring so as to stretch open the anastomotic site. The method has been tested in experimental rats and compared with the standard technique of anastomosis. The results and possible clinical implications of this method are discussed.
A microtourniquet carrier for use in the microsurgical laboratory
Authors: Haines Peter C.
Published: March 2007

The construction of a simple, inexpensive microtourniquet carrier is described. The carrier can be made from materials readily available in the microsurgical laboratory or the operating room. The carrier increases the ease of occluding a vessel with a microtourniquet and increases the speed of applying a number of tourniquets sequentially, thereby making the microtourniquet an attractive alternative to the more expensive and less flexible microvascular clip for temporary vascular occlusion.
Comparison of two laser Doppler flowmeters for the monitoring of dermal blood flow
Authors: Fischer Joseph C. , Parker Paul M. , Shaw William W.
Published: March 2007

Laser Doppler flowmetry (LDF) is a noninvasive and continuous method of monitoring dermal blood flow in free flaps. There are two LDFs available for clinical application: the LD5000 Laser Doppler Perfusion Monitor and the Periflux Laser Doppler Flowmeter. Varying degrees of arterial (N = 46) and venous (N = 28) occlusion were induced in saphenous island flaps of the dog, while simultaneous measurements with the LD5000 and Periflux LDFs were made. The millivoltage output of both the LD5000 and the Periflux showed a high degree of correlation with arterial and venous occlusion and with each other.
A new anastomosis technique for large‐calibered vein grafts
Authors: Harashina Takao , Takaki Jose Louis
Published: March 2007

A new anastomosis technique for large‐calibered vein graft to repair a smallersized arterial defect is presented. At the proximal (upstream) anastomosis, a combination of sleeve anastomosis technique and plication of excess vessel wall is performed; and at the distal (downstream) anastomosis, the “fishmouth” incision technique is used. The patency rate obtained with this technique is quite satisfactory, which justifies its use in clinical situations.
The effect of stasis on a microvascular anastomosis
Authors: Fernandez Enrique J. , Nadal Richard D. , Gonzalez Sandy M. , Caffee H. Hollis
Published: March 2007

An experiment was done in rats to determine the effect of stopping the flow of blood across a fresh anastomosis. It was found that brief periods of stasis, up to 30 minutes, caused a minimal increase in the rate of thrombosis, but 60 minutes of stasis caused a significant risk of thrombosis in both arteries and veins. The thrombosis associated with stasis could be prevented by the systemic administration of heparin.
Evaluation of the patency rate of fibrous microvascular polyurethane prostheses after implantation in the rat aorta
Authors: Hess Frits , Jerusalem Christoph , Braun Bernd , Grande Peter
Published: March 2007

Two types of fibrous polyurethane prostheses with different compliances were implanted into the rat aorta with interrupted sutures and a running suture line. Excluding two technical failures, one unexplained death, and three infected prostheses, both groups (n = 21) showed a patency rate of 100%, up to 6 months after implantation. Rapid reendothelialisation occurred, and a stable neo‐intima was formed. Compliance of the prostheses, as well as the suture technique used, has proven to be an unimportant factor in the rat aorta model, probably due to the low magnitude of the pulsations of the rat aorta. The experience of the surgeon with microsurgical techniques seems to be an underestimated factor in determining patency rates of microvascular prostheses.
A stereomicroscopic system modified for microsurgical laboratory
Authors: Smahel Jiri , Ballantyne Donald L.
Published: March 2007

An operating table stand incorporating a rotatable mechanical surface with a motorized focusing stage carrier was designed for a standard stereomicroscope. This can be used for microsurgical experiments and practicing microsurgical techniques in small laboratory animals.
Physiologic tremor and microsurgery
Authors: Harwell Richard C. , Ferguson R. Lawrence
Published: March 2007

Physiologic tremor hampers the ability of students to learn microsurgical technique. An understanding of normal tremor both as to origin and methods of control would be of help. Physiological tremor arises from both mechanical and neuromuscular sources and is made worse by a number of factors. The “size principle of motoneuron recruitment” is an important physiologic consideration, and the use of biofeedback techniques enables the student to confirm his understanding of the principle. Knowledge of the factors which aggravate physiological tremor allows the microsurgeon to control his own tremor both in the laboratory and in the operating room.
Heart and spleen “Twin Grafts” in rats: Morphology and function in permanent survivals
Authors: Blanchard Jacqueline M. , Eckner Frederich A. O. , Tauber Jürg W.
Published: March 2007

A new rat allograft model has been investigated for its potential to facilitate organ transplantation. In this procedure heart and spleen of male inbred LEW rat (RT1′) were connected to the main abdominal vessels in inbred ACI rat (RT1a). With optimal surgical technique we obtain 64% permanent graft survival (5–14 months) in the splenectomized recipients. Cardiac histology ranged from preserved myocardium with moderate thickening of coronary artery walls to diffuse myocardial fibrosis with marked involutional changes of coronary arteries. Whereas palpation and EKG wrongly indicate good function beyond the fourth month, only the phonocardiogram shows the rapid functional loss which reflects the true morphologic involution.
The effect of vibration on vision during microsurgery
Authors: Kagan Jonathan , Gehly Joel C. , Wilson Hugh R.
Published: March 2007

This study was initiated to assess the effects of vibrating optics on a microsurgeon's ability to visualize. The results have led to criteria of image displacement versus frequency which could be applied to the design of a surgical‐microscope mounting system. To provide minimum added strain to the microsurgeon, the ideal microscope mounting system should not transmit vibration from the hospital environment to the microscope optics at a level that is detectable by the visual system of the surgeon. This can be avoided by isolating the microscope mounting system from the vibratory environment of the hospital and by designing the microscope support system to minimize vibrations at frequencies that are most readily detectable by the human visual system.
Entrapment of the median nerve after posterior dislocation of the elbow
Authors: Ayala H. , De Pablos J. , Gonzalez J. , Martinez A.
Published: March 2007

The authors present two cases of complete median nerve paralysis due to entrapment after posterior dislocation of the elbow. Previous literature on the subject matter is reviewed, and management and therapeutic indication of these lesions are discussed.
Partial selective denervation in spastic palsies (hyponeurotization)
Authors: Brunelli G. , Brunelli F.
Published: March 2007

Treating spastic palsies is a difficult problem. Hyponeurotization is a technique in which peripheral nerves are partially and selectively denervated to diminish spasm in muscles, hence reducing spasticity and tenseness so inimical to movement. Hyponeurotization can be performed in all spastic patients who are capable of cooperating. It should be avoided in cases of athetosis and brain impairment. Partial denervation is employed to reduce spasm; tenotomies, tendon lengthening, and myoectomy are employed to increase length in retracted muscles. Secondary surgery is usually required to further correct the spasm after the “adoption” phenomenon is complete. The results with hyponeurotization have been good in a high percentage of cases in which the surgery strictly adhered to basic principles.
Preservation of the ureteral blood supply in rat renal transplantation
Authors: Khauli Raja B. , Novick Andrew C. , Choi Hyung K. , Stowe Nicholas T. , Straffon Ralph A.
Published: March 2007

A new technique of preserving ureteral blood supply in heterotopic rat renal transplantation is described. This entails leaving an intact gonadal artery in continuity with the donor aortic stump, which is anastomosed to the recipient aorta. Comparison of this technique with conventional methods wherein the spermatic artery is ligated revealed a marked decrease in the incidence of ureteral complications with the former. Preservation of adequate blood supply to the ureter in experimental rat renal transplantation provides more consistent results and lessens the risk of unnecessary animal loss.