bluuebunny/crossref_metadata_2025 huggingface dataset:
Three years experience with experimental implantation of fibrous polyurethane microvascular prostheses in the rat aorta
Authors: Hess F. , Jerusalem C. , Braun B. , Grande P.
Published: March 2007

The results of a 3‐year study in which a series of 355 implantations of 1‐cm‐long fibrous polyurethane microvascular prostheses into the infrarenal aorta of the rat (group A) were evaluated with respect to patency and formation, structure, and fate of the neo‐intima. Rats were sacrificed at various intervals from 1 day to 2 years in order to obtain a time‐related impression of the reendothelialization and stability of the neo‐intima. A second series of 51 implants was done with prostheses 10 cm in length, placed in a 1.5‐cm loop in the abdominal aorta (group B). An overall patency rate of 92.7% was achieved in group A. Initially, eight technical failures caused early thrombosis of the prostheses. Sixteen prostheses became infected and subsequently occluded. The overall patency in group B was 52.9%, due to kinking from adhesion formation and normal growth of the rat. In both the long and short prostheses, a continuous multilayered neo‐intima developed, growing from the aortic stumps into the prosthesis from both sides. According to the growth rate of 0.3 mm/day, a 1‐cm prosthesis was reendothelialized after ± 20 days and a 10‐cm prosthesis after ± 9 months. Once developed, the neo‐intima, consisting of myofibroblasts and smooth muscle cells covered with a flat endothelium, remained stable and continuous, throughout the observation period. The neo‐intima was firmly anchored onto the prosthetic wall by means of cellular protrusions extending between the polyurethane fibres. The significance of rapid healing of an implanted prosthesis is emphasized with respect to preventing (late) hematogenous, endogenous infection of the prosthesis. It is concluded that in this type of fibrous polyurethane prosthesis, a new lining is rapidly developed and will remain stable and permanent for a long period of time. Further investigations, using other species, are strongly recommended, with a goal of clinical application of this type of prosthesis.
Techniques for perfusion and storage of heterotopic heart transplants in mice
Authors: Blanchard Jacqueline M. , Pollak Raymond
Published: March 2007

Organ pretreatment prior to transplantation has assumed increasing importance. We studied the ability to preserve and perfuse hearts in well defined genetic mouse models, prior to heterotopic engraftment. Hearts were manually perfused through the aortic root and stored in a variety of cold solutions or were perfused using a continuous perfusion pump. Different electrolyte solutions, mouse strains, perfusion, and storage times as well as perfusion volumes were studied. Treated hearts were then transplanted heterotopically and short‐ and long‐term function assessed. Hearts stored for more than 1 hour in cold solutions (saline 0.9%, or lactated Ringer's) failed to function. Hearts perfused with 0.25–0.4 ml of cold solution for a maximum of 30 minutes functioned well after transplantation. C3H (H‐2k) mice provided the most resilient hearts. We conclude that short‐term perfusion or storage of mouse hearts is feasible and should provide an excellent model for the study of organ pretreatment with monoclonal antibodies or other agents prior to transplantation.
Single‐stage hypospadias repair using the operating microscope
Authors: Wesson Lynn , Mandell James
Published: March 2007

Because of the continuing trend toward earlier repair of hypospadias, improved visualization of tissues is important. We have reviewed 33 consecutive hypospadias repairs performed using the operating microscope. Complications included three strictures (9.1%) and five fistulae (15.1%). The microscope proved most useful in resident teaching, allowing both surgeon and assistant to visualize optimally the tissues.
Problems in nerve lesions surgery
Authors: Brunelli G. , Monini L. , Brunelli F.
Published: March 2007

An overview of the concepts on peripheral nerve regeneration and of research on the progress in this field is carried out. Problems of regeneration and factors influencing it, both improving and worsening it, are considered, especially with respect to the clinical treatment of nerve lesions. Classical techniques of repair (sutures and grafts) as well as very new methods (e.g., direct muscular neurotisation) are discussed. Postoperative treatment and result evaluation are presented.
Histopathology of microvenous repair
Authors: Morecraft Robert , Blair William F. , Chang Laurette
Published: March 2007

The histopathology of microvascular repair was investigated in the femoral vein of the rat. Previous microvascular repair studies have primarily involved arteries, giving little insight to similar processes in veins. In our study, 36 rats with an average weight of 440 gm were randomly assigned to experimental groups of 1 hour, 24 hours, 2 weeks, and 4 weeks after repair. Histological evaluation of the suture site included the use of light, scanning electron, and transmission electron microscopy. Endothelial loss was observed in all 1‐hour specimens. Extensive inflammatory response appeared in 2‐hour specimens. Re‐endotheliolization of the intima was achieved in all animals by the 2‐week time interval. At 4 weeks, the animals exhibited evidence of medial regeneration of smooth muscle cells. This was predominantly occurring between adjacent suture sites. Minimal subintimal hyperplasia was localized at the suture site itself in both 2‐ and 4‐week specimens.
Comparison of bursting strength between suture‐ and laser‐anastomosed vessels
Authors: Quigley Matthew R. , Bailes Julian E. , Kwaan Hau C. , Cerullo Leonard J. , Brown J. Thomas , Fitzsimmons John
Published: March 2007

The bursting strength of suture‐ and laser‐assisted vascular anastomosis (LAVA) was assessed using a standard rat femoral artery model. Vessels were studied from 1 hour to 3 weeks. LAVA arteries consistently demonstrated lower bursting strengths than those of suture controls, with significant differences at 1 day, 3 days (P < 0.001), and 1 weeks (P < 0.01). Return of strength occurred in a pattern reminiscent of wound‐healing models. Relatively low bursting strengths at 1 and 3 days in the LAVA cohort may explain the high aneurysm rate reported to complicate this procedure.
Laser doppler flowmeter measurements of skin perfusion changes associated with arterial and venous compromise in the cutaneous island flap
Authors: Fischer Joseph C. , Parker Paul M. , Shaw William W.
Published: March 2007

Laser Doppler flowmetry (LDF) is a noninvasive, continuous measure of tissue surface microcirculatory red blood cell (RBC) flux. LDF was calibrated against varying RBC volume fractions and flow rates using extracorporeal perfusion of saphenous island flaps of dogs. The RBC flux was found to be linear with LDF signal. The difference in vascular geometry of the skin appeared to play a minor role in generating the LDF signal compared to changes in the RBC flux. In vivo experiments of varying arterial perfusion pressure, flap venous pressure, and total blood flow of the cutaneous island flap had a linear relationship with LDF signal.
Plastic double clamp for use in microsurgery
Authors: Valka Jan
Published: March 2007

A disposable plastic double clamp for use in microsurgery is described.
Dual‐ended, multifunction tools for microsurgery
Authors: Hariri Robert J. , Goldstein Marc
Published: March 2007

A new concept in microsurgical instrumentation is herein described and the rationale for its design presented in the context of surgical efficiency. This new concept employs bipolarity or dual‐endedness as a means to enable the microsurgeon to have access to various instruments without the need to exchange tools. The elimination of instrument exchange has increased the speed with which a microsurgeon can perform a variety of procedures as well as decrease fatigue associated with continuous visual reaccommodation between the microscope and surrounding operating room. Following considerable modification through several prototypical stages and long periods of laboratory testing, these instruments boast ideal balance in the hands of the surgeon, and the capacity for modification by the user, allowing a variety of instrument combinations. Hence, personal preference can dictate the ultimate tool configuration, thereby allowing customization of the instruments to the procedure as well as the surgeon, by virtue of an interlocking mechanism between instrument components. The resulting economy of movement and reduced instrument handling engendered by the use of these instruments reduces operating time and often eliminates the need for a highly trained surgical assistant. These instruments can be fitted with a removable extension allowing unipolar use or extended instrument length. Simplicity of design makes these instruments conducive to standard cleaning and sterilization procedures.
Effect of different irrigating solutions on the endothelium of small arteries: Experimental study in rats
Authors: Mazer Nilton , Barbieri Cláudio Henrique , Gonçalves Renato Pinto
Published: March 2007

The effects of four different irrigating solutions (normal saline, Ringer's solution, renal transplantation solution, and C solution) on the endothelium of small arteries were studied, with the femoral artery of rats being used as an experimental model. Perfusion was carried out for 30 minutes in all groups and the influence of exposition and clamping alone was also studied for control, the animals being killed 48 hours, and 1, 2, and 4 weeks postoperatively, depending on the subgroup. A total of 116 rats was operated upon. Morphological studies included light microscopy and transmission and scanning electron microscopy. Increasing degrees of lesion, namely cytoplasmic alterations in the endothelial cells, focal discontinuity of the endothelium, various degrees of subendothelial edema, blood cell aggregation, and blood clotting, were observed consecutively with normal saline, Ringer's, renal transplantation unit (RTU), and C solutions. Normal saline and C solutions were concluded to have the least and the most deleterious effects, respectively.
Microsurgical reconstruction of the biliary duct: Experimental study in rats and dogs
Authors: Lamesch Alfred J. , Dociu Nicolae
Published: March 2007

Surgery of the biliary ducts remains a problem in traumatologic and iatrogenic injuries as well as in liver transplantation. The purpose of this study was to perfect microsurgical technique of anastomosis of the common bile duct and to study the healing and tissue reaction at the anastomotic site. The healing of microsurgical closure of longitudinal choledochotomies was studied as well. Light microscopic and scanning electron microscopic examination were performed at different intervals after operation. The permeability of the anastomosis was studied by transduodenal retrograde choledochography. Reepithelialization was obtained in 2 weeks. Microsurgery offers an interesting perspective to reconstructive biliary and transplantation surgery.
Microsurgical lumbar discectomy: A personal series of 300 patients with at least 1 year of follow‐up
Authors: Sachdev Ved P.
Published: March 2007

A personal series of 300 cases of lumbar disc disease treated by microsurgical lumbar discectomy is presented. Follow‐up is available in all cases. Good to excellent results are reported in 94% of the patients. Six patients (2%) have needed repeat surgery at the same level, all with good results. One of these six patients has had third‐time exploration at the same level. There has been no mortality; one patient had a superficial wound infection, two suffered from minor pulmonary embolii, and one patient had an MI in the postoperative period. Surgical technique as used by the author is discussed.
The use of laser in microsurgical oncology
Authors: Bandieramonte Gaetano , Chiesa Fausto , Lupi Marco , Pietro Sergio Di
Published: March 2007

CO2 laser resection by freehand or microscopic technique versus laser vaporization were compared in a series of 136 consecutive surgical operations. Forty‐nine lesions of the vulva, 61 of the oral cavity, and 19 of the penis were classified as dysplastic, in situ, or initially invasive lesions, ranging from 0.9 to 4.5 cm of maximum extension in width and from 0.4 to 4 mm in thickness (exophytic lesions). Twenty‐two lesions were vaporized, whereas 114 were resected.

An average of 12% discordance was found between pre‐ and postoperative histologic diagnosis among the resected group, thus indicating that the laser vaporization procedure is unsuitable for those lesions because it does not offer the entire surgical specimen. More constant depth of tissue removal, reduction of operating time, and safer use were also recognized as further advantages of the excisional technique.

Resection under microscopic magnification (6 to 40 x) with the aid of the micromanipulation of the beam was used in 91 of the 114 resected lesions. This led to the optimal intraoperative resolution of the lesion borders, minimized the tissue burning effects because of the direction of the incision orthogonal to the tissue surface, and provided an 81% satisfactory histologic report of radicality, whereas the freehand‐resected group reached only 40%.

In conclusion, the maximum obtainable surgical precision can be achieved for the studied lesions with proper spot, focal length, and power density of the laser beam delivered through microscopic instrumentation.
Reversibility of graft rejection following a short cyclosporin‐a administration 5 days after grafting
Authors: Mazzoni Giuseppe , Mazzoni Pietro
Published: March 2007

The aim of this research was to investigate whether cyclosporin‐A (Cy‐A) could exert its action on graft rejection in progress. For this purpose, heartlung grafting was performed in a strong hystoincompatible combination of rats (BN/LEW). In one group of animals, Cy‐A was administered at the dose of 15 mg/kg daily for 10 days starting on the 5th day after grafting. In a control group only olive oil was administered. Five of six animals treated with Cy‐A showed a graft survival over 4 weeks and in two cases it was over 2 months when they were killed.
“New” microvascular clamps for thoracic surgery in the rat
Authors: Marck Klaas W. , Prop Jochum , Wildevuur Charles R. H.
Published: March 2007

The development of “new” microvascular clamps for lung transplantation in the rat was necessary because the generally used microclamps were found to be not feasible in preliminary experiments.

A mosquito clamp modified in a Satinsky‐like manner made lung transplantation in the rat possible. However, most suitable was the smallest Blalock pulmonary clamp with some modifications. This clamp has been used in over 500 left lung transplantations in the rat now, and is no longer subject to further innovations. This report shows that relatively large instruments can be appropriate microvascular clamps.
Rabbit oviduct mucosa healing after accidental transmucosal suture passage
Authors: Vuillemin Mauricette , Pexieder Tomas , Janecek Paul , Stamm Hans
Published: March 2007

The purpose of this study is to show by SEM the characteristics of mucosal healing related to the presence of intraluminal sutures of nylon (nonabsorbable) or dexon (absorable) in the rabbit oviduct.

Altogether, 30 animals with anastomosis in the isthmus were killed 2, 4, 8, or 12 weeks after the operation. Tubular structures or pieces of thread partially or completely covered by the epithelium were found n 36.8% of these cases. Independently of the suture material used, already 2 weeks after surgery, the thread was covered by an epithelium composed mostly of squamous cells and some rare ciliated cells. At 4 weeks, the proportion of ciliated cells was increased. Regions with the usual cellular morphology and repartition of the different cellular types were also observed. However, at 8 and 12 weeks, islets of atypical squamous cells persisted in areas of transmucosal passage of the suture material. At 12 weeks, the dexon suture was not yet completely absorbed.
Sodium hyaluronate as an aid in microvascular surgery
Authors: Arnbjörnsson Einar O.
Published: March 2007

The purpose of this study was to compare the suture of a microvascular anastomosis with and without the aid of sodium hyaluronate. The divided femoral arteries of ten Sprague‐Dawley rats were sutured using sodium hyaluronate on one side. Operating time, bleeding, and patency rates were studied and compared. No significant differences were found in the measured parameters. However, the clinical impression is that the use of sodium hyaluronate facilitates the suture of a microanastomosis.
Experimental study of bridging the peripheral nerve gap with skeletal muscle
Authors: Jiming Kong , Shizhen Zhong , Bo Sun , Shengxiu Zhu
Published: March 2007

A piece of skeletal muscle was used as a conduit to bridge the gap microsurgically between the two ends of the severed sciatic nerve in 30 rats, and a method for histochemical demonstration of acetylcholinesterase was employed to assess the nerve regeneration process 5 weeks or more after the operation. Regenerating nerve fibers were detected in the muscle and could be traced through to the distal stump of the severed sciatic nerve. This suggests that skeletal muscle might serve as a grafting conduit for the repairing of peripheral nerve injuries.
Dynamic computer tomography determining the patency of buried free flaps
Authors: Fischer Joseph C. , Parker Paul M. , Shaw William W. , Colen Stephen R.
Published: March 2007

Numerous methods exist for monitoring the patency of cutaneous free flaps. Monitoring the patency of microvascular anastomosis in buried free flaps are limited. The present case report is of a 39‐year‐old female with Rhomberg's disease who underwent an abdominus rectus muscle free flap to correct the contour deformity of the right face. Dynamic CT scan was performed on the sixth postoperative day. Plots of the rate of change of density of the free flap were compared to an adjacent muscle of the face.

Dynamic CT scanning provides a high degree of resolution of the free flap, the ability to examine the entire free flap, and the ability to determine the patency of buried free flap.
Scanning electron microscopy of crush/avulsion arterial trauma: Effect of heparin and aspirin administration
Authors: Cooley Brian C. , Ruas Ernesto J. , Wilgis E. F. Shaw
Published: March 2007

A model of vascular trauma and subsequent reanastomosis with poor postoperative likelihood of patency was developed in the rat femoral artery. Patency rates were significantly improved with intravenous heparin, intragastric aspirin, and both agents together. Heparin yielded higher patency than aspirin. Intimal surfaces of the vessels at various postoperative intervals were observed with the scanning electron microscope. More fibrin accumulation was seen in the aspirin‐treated animals, while more platelet aggregation was found in the heparin‐treated group. Both platelet aggregation and fibrin strand development appeared retarded with both agents administered. All groups demonstrated good healing of the ruptured intimal surfaces, beginning at 2 days postoperatively. It is concluded that fibrin strand development is a more significant factor in microvascular occlusion than platelet aggregation.
Evaluation of long‐term patency rates of different techniques of arterial anastomosis in rabbits
Authors: Siemionow Maria
Published: March 2007

The results of 160 arterial anastomoses performed with four different techniques are presented. The popliteal arteries (mean diameter 0.7 mm) of 40 rabbits in each of four groups were anastomosed using: I. End‐to‐end techique with assymetrical sleeving of the adventitia; II. end‐to‐end technique with symetrical sleeving of the adventitia and wrapping of the suture site with a collagen cuff; III. end‐to‐end technique with symetrical trimming of the adventitia; and IV. end‐in‐end technique. Long‐term patency rates for the above techniques were as follows: Group I, 92.5%; Group II, 87.5%; Group III, 92.5%; Group IV, 90.0%. Group IV anastomoses were completed in an average of 15 minutes compared with an overall average of 24 minutes for the other three groups.
Microvascular polytetrafluoroethylene (Gore‐Tex®) grafts in the infrarenal rat aorta
Authors: Ribbe Else B. , Holmin Torsten , Löwenhielm Peter C. G.
Published: March 2007

To evaluate the use of microvascular prosthetic grafts, the infrarenal aorta in 33 male Sprague‐Dawley rats was replaced by an interposition graft of PTFE (polytetrafluoroethylene, Gore‐Tex®).

Three groups of experimental animals were studied: Group A consisted of rats with 7‐mm‐long grafts, group B consisted of rats with 20‐mm‐long grafts, and group C consisted of rats with 20‐mm‐long grafts and ligatures of one common iliac and one external iliac artery. In group A all grafts (11/11) were patent after varying observation periods (6–92 days, median value 28 days, mean value 49 days). In group B all grafts but one (13/14) were patent (0–201 days, median value 198 days, mean value 118 days). In group C two grafts occluded immediately postoperatively, whereas the remaining six were patent (0–24 days, median and mean values 9 days). Twelve of 13 grafts observed for 3 months or more remained patent. There were no signs of infection. Angiography did not reveal any stenosis in the anastomoses of patent grafts. Light microscopy demonstrated a good adaptation between the grafts and the aorta in all animals. In the short grafts observed for 3 months and in the long grafts observed for 6 months, the luminal surfaces were completely covered by endothelial‐like cells. In the occluded graft in group B, a stenosis was demonstrated in one of the anastomoses. This was not found in any other specimen. The results of this study document the possibility of using PTFE grafts of 1 mm diameter in experimental microvascular position.
Allogeneic heart‐lung transplantation in mice
Authors: Chang Eil Sung , Chisari Francis V. , Lee Sun
Published: March 2007

Using a simpler technique for mouse heart and lung transplantation, a histological comparison was made between groups of syngeneic and allogeneic transplants. The initial high postoperative mortality encountered was due to technical difficulty and as the operative technique improved, mortality lessened. While direct palpation of the abdomen is the key means in the detection of graft rejection, there is no practical determination of such graft rejection other than histological clarification. Doppler tracing also is not a sensitive method for detecting rejection. The transplanation technique in this study compares the time of rejection of heart and lung transplants more legitimately.
Ovum recovery after microsurgical reanastomosis of the rabbit oviduct
Authors: Land Jolande A. , Evers Johannes L. H. , Boeckx Willy D. , Muytjens Arno , Brosens Ivo A.
Published: March 2007

Causes for failure of pregnancy after tubal reconstructive surgery are incompletely understood. The impact of microsurgical resection reanastomosis on ovum recovery was studied in the rabbit oviduct. One hundred sixty rabbits were divided into three groups: one experimental group in which a resection reanastomosis was made in the ampullar or isthmic tubal segment, respectively, and two control groups. After mating, ovum recovery was evaluated. In ampullary operated oviducts the ovum recovery rate was significantly lower compared with recovery rates in isthmically operated and in control oviducts. Furthermore, in ampullary operated oviducts peritoneal transmigration of ova was frequently observed. Disturbances in ovum pickup from the ovarian surface or the peritoneal cavity seem to be responsible for the decrease in recovery rate found in the ampullary operated oviducts.
Microsurgical reconstruction of congenital tubal anomalies
Authors: Cohen Brian M.
Published: March 2007

Significant numbers of infertile women have congenital anomalies or anatomical distortion of the fimbrial‐gonadal mechanism in their otherwise healthy oviducts. The diagnosis and surgical treatment of multiple congenital accessory tubal ostia, the elongated fimbria‐ovarica syndrome, and management of paratubal cysts is described. Microsurgical correction of these defects was followed by term pregnancies in 46%, 57% and 28% of the three entities respectively and this data indicates that significant numbers of women with these defects may be helped by microsurgery. Failure to recognize these abnormalities may otherwise result in patients being diagnosed as idiopathic infertility, a decision which may exclude them from the possibility of undergoing a successful form of microsurgical treatment.
Comparison between tubouterine implantation and tubouterine anastomosis for repair of cornual occlusion
Authors: Fayez Jamil A.
Published: March 2007

Forty‐four patients with partial or complete cornual occlusion of their tubes had undergone microsurgical repair in the form of either tubouterine implantantion or tubouterine anastomosis. Eighteen of these patients had undergone the implantantion procedure and 26 the anastomosis procedure. None of the patients in the implantation group had previous tubal sterilization, while in the anastomosis group 16 had tubal cauterization and 10 had other causes blocking the cornual end of their tubes. The patency rate in the implantation group was 70% and the pregnancy rate was 39%, while in the anastomosis group the rates were 94% and 69%, respectively. It is concluded that, when feasible, tubouterine anastomosis should be the procedure of choice for the repair of the cornual occlusion of the tube irrespective of the cause of obstruction.
Microsurgical laser technique for abdominal myomectomy
Authors: Reyniak J. Victor , Corenthal Linda
Published: March 2007

This study was designed to evaluate the applicability of a hand‐held CO2 laser combined with microsurgical principles to the abdominal myomectomy in women with menorrhagia and infertility. Seventeen patients with submucous and intracavitary myomata diagnosed by hysterosalpingography were included in this study. The myomectomy technique described was rapid, allowed for excellent intraoperative hemostasis, and resulted in a short, uneventful postoperative hospital stay. In all patients, menstrual pattern returned to normal. Seven out of ten patients who attempted pregnancy succeeded.
Laparoscopic assessment of ovarian healing following CO2 laser microsurgery: Vicryl vs. Surgilon
Authors: McLaughlin David S. , Diamond Michael P. , Daniell James F. , Martin Dan C. , Feste Joseph
Published: March 2007

A prospective multicenter study was undertaken by the Intraabdominal Laser Study Group to assess the type and extent of ovarian adhesions formed following incisional ovarian surgery performed as part of a fertility‐promoting procedure with the aid of the carbon dioxide laser. Ovarian healing with subsequent adhesion formation was evaluated by early second‐look laparoscopy. Two suture closing materials were used—Surgilon (siliconized braided nylon, David and Geck, Wayne, NJ) and Vicryl (polyglactin 910, Ethicon, Somerville, NJ). Sixty‐five ovaries were evaluated in 37 patients with subsequent adhesions found in 37% (18/49) of the Surgilon‐closed ovaries and in 94% (15/16) of the Vicryl‐closed ovaries. The adhesions were filmy in 83% (15/18) of the Surgilon group and 47% (7/15) of the Vicryl group. Densel vascular adhesions were found in 17% (3/18) of the Surgilon group and 53% (8/15) of the Vicryl group. The subsequent conception rates were 68% (17/25) in the Surgilon group and 33% (4/12) in the Vicryl group, although the small number of patients and multitude of infertility factors made pregnancy rate comparisons difficult. One of the authors noted lack of tensile strength in the Vicryl‐closed ovaries within 12 weeks postlaser laparotomy, which led to incisional dehiscence during laparoscopic lysis of ovarian adhesions. From this preliminary study, it is concluded that additional data are needed to more fully resolve the debate on whether absorbable or nonabsorbable suture is preferred for ovarian infertility surgery.
Pathogenesis of adhesion formation/reformation: Application to reproductive pelvic surgery
Authors: Diamond Michael P. , Decherney Alan H.
Published: March 2007

Pelvic adhesions are a major contributing factor to infertility in women with tubal peritoneal disease. Surgical treatment of such adhesions often does not resolve their presence. Such postoperative adhesion formation occurs despite the use of microsurgical techniques in a wide variety of surgical adjuvants. The process of adhesion formation represents a variation of the normal healing process of the peritoneum. However, rather than normal mesothelial healing, the fibrinous mass resulting from the peritoneal defect is infiltrated by fibroblasts with subsequent adhesion formation. A description of the pathophysiology of this process is described. The current understanding of the pathologic/pathophysiologic interaction of the surgical adjuvants with this process is described.
Use of streptokinase for the salvage of a free flap: Case report and review of the use of thrombolytic therapy
Authors: Schubert Warren , Hunter David W. , Guzman‐Stein Gabriela , Ahrenholz David H. , Solem Lynn D. , Dressel Thomas D. , Cunningham Bruce L.
Published: March 2007

This is the first case report of the clinical use of intraoperative streptokinase to promote free flap salvage. A latissimus dorsi free flap was mobilized to cover a scalping type injury. After 4 1/2 hours of ischemia and recurrent thrombosis, streptokinase was perfused into the thoracodorsal artery (7,500 units of streptokinase in 30 cc of normal saline). The free flap was exposed to this concentration of streptokinase for 10 minutes followed by drainage of the venous effluent in order to avoid possible deleterious systemic effects of the streptokinase. Good flow throughout the free flap resulted, and the flap remained viable, providing good coverage for the patient's skull. Controversies regarding the no‐reflow phenomena and the use of various thrombolytic agents are discussed.
Mural repair following obliteration of aneurysms: Production of experimental aneurysms
Authors: Young Paul H. , Fischer Vernon W. , Guity Afrassiab , Young Paul A.
Published: March 2007

One hundred thirty‐two experimental rat carotid artery aneurysms were produced using a variety of methods, in order to determine which of these approaches should be employed in the development of a satisfactory laboratory model. The gross appearance and pathomorphology of aneurysms created by vein pouch and partial arteriotomy methods most closely resembled those features reported in clinical intracranial aneurysms.
Second toe transfer for thumb reconstruction in multiple digit amputations including thumb and basal joint
Authors: Tsai Tsu‐Min , McCabe Steve , Beatty Mary Ellen
Published: March 2007

Amputation of the thumb, including the basal joint, is a disabling injury that leaves limited reconstructive options.

Three cases of multiple digit amputation including the thumb and basal joint are presented in which a second toe transfer was used to reconstruct the thumb.

All patients have functional pinch with an average pinch strength of 27% of the opposite uninjured extremity. The average grip strength for two patients is 44% of the opposite hand. Average motion of the transfer at the MP, PIP, and DIP is 25°, 37°, and 9°, respectively. Adduction and abduction are obtained, the degree depending on the site of proximal bony fixation. No patient has morbidity at the donor site and all are happy with their reconstruction.

In selected cases we feel second toe transfer is an excellent choice to reconstruct the thumb amputated at a proximal level.
The wraparound procedure for thumb and finger reconstruction
Authors: Lowdon Ian M. R. , Nunley James A. , Goldner Richard D. , Urbaniak James R.
Published: March 2007

Nineteen thumb and finger reconstructions were performed using the wraparound procedure; there were five early arterial failures. Thirteen of the 14 successful digital reconstructions were reviewed at an average of 26 months after surgery. There were complications related to the upper limb in seven patients, several of whom had more than one problem; these included radial skin breakdown (2), malrotation (2), and infection (2). One patient underwent late deletion for chronic infection following corrective osteotomy. Time until toe donor site healing averaged 2 months. We considered that cosmesis and function were good. Pinch grip averaged 48% of normal; sensibility returned in all patients—four regained protective sensation and the others attained two–point discrimination (average 9 mm). The wraparound procedure provides a cosmetically and functionally excellent method of thumb reconstruction for amputation distal to the metacarpophalangeal joint.
Free neurovascular cutaneous toe pulp transfer for thumb reconstruction
Authors: Stern Peter J.
Published: March 2007

Free vascularized toe pulp transfer to the thumb is a technique to restore sensibility and durable soft tissue coverage to the thumb. This article reviews alternative techniques for coverage; the neurovascular anatomy of the great toe; and the technique of microvascular toe pulp transfer. Although the procedure is technically demanding, it provides excellent coverage with minimal donor morbidity.
Neurovascular island skin flaps in the hand: Functional and sensibility evaluations
Authors: Stice R. Colleen , Wood M. B.
Published: March 2007

The value of neurovascular island skin flap transfers for digit tip surfacing has been evaluated in 13 patients. A computer assisted sensory evaluation was carried out on six of the patients. All patients were satisfied with the procedure. Sensory acuity did not appear to diminish with time and sensory misreference was not a major functional problem. We suggest that the neurovascular island flap, when available, is still an excellent procedure for restoration of useful digit tip sensibility.
A model for sidewall adhesions in the rabbit: Reduction by an absorbable barrier
Authors: Diamond Michael P. , Linsky Cary B. , Cunningham Tim , Constantine Barry , Dizerega Gere S. , Decherney Alan H.
Published: March 2007

Despite use of surgical adjuvants, pelvic adhesions frequently develop following infertility surgery. Recently a resorbable biocompatible material, TC 7, has been designed to be used as a barrier to reduce adhesion formation. Reproducibly severe sidewall adhesions were only able to be created in one of six models tested. The model consisted of the following steps: excision of a full thickness 2 × 2‐cm musculoperitoneal tissue mass, scraping of an adjacent 2cm length of uterine horn, tamponading of all bleeding, and suturing (6‐0 Vicryl) of normal tube and sidewall so as to directly approximate the traumatized tissues. Studies were conducted in 13 rabbits after creation of the bilateral sidewall and horn lesions, each serving as its own control. Choice of control and TC 7 sides was determined randomly. Adhesion formation was examined 2 weeks postoperatively. No residual material was noted at that time. Adhesion scores were the composite total of extent (0–4), type (0–4), and tenacity (0–3) of sidewall adhesions, and were significantly reduced on the TC 7 side as compared with the control side (mean 6.8 ± 0.4 vs 9.0 ± 0.3, median 6 vs 9, sign test P = 0.0032). No complications of use of the barrier were noted. It is concluded that use of TC 7, a resorbable biocompatible barrier, was able to significantly reduce postoperative adhesion formation on the rabbit sidewall.
Experimental microvascular autogenous vein grafts for arterial defects: A study of anastomotic sites
Authors: Kruavit Arthi , Fletcher Christopher D. M. , McKee Phillip H. , Mayou Brian
Published: March 2007

Autogenous femoral vein grafts with an average external diameter of 1.5 mm and an average length of 2.87 cm have been used to bridge defects in the contralateral femoral artery of 15 adult New Zealand white rabbits. An experimental microvascular technique to minimise trauma to the graft was performed, by which clamps were never applied to the graft itself. Patency was assessed over a 12‐week period, and the overall graft success rate, excluding one technical failure, was 86%. Each of the three failures resulted from thrombosis. Histologic examination of the patent anastomoses showed marked medial damage at 1 week, complicated by fibrosis and calcification by 4 weeks; thereafter the intima developed prominent fibroelastic thickening. This led to a degree of luminal narrowing by 12 weeks. However, the underlying medial damage, attributable to operative trauma, did not seem to diminish luminal patency.
Experimental models for evaluating antithrombotic therapies in replantation microsurgery
Authors: Cooley Brian C. , Gould John S.
Published: March 2007

A variety of anticoagulation and antiplatelet aggregation agents are in use clinically, and in applications to microvascular surgery, a clear choice for the most effective therapy has not been determined. Models of vascular trauma combined with microvascular anastomosis have been developed for comparing the efficacy of these agents in maintaining vascular patency. In a rat model of microvascular thrombosis, heparin effectively prevents occlusion in both arteries and veins, at clinical levels of administration. Aspirin helps prevent thrombosis, but not as well as heparin. These results support the beneficial effect of antithrombotic drug therapies, and suggest a more potent role of the heparininhibited fibrin clot over platelet aggregation in creating thrombotic occlusion of small vessels.
Experimental vasospasm
Authors: Seaber Anthony V.
Published: March 2007

Vasospasm is known to be present during most microvascular procedures. Not until recently has microsurgery made it possible to directly observe the dynamic nature of vascular spasm. This report reviews the physiologic events and the causes of vascular spasm during microsurgery. The current research models and the use of spasmolytic agents to relieve spasm are outlined. Future research in specific areas that pertain to the cremaster muscle model and the future direction and need for research in this area are discussed.
Arteriovenous shunt construction for vascular access in the rat
Authors: Korber Kenneth E. , Flye M. Wayne
Published: March 2007

A method is described that allows high‐frequency venous and arterial blood sampling in the laboratory rat. After distal ligation and division of the external jugular vein and carotid artery, sections of Teflon intravenous catheters are inserted and secured with circumferential ligatures. Between these Teflon segments, a vascular circuit is maintained with the interposition of silicone tubing. The silicone tube segment has been filled with heparinized saline, divided in half, and joined at its center by another segment of the catheter. This in situ arteriovenous (AV) shunt system is secured in the neck of the host animal by creating a subcutaneous tunnel and externalization of a portion of the shunt loop. The shunt facilitates repetitive blood sampling from the conscious rat. The procedure time is approximately 45 minutes, and patency can be assured over several days. Additional uses of the system include pretreatment injection protocols and postoperative drug therapy.
Microvascular transfers of latissimus dorsi and serratus anterior muscles in rats
Authors: de la Pena Jose Abel , Lineaweaver William , Buncke Harry J.
Published: March 2007

The thoracodorsal artery supplies the latissimus dorsi and serratus anterior in the rat in the same fashion as in the human. In the rat, the thoracodorsal artery and vein average 0.57 mm and 0.71 mm in diameter, respectively, at their origins and can be used as pedicles averaging 19 mm in length to the latissimus dorsi muscle and 27 mm to the serratus anterior muscle. We successfully transferred both of these muscles to groin vessels by means of end‐to‐end or end‐to‐side anastomoses. The serratus anterior muscle was technically easier to transfer because its pedicle was longer. We conclude that the serratus anterior transfer in the rat is a feasible animal model for microvascular muscle transfer and may be a useful standard model for pharmacological and biochemical studies in transplanted muscle.
Comparison of skin surface fluorescence and fluorescein tissue concentration with the dermatofluorometer
Authors: Weinberg Hubert , Pozez Andrea
Published: March 2007

Recently sodium fluorescein has been used to determine viability of tissue and assess blood flow. No study, however, has documented the correlation of surface fluorescence as measured by the dermatofluorometer with the actual distribution of fluorescein in tissue. Abdominal skin flaps were raised on Sprague‐Dawley rats. Following intravenous injection of sodium fluorescein, skin surface fluorescence was measured and compared with tissue fluorescein concentration. This study confirms that skin surface fluorescence correlates well with actual fluorescein distribution in tissue. Furthermore, the study clearly illustrates the statistically significant variation of surface fluorescence as a function of distance from the vascular pedicle.
Microsurgery in China and the development of western reconstructive microsurgery
Authors: Cooney W. P.
Published: March 2007

The development of extremity replantation and reconstructive microsurgery was initially carried out independently among the pioneering centers throughout the world. The comparative development of these techniques is outlined. With the fast growth of microsurgical procedures, many of the U.S. residency programs have incorporated microsurgery training into the curriculum.
Induction of experimental aneurysms on the rat common carotid artery using a microsurgical CO2 laser
Authors: Ammirati Mario , Ciric Ivan , Rabin Eleanor
Published: March 2007

Aneurysms were produced on the common carotid artery of rats by milliwatt CO2 laser welding of an adventitia patch over a hole. Sixty‐nine animals were operated on. Aneurysms were present in 35 animals (51%), 7 of which ruptured spontaneously. The time to aneurysm formation was 1 week or longer. The adventitia patch aneurysm model has features (reliability, minimal vessel manipulation, histology similar to human berry aneurysm, and spontaneous bleeding tendency) that make it theoretically suitable for the induction of intracranial aneurysms in experimental animals. The microsurgical skills required to create and dissect the aneurysm make our experimental aneurysm useful as a teaching model in the development of microneurovascular surgery skills.
Microvascular reconstruction of the pharyngoesophagus with free jejunal graft
Authors: McDonough John J. , Gluckman Jack L.
Published: March 2007

Free jejunal graft reconstruction of the pharyngoesophagus has become reliable one‐stage technique, but the microsurgeon must be aware of numerous pitfalls. Forty‐two patients were retrospectively reviewed. There were four graft failures for a success rate of 90.5%. When harvesting the graft the thick fatty mesentery may make dissection difficult, and injuries to the mesenteric artery and vein can occur. Neck preparation can be tedius because of previous radiation, and size discrepancies with the carotid branches and the mesenteric artery are seen. Intimal dissection of the mesenteric artery can present as an isolated flap or a circumferential “rosette,” despite the most careful preparation of the vessels; and great care must be taken in the microvascular anastomosis. The end‐to‐end arterial anastomosis to a branch of the external carotid and an end‐to‐side venous anastomosis to the internal jugular were preferred. Vein grafts are occasionally necessary.
Immediate microvascular reconstruction of combined palatal and midfacial defects using soft tissue only
Authors: Shestak Kenneth C. , Schusterman Mark A. , Jones Neil Ford , Johnson Jonas T.
Published: March 2007

Maxillary and midface defects with or without orbital involvement are disfiguring and disabling problems especially in the elderly cancer patient. Often, palatal prostheses are required to enable speech and swallowing. Elderly patients or those with compromised vision often find these appliances cumbersome and difficult to manage. To help obviate these problems a onestage method of immediate palatal reconstruction was needed to obturate the palate and restore facial contour. Over the past 18 months six patients have undergone immediate reconstruction of complex, composite defects of the maxillary and midface structures after tumor extirpation, three of which extended into the orbit. The latissimus dorsi musculocutaneous flap was utilized because of its bulk, reliable anatomy, ample pedicle length and diameter, and minimal donor site morbidity. No flap loss, suture line dehiscence, or infection occurred. All patients were capable of deglutition and intelligible speech. This technique is a one‐stage reconstruction of the palate and accompanying defects of the midface and maxilla that obviates the need for cumbersome palatal appliances.
Reconstruction of complex cranial and carniofacial defects utilizing iliac crest‐internal oblique microsurgical free flap
Authors: Shenaq Saleh M.
Published: March 2007

Reconstruction of complex cranial and craniofacial defects was accomplished in three patients. The defects were secondary to osteomyelitis, irradiation and infection, and failed reconstruction by alloplastic material. Defects averaged 11.5 × 12.5 cm in diameter. The iliac crest‐internal oblique microsurgical free flap was used in reconstruction of these defects in combination with split rib bone grafts. Satisfactory restoration of contour and continuity of the cranium was achieved in all patients with minimal donor‐site morbidity. We introduce this method for reconstruction of complex cranial and craniofacial defects as a new concept in reconstruction. The results of our experience, although limited, have proven its validity. The muscle portion of the flap enhances the survival of the nonvascularized rib grafts and their contouring effect.
The relationship between structural features of peripheral nerves and suture methods for nerve repair
Authors: Zhong Shi‐Zhen , Wang Guo‐Ying , He Yun‐Shao , Sun Bo
Published: March 2007

Based on techniques for identifying and distinguishing motor, sensory, and mixed fasciculi in peripheral nerves, the authors propose guidelines for selecting suture methods for nerve repair. When many mixed fasciculi are known to exist at the nerve lesion, epineurial repair is preferable; fascicular (perineurial) repair is more suitable when pure motor and sensory fasciculi are clearly recognized. Generally, epineurial repair is indicated for more proximal injuries, with fascicular repair most appropriate for more distal sites. A greater ratio of epineurial connective tissue to intrafascicular nervous tissue implies an inclination toward fascicular repair.
Microvascular replantation in a seven‐month‐old girl: A case report
Authors: Gaul John S. , Nunley James A.
Published: March 2007

Replantation of an amputated digit in a child demands special techniques for success. Our experiences with replantation in this age group have shown that although these patients have a lower viability rate after digital replantation, those digits that do survive develop excellent function. In this case report of a 7‐month‐old with an amputated thumb, the indications, techniques, and prognosis of replantation in children are discussed.
Improving micrograft patency
Authors: Nichter Larry S. , Bindiger Alan
Published: March 2007

To help clarify many of the controversial issues affecting early microvascular graft patency, a series of experiments was performed comparing the relative importance of graft material used alone and in conjunction with antiplatelet agents. Using a rat carotid model employing 1 cm micrografts with 1 mm luminal diameter, this study demonstrated that 1) untreated 1 mm polytetrafluoroethylene (PTFE) and human umbilical vein (HUV) micrografts have unacceptably low patency rates; 2) treatment with the antiplatelet agents indomethacin, ibuprofen, and aspirin significantly improved micrograft patency; 3) differences in patency among the three agents were not significant; and 4) PTFE had higher patency rates than HUV, although this difference did not achieve significance.