bluuebunny/crossref_metadata_2025 huggingface dataset:
Replantations and their functional results: The Turkish experience
Authors: Bora Arslan , Ada Sait , Ozerkan Fuat , Tetik Firdevs
Published: March 2007

The development of microsurgery with regard to replantation of severed extremities has in Turkey been a relatively recent although rapid process. The first revascularization was performed by our team in Izmir in 1986. By 1988 a 24‐hr emergency replantation service was available and a special surgery branch hospital in hand and microsurgery was established in 1991. This hospital was the first of its kind in Turkey and one of the few in the world. Here we present our replantation series comprising 83 patients treated between July, 1986, and December, 1990. From a total of 83 patients, 136 extremities were involved, with only 24 of 136 lost; a success rate of 82%. Functional results were rated as excellent or good in 49 cases. © 1993 Wiley‐Liss Inc.
Microvascular transplant of the gastrocnemius muscle in rats
Authors: Tonken Heidi P. , Zhang Feng , Sudekum Anthony E. , Siko Peter P. , Newlin Leonard , Partington Marshall T. , Buncke Harry J. , Lineaweaver William C.
Published: March 2007

The rat gastrocnemius muscle can serve as a vascularized, innervated muscle transplant model. To establish the anatomic and technical details of this model, we performed ten gastrocnemius transplants and collected data on muscle weight, dimension, and vessel caliber from each muscle. The muscle, consisting of medial and lateral heads, is supplied by pairs of sural vessels averaging 0.2 mm in diameter. These vessels, however, can be taken in continuity with the femoral vessels (averaging 1.0–1.6 mm in diameter), which are used for transplantation. The muscles weighed an average of 2.8 g, and the average pedicle length was 24 mm. Eight of ten transplanted muscles were viable with intact circulation at 72 hr. The gastrocnemius transplant was technically reliable, and the muscle bulk and contour could allow biochemical and functional studies. Donor site morbidity limits this model to transplantation Studies. © 1993 Wiley‐Liss Inc.
Free skeletal muscle transplantation to an infarction area: An experimental study in the dog.
Authors: Beyer Michael , Hoffer Harald , Eggeling Thomas , Matt Otto , Beyer Ulrike , Hannekum A.
Published: March 2007

In plastic surgery, free skeletal muscle flaps are used for treatment of non‐healing injuries like chronic osteitis or radiation ulcers. We wanted to evaluate if the neoangiogenesis induced by these flaps can also constitute a method for revascularization in ischemic heart disease. In diffuse small vessel coronary heart disease, patients are not suitable for bypass surgery because it is impossible to create a microanastomosis with the coronary artery. As an alternative, a free striated muscle flap, transplanted onto the heart, can constitute a source of neovessels. With the induction of extra‐intracardial collaterals that develop within 4 weeks after transplantation of the flap, a new surgical approach may be offered to those patients. Our experimental work was performed with 20 dogs. In these, a myocardial infarction of the anterior wall was selectively produced using the Judkins‐technique (Radiology 89: 815–824, 1967) for injection of Sephadex‐microspheres. Four weeks later a free pectoralis muscle flap was transplanted onto the anterior wall of the heart. Arterial blood supply was achieved with an anastomosis with the internal mammary artery. The venous flow was directed into the right atrium. Four to eight weeks after surgery, the patency of the anastomosis was studied by angiography, showing patency in almost all surviving animals. Histological examination of the hearts revealed a prominent vascular network penetrating into the underlying myocardium. Corrosion cast preparations, as well as a postmortem angiography, showed even further penetration of the neovessels into the uninjured parts of the myocardium. Thus, myocardial revascularization may be achieved by transplantation of a skeletal muscle onto the heart. © 1993 Wiley‐Liss Inc.
Nerve repair using freezing and fibrin glue: Immediate histologic improvement of axonal coaptation
Authors: Bertelli Jayme Augusto , Mira Jean‐Claude
Published: March 2007

Despite the fine microsurgical techniques available, injuries to peripheral nerves are still a surgical problem. Sutures placed in the epineurium or perineurium cause compression, brushing, and misdirection of endoneural tissue. A technique of nerve repair using freezing to trim the nerve and fibrin glue to coat it before thawing is described. The entire surgical repair procedure is carried out with the nerve stumps frozen. The observed axonal alignment with this technique was much better than that obtained by microsuture alone. © 1993 Wiley‐Liss Inc.
Effect of pre‐existing health conditions on the results of reconstructive microvascular surgery
Authors: Al Qattan Mohammad M. , Bowen Vaughan
Published: March 2007

The effect of different pre‐existing health conditions on the results of reconstructive microvascular surgery are reviewed. These conditions include: age, vital organ failure, diabetes, arterial and venous diseases, medications, smoking, wound healing disorders, epidermolysis bullosa, hematological diseases, multiple injury patients, pregnancy, and neuropsychiatric disease. © 1993 Wiley‐Liss Inc.
Operative complications and the management of intraoperative flow failure
Authors: McKee Nancy H.
Published: March 2007

Free flap flow failure can be either that of an artery and/or vein(s). One approach is to ascertain precisely which vessel(s) is compromised, then figure out whether the problem is on the patient's side or the flap side or at the anastomosis itself. A well perfused patient can minimize a patient‐side problem. An anastomotic problem can be revised with or without adding a graft. There is potential to avoid further anastomotic problems with the use of some form of anticoagulant. Problems on the flap side, if limited, can be dealt with by resection or repair. Anticoagulants may be of value. Occasionally, another free flap is needed. © 1993 Wiley‐Liss Inc.
Ischemia reperfusion injury: A review
Authors: Kerrigan Carolyn L. , Stotland Mitchell A.
Published: March 2007

Ischemia reperfusion injury is reviewed in the context of the evolution of flap research over the past decade. A description of the clinical relevance of this field is presented and the possible etiologies are reviewed. The pathophysi‐ology of this injury is then explored in some detail. Both skin and myocuta‐neous flaps, in a variety of animal models, are discussed. Research performed in vitro, as well as in other organ systems similarly affected by ischemia and reperfusion, is also examined. Particular attention is placed on the function of several newly described inflammatory mediators where it appears relevant to future research and treatment in the field of reconstructive microsurgery. © 1993 Wiley‐Liss Inc.
En bloc kidney and whole pancreaticoduodenal transplantation with bladder drainage in the rat: Microsurgical technique and outcome
Authors: Nakai Ichiro , Oka Takahiro , Kaufman Dixon B. , Field M. Jane , Sutherland David E. R.
Published: March 2007

A microsurgical technique for en bloc kidney and whole pancreaticoduodenal transplantation with bladder drainage employing triple vascular anastomoses without the need for a vascular cuff is described. Nineteen combined isografts were performed using this technique in inbred male Lewis (RT1:l) rats with streptozotocin‐induced diabetes. Six recipients died within 1 month from early complications (two from uremia, two from pancreatitis, one from bleeding, one from peritonitis); the other 13 survived more than 1 month after transplantation with both the pancreas and kidney grafts functioning. Four of the 13 rats died after 1 month (one from uremia secondary to an obstructed ureter, one from unexplained uremia, one from peritonitis after a biopsy, and one of unknown causes). The pancreas isografts of two animals were excised at 1 and 3 months to confirm dependence on the graft; both animals became hyperglycemic after graft pancreatectomy and had immediate declines of urine amy‐lase activity to normal. One animal was sacrificed at 3 months to determine the insulin content of its native and transplanted pancreas; insulin was very low in the former and normal in the latter. The remaining rats survived with both grafts functioning for at least 6 months (normoglycemic, high urinary amylase levels, normal or near‐normal plasma creatinine concentrations), before being sacrificed within the context of other experiments and for histological observations. Both the kidney and pancreas isografts were well preserved microscopically. En bloc pancreas and kidney transplantation with bladder drainage of excretions from both grafts is technically possible, and the success rate with our method is sufficiently high that studies designed to answer questions relevant to combined pancreas and kidney transplantation can be carried out. © 1993 Wiley‐Liss Inc.
Bridging nerve defects with combined skeletal muscle and vein conduits
Authors: Brunelli Giorgio A. , Battiston Bruno , Vigasio Adolfo , Brunelli Giovanni , Marocolo D.
Published: March 2007

The use of vein or muscle grafts to bridge nerve defects longer than 1‐1.5 cm gives poor results. Veins collapse and in muscle grafts axons may regrow outside the graft. We used veins (to guide regeneration) filled with muscle (to avoid vein collapse). Nerve regeneration through 1 and 2 cm grafts made of vein plus muscle was compared with similarly long traditional nerve grafts, free fresh muscle grafts, and empty vein grafts. Regeneration was assessed clinically and histologically (qualitative and quantitative evaluation) in the graft and distal nerve stumps. Vein plus muscle grafts were superior to vein and fresh muscle grafts both functionally and histologically. Functional results were similar to those found in traditional nerve grafts, but axon number was superior in the veins filled with muscle. This suggests that vein filled with muscle might serve as a grafting conduit for the repair of peripheral nerve injuries and could give better results than traditional nerve grafting. © 1993 Wiley‐Liss Inc.
Total scalp replantation based on one artery and one vein
Authors: Eren Serdar , Hess Jürgen , Larkin Grahame C.
Published: March 2007

A successful replantation of a totally avulsed scalp, including both eyebrows, with only one arterial and one venous anastomosis to the superficial temporal vessels is described. Apart from a small partial skin necrosis of the right eyebrow, the entire transplant survived. Subsequently, the patient required only minor additional skin grafting, correction of scars with a skin expander, and reconstruction of the eyebrow with hair micrografts. Replantation of the total scalp based on two or more vessels has previously been recommended and reported elsewhere. In the present case, complete survival of the scalp on only one artery and one vein was demonstrated, indicating that replantation should be considered even if available vessels for anastomosis are minimal. © 1993 Wiley‐Liss Inc.
Aneurysmal cyst of the proximal radius: Resection and free vascularized fibular bone graft
Authors: Nonnenmacher Jean , Bahm Jörg , Laforest Patrick , Kempf Ivan
Published: March 2007

We present the case of a 22‐year‐old woman with an aneurysmal cyst of the right proximal radius, treated by resection and a free bone graft (microvascular fibular transfer), without recurrence after 4 years. Over a 4 month period, there was a rapidly expanding and lytic lesion found in the radius. There were symptoms of elbow and wrist pain and early radially innervated muscle weakness. Radiological examination showed a localized tumour of the proximal radius, type 2, grade C, according to the classification of Campanacci. Biopsy led to the diagnosis of an aneurysmal bone cyst. Complete tumour resection was followed by a free vascularized fibular bone graft, resulting in good functional improvement, without local recurrence. Aneurysmal bone cysts are a rare condition, and the location in the radius has not previously been described. Vascularized bone grafts are mechanically and biologically superior in this type of case. © 1993 Wiley‐Liss Inc.
Neurotizations by means of the cervical plexus in over 100 patients with from one to five root avulsions of the brachial plexus
Authors: Rutowski Roman
Published: March 2007

In the years 1982–1991, we treated over 100 patients with avulsion of from one to five roots in perinatal (n = 21) and traumatic (n = (81) lesions of the brachial plexus. Based on the clinical diagnosis and the surgical findings, we divided all operated patients into four groups: (1) avulsion of all roots or avulsions and disruption of the rest of the brachial plexus; (2) avulsion and disruption of one to four roots and preservation of some elements of the brachial plexus with fibrotic changes; (3) avulsion and disruption of one to three roots, with some elements showing no macroscopic changes; and (4) children with perinatal brachial plexus palsy. In cases of root avulsion, we performed neurotization from the cervical plexus, the accessory and intercostal nerves. In patients with One to three root avulsions, we have performed selective neurotization for 3 years. The best results were obtained in groups 3 and 4, but some improvement was also noted in the other groups. © 1993 Wiley‐Liss Inc.
Clinical application of motorsensory differentiated nerve repair
Authors: Deutinger Maria , Girsch Werner , Burggasser Georg , Windisch Alfred , Joshi Divia , Mayr Norbert , Freilinger Gerhard
Published: March 2007

Since 1979 acetylcholinesterase has been used in clinical practice for motorsensory differentiation. It was first used for median and ulnar nerve injuries at the wrist. Recently the application was extended to secondary nerve repair, including plexus reconstruction. The aim of this study was to present, for the first time, clinical results of motorsensory differentiated median and ulnar nerve repair and to show the advantage of this method in secondary repair. We compared a group of nine patients with motorsensory differentiated median and ulnar nerve repair with a group of 13 patients without motorsensory differentiation. Sensibility testing, strength measurements, and anatomical examinations were performed. The hand function was expressed in percentage values. Compound muscle action potentials and sensory antidromic conduction velocities were measured electroneurographically. Sensibility recovery was significantly better after motorsensory differentiated median nerve repair (P < 0.05). In secondary nerve repair acetylcholinesterase was used additionally for evaluating the level of resection of the proximal stump. The time required for perioperative histochemical differentiation has now been reduced to 2 hr. © 1993 Wiley‐Liss Inc.
An intravascular oxygen tension monitoring device used in myocutaneous transplants: A preliminary report
Authors: Hofer Stefan O. P. , Timmenga Erik J. F. , Christiano Rudy , Bos Kurt E.
Published: March 2007

An intravascular oxygen tension (PO2) sensor (Continucath 1000) was used to assess flap viability in microsurgically revascularized free flaps for 36 hours postoperatively. In vitro, long term stability, linearity, and response time of the PO2 sensor proved to be excellent. In 14 patients with sound flaps tissue PO2 values were found to be between 15 and 35 mm Hg. In three cases a failing flap needed reexploration. In these cases the PO2 sensor was accurate in detecting circulatory failure while in other cases it traced a number of physiological changes. The device holds promise for free flap monitoring but further studies are indicated. © 1993 Wiley‐Liss Inc.
Successful microvascular replantation of a completely amputated ear
Authors: Rapaport David P. , Breitbart Arnold S. , Karp Nolan S. , Siebert John W.
Published: March 2007

A case of successful microvascular replantation of a traumatically amputated ear is presented. The postoperative course was complicated by venous thrombosis requiring the use of medicinal leeches and systemic heparinization for salvage. This is the tenth successful microvascular ear replantation reported in the literature. © 1993 Wiley‐Liss Inc.
Autotomy and the sciatic functional index
Authors: Weber Robert A. , Proctor Warren H. , Warner Michael R. , Verheyden Charles N.
Published: March 2007

The rat sciatic nerve serves as a good model of nerve regeneration and, as such, is often used in investigations of nerve repair. After transection of the sciatic nerve, rodents frequently scratch and bite their anesthetic foot, resulting in amputation of one or more toes. This is termed autotomy or autophagy. When these rats are part of a study using the sciatic functional index (SFI), autotomy results in unusable data, since necessary foot landmarks have been removed. It would be helpful, therefore, to be familiar with the phenomenon of autotomy and to know which rats are least likely to mutilate themselves. In our experiment involving 64 rats in which the sciatic nerve was transected and repaired, we found that female Sprague‐Dawley rats were significantly less likely to perform autotomy than males (33% vs. 65%, P =.04). In addition, we noted that two‐thirds of the autotomies that occurred did so by postoperative week 4 and that tabasco sauce did not decrease this activity. We present our experience and a survey of the literature on autotomy and the SFI. © 1993 Wiley‐Liss Inc.
Effect of caval‐portal shunt on ovarian tissue in rats: I. Histological observation
Authors: Chung Do Young , Mao Lan , D'Silva Milbhor , Fazi Marilena , Bai Sammy , Subin Kenneth , Coopersmith Allen , Wolf Paul , Gittes Ruben F. , Lee Sun
Published: March 2007

Forty‐three female Sprague Dawley rats were divided into five groups, with groups 1–4 subjected to end‐to‐side caval‐portal shunt (CPS). In addition to CPS, group 1 (n = 13), group 2 (n = 10), and group 3 (n = 7) rats had undergone removal of the right ovary and one‐half of the left ovary, the left ovary, and one‐half of the left ovary, respectively. Group 4 (n = 6) rats were not subjected to ovariectomy. Group 5 (n = 7) animals were not subjected to CPS but underwent left ovarian hemiresection. The ovarian volume of the hemiresected ovaries increased to 393.00 ± 4.83 mm3 and 126.00 ± 44.3 mm3 from 18.40 ± 0.54 mm3 and 18.40 ± 0.59 mm in groups 1 and 3, respectively, at the end of three postoperative months. The nonresected ovaries enlarged to 339.98 ± 5.09 mm3 and 226.3 ± 46.2 mm3 from 36.79 ± 1.09 mm3 in groups 2 and 3, respectively. When no ovaries were resected, the CPS animals in group 4 showed an increment of ovarian volume of 1.75–2.2 times as much as the preoperative ones. In the animals that had undergone simple hemiovariectomy (group 5), the contralateral ovaries showed a significant increase in volume (40.2 ± 8.3 mm3 to 243.1 ± 114.8 mm3) at 3 months. The hemiresected ovarian volume increased from 27.1 ± 5.5 mm3 to 44.1 ± 11.8 mm3. The histological sections of ovaries in group 1 showed early formation of theca‐luteoma 3 months postoperatively, and there were demonstrable corpora atretica 6 months postoperatively. In the group 2 ovarian sections, there were multiple follicular cysts, and these cysts were lined by clusters of granulosa cells. There were nondisintegrated ova ejected from the cumulus oophorus in the ovarian sections from group 2 3 and 6 months postoperatively. In the group 3 ovaries, there were abundant theca‐luteal cells in the sections. Prominent granulosa‐theca cell activity was present in the ovaries subjected to CPS. A similar observation was made in group 4, where more ovarian mass was left in situ. Group 5 animals not subjected to CPS showed compensatory hyperplasia in the nonresected ovaries, and the hemiresected ovaries showed a slight enlargement. No typical granulosatheca cell tumors were formed in any of the groups of rats, indicating that gonadotrophin‐estrogen imbalance could not be achieved as a result of the large quantity of the ovary remaining in situ. © 1993 Wiley‐Liss Inc.
Mandibular reconstruction: Experience with the free vascularized fibula transfer
Authors: Khanijow Vijay Kumar , Ahmad Tunku Sara , Lian Chin Boon , Jalaludin Mohamad Amin
Published: March 2007

Mandibular resection, following surgery for tumor or osteoradionecrosis, leaves a patient with a swallowing, speech, and cosmetic disability. Repair of the oromandibular defect is difficult and various prostheses and grafts have been used and reported. The most popular form of mandibular reconstruction is the use of the free, vascularized bone transfer. We report our experience with the free vascularized fibula bone transfer in eight patients. © 1993 Wiley‐Liss Inc.
Replantation of an amputated nasal tip with open venous drainage
Authors: Sánchez‐Olaso Alberto
Published: March 2007

Replantation of small parts often results in failure. The impractical size and the frequent absence of veins suitable for anastomosis, together with venous congestion and thrombosis, are the main problems. A case is described of an amputated nasal tip and successful replantation by means of microsurgical arterial repair and open venous drainage due to absence of suitable veins in the specimen. In cases in which there is no possibility of repairing the venous system, open venous drainage may be an easy and feasible method to prevent venous congestion and replant failure. © 1993 Wiley‐Liss Inc.
Functional and esthetic reconstruction of a mutilated hand using multiple toe transfers and iliac osteocutaneous flap: A case report
Authors: Wei Fu‐Chan , Seah Chee‐Seng , Chen Hung‐Chi , Chuang Chwei‐Chin
Published: March 2007

With reconstructive microsurgical techniques, some previously hopelessly mutilated hands have become reconstructable. The functional and esthetic results of such hands can be improved to an acceptable degree with thorough prereconstruction evaluation and planning. This case report demonstrates the approach to reconstruction of a mutilated hand using the following: a pedicle groin flap for soft tissue reconstruction of the first web space and the amputation stump of the thumb; a combined second and third toe transfer for reconstruction of opposable fingers at the amputated index and middle finger stumps; a single second toe for reconstruction of the thumb, and an iliac osteocutaneous flap for reconstruction of the ulnar border of the palm. © 1993 Wiley‐Liss Inc.
Is laser repair effective for secondary repair of a focal lesion in continuity?
Authors: Dubuisson Annie S. , Kline David G.
Published: March 2007

It is possible to seal nerve ends together with the laser, and this can be effective for sharp injuries that are repaired relatively acutely or primarily. The possibility of utilizing the laser for secondary nerve repair after resection of a lesion in continuity was investigated in a rat sciatic nerve model. After baseline recording of nerve and muscle action potentials (MAP), a 3‐mm‐long crush injury of the sciatic nerve was performed bilaterally in 12 rats. Two weeks later, the crushed segment was resected, and the nerve on one side was repaired by end‐to‐end anastomosis using epineurial sutures and on the other side by sealing the nerve ends together with the CO2 laser. At reexploration 50 days postoperatively, all 12 suture repairs were anatomically in continuity and conducted a nerve action potential (NAP), while 10 of the 12 laser‐repaired nerves had distracted. Laser repairs not distracted showed electrical and histologic evidence of regeneration. It is concluded that laser repair is not effective for delayed repair of lesions in continuity unless tension at the repair site can be lessened. © 1993 Wiley‐Liss Inc.
Experimental study of the relationship between alterations in tissue perfusion and anastomotic patency
Authors: Barker John H. , Anderson Gary L. , Gu Jin‐Mei , Wyllie Francis , Acland Robert D.
Published: March 2007

It is generally believed that alterations in perfusion which endanger a free flap or replant are directly related to thrombus formation and obstruction of blood flow at the anastomotic site. Recent experimental work in our laboratory suggests that the presence of platelet emboli downstream in the microcirculation might be responsible at least in part for postoperative perturbations in perfusion. To determine whether changes in tissue perfusion can occur in the absence of corresponding changes in anastomotic patency we studied microvascular blood flow in the exposed rat cremaster flap model. We made continuous measurements of both anastomotic patency and downstream microcirculatory perfusion following small vessel repair. Using this approach we found that during one hour after clamp release and reperfusion in the 10 animals studied, pedicle artery blood pressure, which indicates pedicle patency in this model, was functionally normal 97% ± 2 of the time while blood flow in the downstream tissue (cremaster) remained normal an average of only 65% ± 7 of the time. In most cases these flow alterations were associated with the presence of visible platelet emboli in the microcirculation. From these studies we conclude that when flap perfusion failure temporarily occurs, a microsurgeon must consider not only the anastomosis but also the downstream microcirculation when searching for a possible cause. © 1993 Wiley‐Liss Inc.
Microvascular transfer of the rectus abdominis muscle and myocutaneous flap in rats
Authors: Zhang Feng , Lineaweaver William C. , Kao Samuel , Tonken Heidi , Degnan Kevin , Newlin Leonard , Buncke Harry J.
Published: March 2007

A rat microvascular free rectus myocutaneous flap model with a superior epigastric vessel pedicle is presented. The rectus muscle has a predictable „flow‐through”︁ axial vascular system consisting of superior and inferior epigastric vessels anastomosing under the fascial sheath, and six to seven musculocutaneous perforating branches to the skin. The superior epigastric artery and vein, averaging 0.45 mm and 0.5 mm in diameter, can be used as the vascular pedicle in muscle or myocutaneous flap transplantation. Eight muscle and 15 myocutaneous flaps were transplanted to the groin. The myocutaneous flaps averaged 3.5 cm by 1.2 cm in size; the pedicle length averaged 11 mm. The 5 day survival was 100% for muscle flaps and 67% for myocutaneous flaps. The rectus myocutaneous flap is believed to be the first true myocutaneous model in the rat. © 1993 Wiley‐Liss Inc.
Enzymhistochemical evaluation of ulnar nerve grafts in brachial plexus lesions
Authors: Becker Michael H.‐J. , Lassner Franz , Schaller Eberhard , Berger Alfred
Published: March 2007

Our concept for the reconstruction of brachial plexus injuries includes an intercostal nerve transfer to the vascularized ulnar nerve graft. A free neurovascular latissimus dorsi is then transferred in a second stage operation. For optimization of the regeneration result, the operative planning of the second step includes nerve biopsies and enzymhistochemical evaluation for the distribution of motor axons. The staining method according to Scabolcz et al.13 is described and clinical cases are presented. © 1993 Wiley‐Liss Inc.
Replantation of the thumb: Survival rate and functional recovery in correlation with type of injury
Authors: Daoutis N. , Efstathopoulos D. , Gerostathopoulos N. , Misitzis D. , Bouchlis G. , Anangnostou S. , Spiridonos S.
Published: March 2007

During a period of 4 years, we attempted replantation of an amputated thumb in 21 patients. We present the survival rate as well as the functional recovery in correlation with type of injury. In 21 thumbs, 16 survived surgery (76.2%); 2 out of 5 losses belonged to the guillotine category and 3 belonged to the crush‐avulsion category. Out of the 11 thumbs that belonged to the crush‐avulsion type, 8 survived, which is a 72.7% success rate. Eight out of 10 thumbs of the guillotine type survived, an 80% success rate. The cosmetic and functional result was satisfactory. © 1993 Wiley‐Liss Inc.
Preservation of peripheral nerve grafts with Schwann cell culture medium
Authors: Lassner Franz , Becker Michael , Fansa Hisham , Schaller Eberhard , Berger Alfred
Published: March 2007

Preservation of peripheral nerves may, in the near future, play an important role in reconstructive surgery, especially if recent advances in immunosuppressive therapy are taken into account. Therefore, it has to be investigated whether peripheral nerves can be stored for some time after harvesting without diminishing their regenerative potential. Previous experiments of our group could demonstrate only little benefit of organ storage solution (HTK) or normal saline (NaCI 0.9%) to peripheral nerves when kept at cold ischaemia of 4°C for 32 and 72 hours. In this presentation, we are reporting the results of peripheral nerve storage in Dulbecco's Modified Eagle Medium which has been used for Schwann cell culture. In 30 adult Sprague‐Dawley rats, a 2.5 cm segment of the right sciatic nerve was harvested and kept at 4°C for 14, 32, 72, and 120 hours. It was then reimplanted into the donor animal; regeneration quality was assessed clinically, histologically and morphometrically after 6 weeks. Best regeneration results were obtained in the 32 and 72 hour groups; regeneration here was comparable to the normal controls. These results are explained with the positive effect of nerve predegeneration. © 1993 Wiley‐Liss Inc.
Vascular complications of vascularized composite tissue transfer: Outcome and salvage techniques
Authors: Yajima Hiroshi , Tamai Susumu , Mizumoto Shigeru , Ono Hiroshi , Fukui Akihiro
Published: March 2007

Two hundred fifty‐two vascularized composite tissue transfers were performed from 1985 to 1992 at Nara Medical University Hospital. Free tissue transfers were performed in 185 patients and island tissue transfers in 67 patients. Of these, 39 flaps were reexplored because of vascular complications. On initial reexploration, vascular obstruction was found at the site of anastomosis or in the main vascular pedicle in 36 patients and in the perforating vessels to the monitor flap in three patients. Arterial thrombus occurred in 11 patients, venous thrombosis in 12, and both in nine. Twenty‐five reexplored flaps were salvaged. Initially, heparin was administered systemically when vascular compromise was suspected intraoperatively or postopera‐tively. Recently, we have used a „continuous local heparinization”︁ technique to minimize blood loss. This method has been used in 12 patients who underwent reexploration and in nine patients in whom vascular compromise was suspected. Nineteen flaps survived completely, and two flaps failed. © 1993 Wiley‐Liss Inc.
Fiber regeneration in nerve grafts without connection to a target muscle: An experimental study in rabbits
Authors: Koller Rupert , Frey Manfred , Meier Urs , Liegl Christian , Gruber Helmut , Meyer Viktor E.
Published: March 2007

In 30 rabbits, both saphenous nerves were harvested as autografts and coapted to the branch for the rectus femoris muscle without connection to any distal target muscle. The graft from the right thigh was led to the contralateral extremity (crossover grafting). The graft on the left side remained on the same extremity (ipsilateral grafting). Animals were separated into four groups and were sacrificed 3, 6, 9, and 12 months after grafting. Specimens of the grafts and the donor motor branches were harvested for histomorphometric examination. The number of myelinated nerve fibers in the distal end of the nerve grafts was significantly increasing from 3 to 6 months after grafting and remained on a relatively constant level in the long‐term groups. Three months after the first operation, greater numbers of myelinated nerve fibers were counted after ipsilateral grafting than after crossover grafting. In the long‐term groups, this difference could not be observed. © 1993 Wiley‐Liss Inc.
Results of vascularized joint allograft under immunosuppression with cyclosporine
Authors: Muramatsu Keiichi , Doi Kazuteru , Akino Tatuaki , Shigetomi Mitunori , Kawai Shinya
Published: March 2007

The effects of cyclosporine (CsA), a strong immunosuppressive drug, on vascularized allogeneic joint transplantations were examined. An orthotopical transplant model of a vascularized knee joint allograft was developed using inbred DA and Lewis rats to investigate the fate of grafts following withdrawal of short‐term immunosuppression compared to continuous immunosuppression with CsA. Five isograft controls acquired solid bone union at both femur and tibia sites within 4 weeks, and joint function as skeletal support was maintained until 25 weeks. Without immunosuppression, ten allografts were severely rejected within the first week, and joint destruction occurred immediately. Twenty‐five short‐term immunosuppressed rats acquired solid union, but, after withdrawal of immunosuppression, grafted joints showed gradual rejection and were destroyed due to pathological fractures or joint instability, although partial revascularization from the recipient occurred. Ten allografts under continuous immunosuppression at a dose of 10 mg/kg/day showed no rejection and remained viable for 12 weeks postoperatively, but thereafter all rats died. Death was considered to be a side effect of CsA. Fifteen animals, under continuous immunosuppression at a dose of 5 mg/kg/day, showed no rejection except in the bone marrow; the grafted joint function was not effected until 25 weeks. Continuous treatment with low and nontoxic doses (5 mg/kg/day) of CsA was necessary to maintain the functions of the grafted joint. © 1993 Wiley‐Liss Inc.
Uw solution as an experimental microvascular skin flap perfusate
Authors: Weinberg Hubert , Zhang Wen X. , Urken Mark L.
Published: March 2007

UW solution has been found to be an effective organ perfusate for transplantation. Initial studies in experimental pedicle skin flaps have also demonstrated its unique effectiveness in prolonged ischemia. To understand better the limits of its preservation properties without the influence of endothelial clamp damage, we have undertaken to study the properties of UW solution in experimental microvascular free flaps. Control, lactated Ringer's, and UW solutions were utilized in pedicle and microvascular free flaps in Sprague‐Dawley rats over varying periods of ischemia. UW solution demonstrated a clear superiority over all other solutions in both flap models. In addition there also was a significant prolongation of critical ischemia time in UW‐treated free flaps compared to pedicle flaps. © 1993 Wiley‐Liss Inc.
Protocol for the technique of orthotopic liver transplantation in the rat
Authors: Kobayashi Eiji , Kamada Naoshi , Goto Shigeru
Published: March 2007

Orthotopic rat liver transplantation (OLT) has been generally accepted as an excellent model for the analysis of pathological, physiological, and immunological aspects related to organ transplantation. However, many researchers require a long training period to achieve a high success rate using this major surgical procedure on small animals. We therefore developed a protocol for learning rat OLT. It is recommended, initially, that the heterotopic heart transplantation (HHT) model be used to master the cuff technique, since this technique is similar to that in OLT and leads to an understanding of another organ transplantation technique. For beginners who advance beyond the HHT step to OLT but cannot finish the anhepatic phase within 30 min, we recommend the use of portosystemic‐shunted rats as recipients. These animals have had their spleens transposed subcutaneously more than 3 weeks before use. The use of these modifications and this training program makes it possible to master the techniques and to achieve a high success rate with a short training period. © 1993 Wiley‐Liss Inc.
Precision of suture placement with microscope‐ and loupe‐assisted anastomoses
Authors: Rooks Michael D. , Slappey Joseph , Zusmanis Kathy
Published: March 2007

Twenty‐eight anastomoses involving seven surgeons were done on 2 mm Gortex vascular prostheses to test the effect of magnification on the precision of suture placement. One‐half were done with 3.5‐4 × prism loupe magnification and the other one‐half with 8‐30 × microscope magnification. The variability of suture placement (defined here as precision) was measured in a blinded fashion. The mean suture puncture to prosthesis edge measurement for the microscope‐assisted group was ∼ 0.03 mm closer to the edge. The variability from the mean for the microscope‐assisted group was ∼ 0.01 mm less than that for the loupe‐assisted group. This difference was statistically significant at a P value of 0.0123. © 1993 Wiley‐Liss Inc.
Non‐revascularized epigastric free flap: No all‐or‐none survival pattern
Authors: Franken Ralph J. P. M. , Werker Paul M. N. , Overgoor Max L. E. , Kon Moshe
Published: March 2007

We have previously shown that the epigastric flap in Dark Agouty rats, measuring approximately 6 × 4 cm with borders related to well‐defined anatomical structures, does not exhibit an all‐or‐none survival pattern. This study was designed to investigate the survival pattern of non‐revascularized epigastric flaps in three other rat strains (Sprague‐Dawley, Brown‐Norway, and Lewis). In concordance with our earlier observations, but in contrast to reports by many other groups, in none of the used strains was an all‐or‐none survival pattern observed. Survival varying from 2 to 30% (mean, 12%) of the original flap, without significant differences between the strains, was found. The locations of survival exhibited a clear pattern, probably owing to the fat pad in the subcutis and revascularisation from the recipient wound edges. © 1993 Wiley‐Liss Inc.
Axonal regeneration rate through cross‐face nerve grafts
Authors: Braam Marjorie J. I. , Nicolai Jean‐Philippe A.
Published: March 2007

The disfigurement of irreversible unilateral facial paralysis can be corrected by cross‐face nerve grafting in conjunction with muscle transplantation. A total of 33 patients underwent cross‐face nerve grafting using the sural nerve prior to undergoing the second stage of the procedure. Before a muscle transplant can be successfully connected to the distal end of the cross‐face nerve graft, the regenerating axons need to have grown from the contralateral facial nerve to the distal end of the nerve graft. This can be tested by the Tinel sign. A retrospective study was performed to determine the rate of growth of regenerating axons through the cross‐face nerve graft. A rate of axon growth of 1.8 mm/day was found, and also an inverse relationship between the age of the patient and the regeneration rate. These results can be used as a guide in planning patients' treatment. © 1993 Wiley‐Liss Inc.
Inside‐out vein graft promotes improved nerve regeneration in rats
Authors: Wang Kai‐Kai , Costas Paul D. , Bryan David J. , Jones David S. , Seckel Brooke R.
Published: March 2007

Vein grafts have been used both experimentally and clinically to bridge gaps in peripheral nerves. This study describes a modification of the vein graft technique in which vein graft conduits are pulled inside‐out before anastomosis with proximal and distal nerve stumps. This technique creates an autogenous vein conduit with the collagen‐rich adventitial surface exposed to the regenerating axons. The inside‐out technique is a fast and simple modification of the standard vein graft technique and produces an accelerated rate of nerve regeneration and significantly earlier myelination compared with the results obtained from the use of polyethylene nerve guides and standard vein graft conduits. © 1993 Wiley‐Liss Inc.
Free fibular transfer in a growing individual (long‐term results)
Authors: Concannon Matthew J. , Croll Gregory H. , Boschert Mark T. , Gaines Robert W. , Puckett Charles L.
Published: March 2007

We present a case report of a 4‐year‐old in whom the distal fibula and epiphyseal plate had been traumatically destroyed. A free vascularized epiphyseal transfer using the ipsilateral proximal fibula was performed which provided good bony stability at the ankle, as well as excellent long‐term growth characteristics. We demonstrate immediate postoperative results, as well as long‐term (5 years) follow‐up. © 1993 Wiley‐Liss Inc.
Reconstruction of oropharyngeal defects utilizing a free radial forearm flap
Authors: Aki Fabio Ezo , Besteiro Julio Morais , Ferreira Marcus Castro
Published: March 2007

The authors report their experience with free radial forearm flaps for oropharyngeal reconstruction.

Fifteen patients who submitted to intraoral reconstruction with this flap were followed for periods ranging from 3 to 36 months, with a mean of 14 months. Ages ranged from 15 to 58 years with a mean of 41. The defects were secondary to tumor ablation (11 patients), complications of conventional treatment for congenital deformities (3 patients) and trauma resulting from a gunshot wound to the upper lip and palate (1 patient).

Total necrosis of 1 flap occurred and 1 patients required reoperation on the first postoperativeday for revisionof the anastomoses.

Our results enable us to recommend the radial forearm flap as the flap of choice for reconstruction of extensive oropharyngeal defects. © 1994 Wiley‐Liss, Inc.
Extraplexual neurotization of brachial plexus
Authors: Azze Ronaldo J. , Mattar Rames , Ferreira Marcus Castro , Starck Regina , Canedo Antonio Carlos
Published: March 2007

The authors reviewed 62 neurotizations of the brachial plexus in 71 patients performed between 1974 and 1989. The nerves used were the accessory, the motor or sensory branches of the cervical plexus, and the intercostals. Twenty‐five suprascapular nerves, 19 musculocutaneous, 4 medial roots of the median nerve, and 12 lateral roots of the median nerve were neurotized. The authors concluded that useful results can be achieved using extraplexual neurotizations. © 1994 Wiley‐Liss, Inc.
Reconstruction of the foot with microvascular free flaps
Authors: Ferreira Marcus Castro , Besteiro Julio Morais , Monteiro Araldo A. , Zumiotti Arnaldo
Published: March 2007

Reconstruction of the foot using microvascular flaps has been widely performed in the last 15 years but the choice of flap to repair some areas in the foot remains controversial. We present a series of 128 free flaps to the foot performed during the period of 1975–1990. One hundred and seventeen had a successful outcome (91%). The etiology of the problem was traumatic in 94, congenital in 10, tumor in 9, and chronic ulcerations due to vascular problems in 15. The indications for a specific flap depended on the site and extension of the foot problem, and were divided into four groups:

Dorsum of the foot. Cutaneous parascapular flap was the best choice.

The sole‐weight‐bearing area. We favored the use of the latissimus dorsi muscle flap covered with a split thickness skin graft, done immediately. A proper tailoring of the flap and postoperative care by the patient are very important to maintain the result without ulceration. Tactile sensation does not seem to be essential.

The area over the calcaneus tendon. We have used cutaneous flaps such as the parascapular and lateral arm flap or fascial flaps covered by split thickness skin grafts (STSG). The fascia used were the serratus or the parascapular.

Complex trauma problems with extensive skin loss or chronic ulcerations due to vascular diseases: the latissimus dorsi musculocutaneous or muscle plus STSG was mostly used.

The overall number of donor areas were 5 groins, 48 parascapular, 2 gluteal fold flaps, 4 lateral arm, 61 latissimus dorsi, and 8 fascial flaps. © 1994 Wiley‐Liss, Inc.
Treatment of congenital pseudarthrosis of the tibia by microsurgical fibula transfer
Authors: Zumiotti Arnaldo , Ferreira Marcus Castro
Published: March 2007

Conventional methods for the treatment of congenital pseudarthrosis of the tibia (CPT) often lead to unsatisfactory results and so microsurgical fibula transfer (MFT) has appeared as an option to treat this challenging problem.

In this series of 27 patients with CPT, we obtained satisfactory results in 23 as assessed by the timing of bone union and bone hypertrophy of the fibular transplant.

The overall functional results were also good; in 18 patients, the residual shortening was less than 2 cm (with no limb shortening in 4) and in 7, shortening ranged between 2 and 4 cm. All 25 patients resumed normal walking without the help of braces after an average of 12 months. This report suggests that microvascular fibula transfers provide superior results in the treatment of CPT, especially when considering that many of such cases represented previous surgical failures. © 1994 Wiley‐Liss, Inc.
Distal adrenergic innervation remains normal after perivascular sympathectomy
Authors: Kaarela Outi I. , Raatikainen Timo K. , Junila Juhani A. , Waris Timo H.
Published: March 2007

Perivascular sympathectomy, which has been used for vasospastic disorders of the hands, was examined in experimental models. Perivascular sympathectomy was performed on the central ear vessels and forepaw metacarpal vessels of the rabbit and on the common digital vessels in the monkey. The effects on adrenergic nerves were studied using a glyoxylic acid‐induced fluorescence method. Adrenergic nerves were removed only at the site of the perivascular sympathectomy and the distal adrenergic innervation appeared normal. Because the distal sympathetic nerves appeared normal after the operation, it should rather be called adventitectomy and we feel its clinical effects should be reevaluated. © 1994 Wiley‐Liss, Inc.
Evaluation of a temporary arteriovenous shunt to establish neovascularization in a musculocutaneous flap: An experimental study
Authors: Zhou Zhao Y. , Nichter Larry S. , West Brian R. , Navarrette Patricia M.
Published: March 2007

On the dorsum of adult Sprague‐Dawley rats, 3 × 7 cm pedicle flaps were raised and a temporary arteriovenous shunt (AVS) from anastomosis of the tail artery and vein was placed beneath. Fourteen, 21 and 28 days later, the pedicle flaps were converted to island flaps leaving only the AVS attachment. The degree of subsequent flap viability was directly related to the amount of time before flap conversion. At 14, 21 and 28 day intervals, there was 33.4%, 73.5% and 98% flap viability, respectively. Long‐term AVS patency was found not to be required for flap survival. Normal hair growth, quantity and quality, occurred in only the 28 day delay group. Microangiography and histologic examination revealed extensive neovascularization from both the AVS artery and vein extending into the muscle, subcutaneous tissue and skin layers of each island flap.

In summary, neovascularization of a large random pattern musculocutaneous island flap is possible using a temporary arteriovenous shunt. Flap survival is directly related to the length of time between AVS placement and cutaneous pedicle division, although long‐term AVS patency is not required for continued flap viability. Hair growth may directly reflect the degree of underlying neovascular maturation. This AVS neovascularization technique could be applied to create new donor sites for free tissue transfer. © 1994 Wiley‐Liss, Inc.
Distal phalanx replantation
Authors: Chen Chien‐Tzung , Wei Fu‐Chan , Chen Hung‐Chi , Chuang Chwei‐Chin , Chen Hung‐Tang , Hsu Wen‐Ming
Published: March 2007

Microsurgical replantation has been attempted in the distal phalanx of the digits. Twenty‐three complete, single digit amputations are reviewed. The patients' ages ranged from 9 months to 48 years. Viability was 78%. Sensory recovery averaged 7 mm static two‐point discrimination. Range of motion in the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb averaged 64 and 51 degrees, respectively. Eight of the 17 successfully replanted digits had mild to moderate atrophy. Eighty‐two percent of patients were able to use the replanted digit successfully in their daily work. We feel that distal digital replantation is rewarding. In successful cases, it always preserves acceptable function and good appearance at a price of an average of 2.3 months off work. © 1994 Wiley‐Liss, Inc.