bluuebunny/crossref_metadata_2025 huggingface dataset:
The greater omentum transplantation model in the rat
Authors: Zhang Feng , Lineaweaver William C. , Kao Samuel , Newlin Leonard , Buncke Harry J.
Published: March 2007

Dissections of the rat omentum were performed to study the feasibility of rat omental free transfer. The right epiploic vessels were found to be adequate for anastomosis in transfer. Twelve omental free flaps were transferred to the groin, with 100% survival of flaps in the 10 animals that survived the operation. The artery and vein averaged 0.3 and 0.4 mm in diameter, respectively. The average pedicle length was 5 mm, and the average flap weight was 136.9 mg. This omental transplant offers a new experimental means of studying lymphedema, neovascularization, and tissue revascularization. © 1994 Wiley‐Liss, Inc.
Successful heterotopic heart transplantation in rat
Authors: Schmid Christof , Binder Jochen , Heemann Uwe , Tilney Nicholas L.
Published: March 2007

Heterotopic heart transplantation in rats has become a substantial tool for numerous investigations. This report describes a surgical technique of infrarenal heterotopic heart transplantation with a prodigious surgical success rate which was developed over many years of practice. Difficulties arising from anatomic variations are depicted and alternative approaches are discussed. © 1994 Wiley‐Liss, Inc.
Postoperative results of vascularized double fibula grafts for femoral pseudoarthrosis with large bony defect
Authors: Tomita Yoshitsugu , Murota Kagehisa , Takahashi Fumito , Moriyama Masatoshi , Beppu Moroe
Published: March 2007

In open femoral bone fractures osteomyelitis may develop as a complication. Many difficulties are experienced in the treatment of those fractures because an extended bone defect may be formed after repeated operations, and then amputation of the femoral bone becomes necessary. Since 1981 the present authors have performed the vascularized double fibula grafts in the treatment of 18 patients with successful results. With this grafting method, both vascularized double fibula grafts are collected at the same time, one as an intramedullary graft and the other as an onlay graft.

The most important point in carrying out grafting by this method is to prepare the recipient bone bed adequately. In many cases, it is necessary to carry out the primary operation to curette the focus, and resect necrotic tissues and sequestrated bone before the vascularized double fibula grafts, and then grafting is performed as a second operation after infection has been controlled following the initial operation. Although differences in time required for recovery cannot be eliminated completely, it becomes possible for 16 out of 18 patients to walk without the use of a brace and crutches within 13 months on average. © 1994 Wiley‐Liss, Inc.
A modified free gracilis flap in the rat
Authors: Yeh Lih‐Seng , Hou Sheng‐Mou , Lin An‐Chung , Lin Jinn
Published: March 2007

We present in this paper the use of a combined neurovas‐cularized flap of gracilis muscle and inguinal skin in the rat with the femoral vessels and obturator nerve serving as the pedicles. The epigastric, saphenous, and muscular branch vessels arising from the femoral vessels were preserved, and a portion of adductor magnus muscle was included in the flap to protect the delicate muscle vessels at their origins. The inguinal skin and muscle flap both had independent blood supplies, thus, separate assessment of muscle and skin rejection was possible in the single transplanted “packet.” The muscle flap with the reconnected motor nerve regained contractile ability upon nerve stimulation within 30 days after the iso‐transplantation. The results suggest that the modified gracilis myocutaneous flap provides an ideal model for transplantation research. © 1994 Wiley‐Liss, Inc.
Pattern assembly—an aid to flap design during oral microsurgical reconstruction
Authors: Grime Peter David , Wei Fu‐Chan
Published: March 2007

Surgical ablation of tumors within the oral cavity results in a three‐dimensional defect and a potential puzzle for the reconstructive surgeon. Although a myriad of papers discussing the relative advantages and disadvantages of various methods of reconstruction are readily available for consultation, very few publications have provided the surgeon with a guide either to visualization of the defect or to how to reconstruct a three‐dimensional defect with an essentially two‐dimensional flap. Our intention is not to provide the answer for every oral reconstructive problem—after all, no two patients are alike—but we will demonstrate that an appreciation of the defect in three‐dimensions, together with an understanding of oral function, provides a template for flap design and inset. This is achieved by simplifying the complex anatomical shape of the oral cavity into a geometric form from which a series of simple, easily recognisable shapes can be derived and assembled as necessary into a pattern that reproduces the defect, providing a template for flap design and inset. © 1994 Wiley‐Liss, Inc.
Fibula osteoseptocutaneous free flap in maxillary reconstruction
Authors: Yim Kenneth K. , Wei Fu‐Chan
Published: March 2007

The skin paddle in the fibula osteoseptocutaneous flap is thin, soft, and pliable, and it can be used for external skin coverage and intraoral linings. The flexibility of the fibula in three‐dimensional positioning after multiple osteotomies is desirable in complex spatial skeletal reconstruction. The fibula osteoseptocutaneous flap is suitable for one‐stage reconstruction of composite maxillary defects. The unique characteristics of the fibula osteoseptocutaneous flap and its application in the one‐stage composite maxillary defect are discussed. © 1994 Wiley‐Liss, Inc.
Selection of recipient vessels for free flaps to the distal leg and foot following trauma
Authors: Chen Hung‐Chi , Chuang Chwei‐Chin , Chen Samuel , Hsu Weng‐Ming , Wei Fu‐Chan
Published: March 2007

The recipient vessels are of prime importance in free flap transfers to the lower limbs. To determine the incidence and pattern of vascular trauma, a study was carried out in 126 patients who had Gustillo Type III open fractures of the distal legs and feet that required free flaps for wound coverage.

In comparison with the posterior tibial artery, the anterior tibial artery has a much higher incidence of injury with more extensive damage. It can be injured at a more proximal level than estimated from gross inspection during surgery. This should be borne in mind when the anterior tibial artery is selected as the recipient artery in order to prevent reexploration and failure of the flaps. However, the posterior tibial artery is much less vulnerable to damage in most injuries and is more reliable as the recipient artery. In this series there was no problem in finding proper recipient veins in the legs. A general principle is proposed for selecting recipient vessels in crushed legs, with a warning against the pitfalls that have been encountered. © 1994 Wiley‐Liss, Inc.
In vivo microscopy of microcirculatory injury in skeletal muscle following ischemia/reperfusion
Authors: Pemberton Mark , Anderson Gary , Barker John
Published: March 2007

While the sequence of biochemical and cellular events in the pathogenesis of ischemia/reperfusion injury is increasingly well understood, the way that these processes interact at the level of microcirculation to promote a distinctive reperfusion injury is less well defined. It is becoming clear, however, that these processes are initiated at the level of microcirculation, and that microcirculatory damage may precede actual tissue injury. Such damage causes microvascular no‐reflow, which in turn effectively prolongs the time of tissue ischemia and extends tissue injury. Recently, microcirculatory models have been adapted for study of the microvascular effects of ischemia/reperfusion. We have used a new in vivo mouse cremaster muscle model to study, by direct and quantitative measurement, the acute microvascular changes involved in ischemia/reperfusion. Previously described changes in capillary perfusion and venular leukocyte adhesion were observed in this model following reperfusion after prolonged ischemia (4–6 hours). We have further characterized an intense reactive vasoconstriction or vasospasm that occurs after prolonged ischemia; this vessel reaction may represent an important overlooked cause of no‐reflow following ischemia/reperfusion. This article summarizes our work in the context of other available methods that have been used to define the microvascular changes of ischemia/reperfusion. © 1994 Wiley‐Liss, Inc.
Microcirculation research, angiogenesis, and microsurgery
Authors: Frank Johannes M. , Kaneko Shino , Joels Charles , Tobin Gordon R. , Banis Joseph C. , Barker John H.
Published: March 2007

Angiogenesis, the formation of new blood vessels, is essential to a variety of normal and pathologic processes such as wound healing and tumor growth. In microsurgery the development of new vessels between the transferred tissue and the recipient bed is critical to the final outcome of the reconstruction.

Several experimental models have been previously developed to study angiogenesis and the effect that new substances have on regulating this process, but they lack the ability to make quantitative measurements. Therefore, we have developed an animal model using the homozygous (hr/hr) hairless mouse ear; by using intravital microscopy and computer‐assisted analysis, angiogenesis can be quantitatively measured. Using this model we showed that basic fibroblast growth factor and transforming growth factor beta significantly increased total vessel length by 32% and 63%, respectively, during 20 days following subcutaneous injection. In this paper the importance of angiogenesis research to reconstructive microsurgery is presented and discussed. © 1994 Wiley‐Liss, Inc.
Direct visualization and measurement of microsurgically induced thromboembolism
Authors: Andresen Dorthe M. , O'Shaughnessy Michael , Acland Robert D. , Anderson Gary L. , Schuscke Dale , Banis Joseph , Barker John H.
Published: March 2007

A common cause of free flap and replant failure is thrombotic occlusion of the anastomosed pedicle vessel(s). Clinical observations and subsequent experimental studies showed that platelet emboli generated at the arterial anastomosis caused significant alterations in the downstream microcirculation. To study both the thrombogenic arterial (anastomosis) site and the downstream microcirculation, we developed an animal model (the isolated rat cremaster) in which we could directly view and quantitatively analyze thrombus formation and the appearance of emboli in the downstream microcirculation. Using this model we studied the effect that reducing blood flow across the arterial anastomotic site had on thrombus formation at the anastomotic site and the appearance of emboli in the downstream microcirculation. In 40 male Spra‐gue‐Dawley rats we found that reducing blood flow velocity to approximately half of normal during reperfusion nearly eliminated emboli appearing in the downstream microcirculation compared with controls, 43.9 ± 31.5 vs. 259.5 ± 117.8 emboli, respectively. We also found that the same low flow had no effect on thrombus size at the pedicle artery injury site yet significantly decreased the rate at which thrombus formation occurred (time to maximum thrombus size; low flow = 25.3 ± 8 minutes, normal flow = 6.6 ± 3 minutes). From these studies we conclude that reducing pedicle artery blood flow in our rat model during reperfusion can protect the downstream microcirculation from platelet emboli‐induced injury; however, the same reduction in flow does not affect thrombus formation in the pedicle artery. Further studies using direct observation/measurement techniques are needed for a better understanding of the mechanisms regulating free flap and replant failure. © 1994 Wiley‐Liss, Inc.
Microvascular response in the rabbit ear to total body cooling: A model for study of human digits
Authors: Pollock F. Edward , Smith Thomas L. , Koman L. Andrew
Published: March 2007

Conditions such as Raynaud's disease, cold intolerance following digit replantation, and reflex sympathetic dystrophy are all exacerbated by diminished blood flow in the digits. The rabbit ear, being similar to the human digit, is an excellent model for studying microvascular responses during thermoregulation and was used in this study of microcirculatory changes during total‐body cold stress. In eight rabbits a window was placed in one ear each, and the underlying vascular beds were photographed with the unanesthetized animal at room temperature (23°C) and in a cold room (6°C). Luminal arterial diameters constricted more than venular diameters during cold stress (39.6% vs. 16.5%, respectively, of the control diameters; P = 0.014). All responses were linear; the slopes of the regression lines were significantly different between arterioles and venules (P < 0.0001). This study suggests that decreased circulation in response to cold is due to decreases in the diameter and number of vessels available for perfusion, as predicted by the Poiseuille equation. © 1994 Wiley‐Liss, Inc.
A comparison of nerve grafting and tissue expansion techniques in the rat
Authors: Hall Gary D. , van Way Charles W.
Published: March 2007

This study compares nerve repair following tissue expansion with nerve repair using an interposed graft in the rat. Group I had expansion conducted over 2 weeks at 40 mmHg. A 4 mm segment was excised from the lengthened nerve and repaired primarily. Group II had a 4 mm segment of nerve excised and then replaced as an interposition graft. Group III was sham‐operated controls. Thirteen weeks postoperatively, all animals were evaluated using walking track analysis. Thirty‐five rats finished the study: Eleven in group 1, 10 in group II, and 14 in group III. The Sciatic Functional Index (SFI) was calculated for each group as follows: group l, −57 ± 11 (mean ± standard deviation); group II, −59 ± 25; group III, −13 ± 6.5. The control group was significantly better than either experimental group (P < 0.01). The two experimental groups were not statistically different. Nerve repair following expansion allowed only one coaptation to be used. Functional results were the same as with interposition grafting. Repair by the expansion technique would eliminate the need to harvest a nerve graft, and the subsequent donor defect. © 1994 Wiley‐Liss, Inc.
Continuous rat intravenous infusion
Authors: Kononov Anatoly , Browne Earl Z. , Alexander Frederick , Porvasnik Stacy
Published: March 2007

Hypovolemic shock and ischemic injury to the graft commonly cause death in small animals after organ transplantation. A venous line must be readily available to replace fluids before fatal complications occur. To establish a venous line, researchers expose a vein by preliminary surgery. This time‐consuming procedure adds unnecessary trauma to the recipient and worsens the results. The possibility of long‐term fluid transfusion in small animals by serial injections at close intervals is quite limited.

We describe a simple technique of continuous IV infusion by catheterization of the rat dorsal penile vein with a 24‐gauge, 3/4‐inch catheter. This easy‐to‐learn technique has permitted us to establish a venous line quickly without trauma in 148 rats while doing donor and recipient procedures for small bowel and ileocecal segment transplantation. The technique we describe has eliminated one of the most frequent causes of postoperative mortality after organ transplantation—hypovolemic shock. We would like to emphasize that other measures, including avoiding massive bleeding and reducing operative and warm ischemic time, are also very important in preventing this complication. The massive IV infusion alone may not totally eliminate hypovolemic shock if other factors are neglected. The use of this technique has allowed us to perform small bowel transplantation with 90% success. © 1994 Wiley‐Liss, Inc.
Bilateral thumb amputation
Authors: Soucacos Panayotis N. , Beris Alexandros E. , Malizos Konstantinos N. , Touliatos Alexandros S.
Published: March 2007

Seventy‐one patients with thumb amputations, 45 complete and 26 incomplete nonviable, have been treated at the Microsurgical Unit of the Department of Orthopaedic Surgery at the University of Ioannina Medical School over the past 15 years. Of these thumb amputations, which included crush, avulsion, and guillotine injuries, three cases involved amputation of both thumbs. The three patients with complete bilateral thumb amputations are presented. Because of the importance of the thumb, microsurgical replantation efforts were made which proved successful for two of the patients. Replantation efforts in the third patient, who had severe crush injuries of both thumbs, were not successful. Bilateral thumb amputation is a serious and disabling injury. When replantation is attempted by a team of surgeons well trained in microsurgery, the final result can be impressive, with exceptionally good function of the replanted thumbs. © 1994 Wiley‐Liss, Inc.
Microsurgical treatment of ring avulsion injuries
Authors: Beris Alexandros E. , Soucacos Panayotis N. , Malizos Konstantinos N. , Xenakis Theodore A.
Published: March 2007

Fourteen patients with ring avulsion injuries were treated at the University of Ioannina from 1982 to 1991. One patient was classified as Urbaniak class II, and microsurgical repair produced good functional results. The remaining 13 patients had class III injuries. Six of these patients had class IIIa injuries, defined as skin avulsions at the level of the proximal phalanx, amputation at the distal interphalangeal joint with an intact flexor digitorum superficialis. Replantation was successful in four patients. Seven patients had class IIIb injuries, defined as skin avulsion and complete amputation at the level of the proximal phalanx, with severance of both flexor tendons. Replantation was successful in four patients, with compromised functional results in two. Primary surgical repair is the treatment of choice for class II and IIIa injuries which usually have rewarding results. Although there may be some functional compromise following replantation in class IIIb injuries in adults, we suggest that microsurgical replantation should also be attempted after the prognosis is clearly explained to the patient. © 1994 Wiley‐Liss, Inc.
Major limb replantation in children
Authors: Beris Alexandros E. , Soucacos Panayotis N. , Malizos Konstantinos N. , Mitsionis Gregory J. , Soucacos Panayotis K.
Published: March 2007

After the first successful replantation of a completely amputated extremity in a 12‐year‐old boy undertaken by Ronald Malt at the Massachusetts General Hospital in 1962 (Malt and McKhann, Journal of the American Medical Association, 189:716–722, 1964) numerous series of major limb replantations have been reported in adults. The reports of major limb replantation in children are relatively rare and are usually included in adult series. During the last 14 years, 18 children with major limb amputations were treated at the Microsurgical and Replantation Unit of the Department of Orthopaedic Surgery at the University of Ioannina Medical School. Of these, 13 were complete amputations (11 upper extremity and 2 lower extremity), while 5 were incomplete nonviable amputations (3 upper extremity and 2 lower extremity). The success rate following replantation of the complete amputations was 76.9%, while for the incomplete, nonviable amputations success was 80%. Preoperative evaluation, operative management, postoperative care, and the results of this difficult but rewarding procedure are analysed and discussed in this review. © 1994 Wiley‐Liss, Inc.
Osteonecrosis of the femoral head in immunosuppressed patients: Hip salvaging with implantation of a vascularised fibular graft
Authors: Malizos Konstantinos N. , Soucacos Panayotis N. , Beris Alexandros E. , Korobilias Anastasios B. , Xenakis Theodore A.
Published: March 2007

Osteonecrosis frequently occurs in patients being treated with steroids for conditions such as systemic lupus erythematosus and other collagen diseases and in renal transplant recipients. It remains an unsolved problem and can cause more disability than the underlying disease, particularly in young patients. In a series of eight young patients who received continuous corticosteroids and immunosuppressive agents, we attempted hip salvage in ten joints by implantation of a vascularised fibular graft into the necrotic femoral head. Follow‐up ranged from 18 to 36 months. Joints which were operated on prior to articular surface collapse had complete restoration of normal function. In patients with more advanced lesions, surgery resulted in a painless hip, improved range of motion, and cessation of further progress of the disease. The preliminary data are considered encouraging enough to suggest that the vascularised fibular graft is an appropriate method for hip salvage in immunosuppressed patients with osteonecrosis of the femoral head. © 1994 Wiley‐Liss, Inc.
A rabbit ear model for cold stress testing
Authors: Smith Thomas L. , Gordon Stanley , Holden Martha B. , Smith Beth P. , Russell Gregory B. , Koman L. Andrew
Published: March 2007

A rabbit ear model resembling the human digit was studied to determine the vascular response of the rabbit ear to a cold stress. Following moderate cooling (10 minutes at 5°–8°C), auricular blood flow and cutaneous perfusion were reduced. This decrease was reversed by 30 minutes of warming. The response in the rabbit ear to cold stress is similar to that of normal human digits. The similarities between the control of the circulation in human digits and rabbit ears may result from the similarities in digital and auricular vascular receptors and receptor subtypes. Verification of the rabbit model provides an experimental method for obtaining important data regarding digital pathophysiology and the treatment of cold intolerance. Further study with this model will provide clinically relevant information regarding the pathophysiology of digital thermoregulatory abnormalities. © 1994 Wiley‐Liss, Inc.
Prefabricated flap size limitations utilizing an omental carrier
Authors: Zhang Ling , Michaels Basil M. , Bakshandeh Norman , Tuchler Robert E. , Siebert John W. , Kasabian Armen
Published: March 2007

Several researchers and clinicians have taken advantage of the omentum's rich vascular arcades to support skin grafts. We have previously described an experimental model using the omentum as a vascular carrier for prefabricated free flaps in the rat. In this study, we used this model to compare three different sizes of free flaps using the same size omental carrier. Twenty‐four male Sprague‐Dawley rats were used for this study. A 2.5 × 4 cm patch of omentum with gastroepiploic vessels and its rich vascular arcades was transferred under a bipedicled 2.5 × 6 cm (group I), a 2.5 × 8 cm (group II), and a 4 × 10 cm (group III) right abdominal panniculocutaneous flap. On the seventh postoperative day, the skin pedicles were divided and the skin flap raised as a composite island flap vascularized only by the underlying omental patch. The composite flap was then sutured back in place. Prefabricated flaps examined 7 days postoperatively demonstrated a dye florescence index percent (DFI) of 38.19 ± 7.52 and 98.13 ± 3.72% flap survival (FS) in the 6 ± 2.5 cm skin flap group; a DFI of 39.96 ± 6.81% and FS 94.88 ± 7.08% in the 8 ± 2.5 skin flap group (P > 0.05) and a DFI 29.71 ± 2.85% and FS 57.06 ± 9.52% in the 10 × 4 cm skin flap group (P < 0.05). India ink injection study and histologic examination confirmed revascularization of the overlying skin at 7 days. This study confirms that omentum can be used as a vascular carrier for prefabricated flaps. However, there is a limit to the size of the flap. A 10 cm2 carrier can support 57% of a 40 cm2 (10 × 4 cm) flap for a total area of 22.8 cm2, more than twice the area of the carrier. © 1994 Wiley‐Liss, Inc.
Hemodynamic comparison of microsurgical repairs for large arterial defects
Authors: Cipoletti Robert D. , Moneim Moheb S. , Greene E. R.
Published: March 2007

Twenty‐eight femoral arteries in 14 rats were used to compare transverse closures and end‐to‐end anastomoses in blood vessels approximately 1 mm in diameter. The transverse closures were applied to arteriectomies created by excising one‐half the circumference of the vessel over a length of 1 mm. The end‐to‐end anastomoses were performed after resecting a 1‐mm segment. Recordings were made of pre‐and postrepair flow velocity and three‐point diameter measurements every 5 minutes using a 20‐MHz pulsed Doppler velocimeter and digimatic caliper. Maximum reductions in flow velocity were 18% and 31% for the transverse repair and end‐to‐end anastomosis, respectively. Otherwise, intergroup comparisons of the postrepair normalization of both flow velocity and vessel diameter showed few significant differences (P < 0.05). We conclude that arterial defects involving no more than half the diameter of the vessel can be effectively repaired in significantly less time using the transverse closure. © 1994 Wiley‐Liss, Inc.
Congenital pseudarthrosis of the tibia in adults treated by a free vascularized iliac crest graft
Authors: Kumta S. M. , Spinner R. , Hung L. K. , Leung P. C.
Published: March 2007

Congenital pseudarthrosis of the tibia is a rare condition. It usually presents during early childhood, at which time the surgeon is faced with numerous challenges including difficulties in achieving union and preventing refractures and recurrences. Patients frequently end up with a severe deformity or an amputation. When an adult patient presents with previously untreated congenital pseudarthrosis of the tibia, the surgeon is faced with the additional problems of a longstanding soft tissue contracture and disuse atrophy of the limb. Two patients with congenital pseudarthrosis of the tibia were treated by free vascularized iliac crest graft. Soft tissue deformity was corrected using an external fixation device. The patients were not freely ambulatory before surgery. Union across the pseudarthrosis was achieved in both patients with a double‐staged operation, within a short period of time. A functional stable painless limb with good knee and ankle motion has allowed both patients to resume bipedal gait and achieve a successful rehabilitation. © 1994 Wiley‐Liss, Inc.
Modern therapeutic approaches to postmastectomy brachial lymphedema
Authors: Filippetti Massimo , Santoro Emanuele , Graziano Franco , Petric Marija , Rinaldi Giuseppe
Published: March 2007

Over the past 10 years we have treated 36 patients affected by upper limb lymphedema, associated with mastectomy and axillary dissection, by either macrosurgical exeresis or microsurgical techniques. All cases had been unresponsive to prior drug or physical therapy (pressure and thermal therapy). Preoperative upper limb status was thoroughly examined by evaluating volume measurements, dynamic lymphoscintigraphy, venous Doppler fluximetry, ultrasonography, and nuclear magnetic resonance. Selected tests were repeated during follow‐up to obtain more statistically significant results. Twenty‐five of the 36 patients in our series presented a grade II lymphedema and underwent Degni‐Cordeiro's microsurgical indirect lymphatico‐venous shunt (L.V.S.) surgery. Fifteen of the 25 also received fasciotomies performed along the posterior aspect of the forearm. Three of the 36 patients presented grade II lymphedema and upper limb venous hypertension. These were treated with multiple fasciotomies alone. The remaining eight patients presented grade III lymphedemas. Seven underwent Kondoleon's partial superficial lymphangectomy, and one was treated with Servelle's total superficial lymphangectomy. Of the 36 patients who underwent surgery, only 27 were checked at 6 months; 22 were seen at 18 months. The remaining patients were followed up for too short of a period of time to be considered. Results were arranged into three groups. Classification criteria were: reduction of upper limb dimensions and the presence of the pre‐existing symptoms (episodes of lymphangitis, pain, functional deficits). Results were considered good (class 3), fair (class 2), or poor (class 1). A positive clinical picture (class 2–3) was seen in 74% (20/27) at 6 months and in 59% (13/22) at 18 months. Of the patients who had undergone microsurgery, 74% (14/19) showed a positive clinical appraisal at 6 months and 55% (10/18) at 18 months. Of the patients who had undergone Kondoleon's and Servelle's macrosurgery, 66% (4/6) showed positive results at 6 months and at 18 months. Since a mere handful of patients were treated by fasciotomy alone, relevant results are not statistically significant. © 1994 Wiley‐Liss, Inc.
A simple emergency method for improvising a lost surgical loupe's hinge screw
Authors: Fraser Keith E.
Published: March 2007

The unexpected loss of a surgical loupe's hinge screw renders surgical loupes virtually useless, and this can have a profound effect on the performance of a tedious microsurgical procedure. The author has devised what is believed to be an extremely practical and effective method for performing an emergency repair of these glasses that utilizes common operating room suture material. This method has many distinct advantages over numerous makeshift remedies that have been attempted by surgeons over the years. To the author's knowledge, this is the first paper to appear in the literature addressing this familiar and not uncommon problem. © 1994 Wiley‐Liss, Inc.
Manipulating prefabricated flaps: An experimental study examining flap viability
Authors: Maitz Peter K. M. , Pribaz Julian J. , Hergrueter Charles A.
Published: March 2007

As flap prefabrication becomes a more commonly used clinical tool, it is necessary to investigate the limitations of this technique. Reconstructive procedures of the face often require “custom fitted” flaps to satisfy esthetic demands. This study examines and compares the safety of manipulating thin prefabricated skin flaps versus established axial pattern skin flaps. Twenty‐seven New Zealand white rabbits were used to determine if prefabricated flaps can be folded 180° around the edge of the rabbits' ears. The survival of these folded prefabricated flaps was compared with the survival of axial pattern flaps sutured into an identically recipient site. In addition, flaps prefabricated in the same manner were sutured onto a straight recipient bed to evaluate the viability of the newly vascularized tissue. The folded prefabricated flaps had reduced survival (56%) compared to equivalent folded axial pattern flaps (85%), P<0.005. The nonmanipulated prefabricated flaps and axial pattern flaps survived completely. © 1994 Wiley‐Liss, Inc.
Current status of topical antithrombotic agents in microvascular surgery
Authors: Das Suman K. , Miller John H.
Published: March 2007

Several technical advances over the years have allowed microsurgery to be successful. However, thrombosis, particularly at the anastomosis site, remains a complication of microvascular surgery. Various preventive measures, including drugs, have been used to improve microvascular surgical anastomotic patency rates. The purpose of this article is to review the literature and the current status of topical antithrombotic agents. From this review along with laboratory investigations it is concluded that a combination of topical as well as systemic agents offers the best patency rates. However, the “ideal” antithrombotic agent is yet to be discovered and investigations need to be continued in order to improve or eliminate the complication of microvascular thrombosis. But the importance of atraumatic technique cannot be overemphasized. © 1994 Wiley‐Liss, Inc.
Reconstruction of refractory defect of scalp and skull using microsurgical free flap transfer
Authors: Shen Zuyao
Published: March 2007

Ten patients—six with acute burns, two with old accident or surgical trauma, and two with cranial carcinoma—experienced extensive full‐thickness necrosis of the scalp and necrosis or defect of underlying skull bone. Microsurgical free flaps were used for the repair. Four latissimus dorsi, two rectus abdominis, one greater omentum, one prefabricated omentum‐cutaneous flap, and two vascularized outer‐table of the cranial bone flaps were used with complete survival. The heat‐devitalized cranial bone covered by living tissue flaps healed well and substantial “regeneration” of previously necrosed bone was shown by roentgenogram, bone scan, and histopathological examination in the postoperative follow‐up. Choosing an artery with high perfusion, bypassing from the carotid artery to support a massive free flap, is recommended. © 1994 Wiley‐Liss, Inc.
Microvascular replantation of a completely avulsed scalp
Authors: McCann Jack , O'Donoghue Joe , Ghazal Sharif Kaf‐Al , Johnston Sean , Khan Khalid
Published: March 2007

Total scalp avulsion is an unusual injury. To obtain good functional and cosmetic results, immediate revascularization using microsurgical techniques and replacement of the scalp in the correct anatomical position is the procedure of choice. This article describes a case report of successful replantation of a totally avulsed scalp from a 26‐year‐old male. Bilateral superficial temporal vessel anastomoses were performed using reversed autologous long saphenous vein grafts on the right side and direct repair on the left. Points of technique are discussed and the literature is reviewed. © 1994 Wiley‐Liss, Inc.
Digital reconstruction by free microvascular transfer of two fingers as a unit from the contralateral paralyzed hand
Authors: Pederson William C.
Published: March 2007

The ideal reconstruction for damaged or missing fingers has yet to be achieved. While toe transfer offers an excellent option for reconstruction of the thumb, this type of reconstruction often falls short in replacement of other digits of the hand. Microsurgical transfer of a finger or fingers from the opposite hand offers an option, but is rarely performed due to the morbidity in the donor hand. The case of a patient with a paralyzed, but otherwise normal, opposite hand presents a unique opportunity to repair the contralateral damaged but innervated hand. This case report deals with such a patient in whom two fingers were moved from a paralyzed hand to replace two traumatically missing digits in his previously normal hand. Technical considerations will be discussed and the result at 33 months will be presented. © 1994 Wiley‐Liss, Inc.
Effects of combined cold and hyperbaric oxygen storage on free flap survival
Authors: Angel Michael F. , Im Michael J. , Chung Hyo‐Kyung , Kolk Craig A. Vander , Manson Paul N.
Published: March 2007

We have previously reported that hyberbaric oxygen (HBO) improved the survival rate of experimental free flaps. The purpose of this study was to evaluate the effects of combined hypothermia and HBO administered during storage on free flaps and on the xanthine oxidase system in rats. Epigastric skin flaps were stored cold for 48 and 72 hours either in room air or under HBO (2.9 atmospheres absolute, 100% oxygen) before free flap transfer. The success rates of free flaps were 80% (8/10) after 48 hours and 20% (2/10) after 72 hours of cold storage in room air. HBO produced no effect after 48 hours but significantly increased the success rate to 70% (7/10) after 72 hours of cold storage. Tissue hypoxanthine (plus xanthine) levels increased to 210% of normal after 48 hours of cold storage in room air and to 176% in HBO. Elevated hypoxanthine levels returned toward normal by 72 hours of cold storage in room air, while the increased levels remained under HBO. Xanthine oxidase activities significantly increased by 60 to 80% during 72 hours of room air storage. HBO treatment inhibited xanthine oxidase activity to 48% of normal by 72 hours of storage. Free flaps exhibited no significant alterations in GR and G6PDH activity after 48 hours of cold storage in room air or HBO. After 72 hours of cold storage, the room air control displayed a trend of decreasing GR activity and a significant 20% decrease in G6PDH activity, while HBO groups showed no significant alterations in both GR and G6PDH activity compared to normal. Protection of the antioxidative enzymes by hypothermia and inhibition of the xanthine oxidase activity by HBO appear to be one of the mechanisms of improved skin flap survival in free flaps. © 1994 Wiley‐Liss, Inc.
Age and tolerance to secondary ischemia in rat epigastric flaps
Authors: Angel Michael F. , Ress Andrew M. , Amiss L. R. , Morgan Raymond F.
Published: March 2007

The use of microvascular procedures is increasing as the population continues to age. The purpose of this study was to observe the survival of skin flaps after ischemic injury. Skin flaps (n = 50) underwent either 3 hours of primary (1°) or secondary (2°) venous occlusion in young (2–3 mo) and old (18–22 mo) rats. Skin flap survival was assessed on postoperative day 7. Survival rates for young and old after 3 hours of 1° ischemia was 100% and 90% (ns). Survival rats for young and old after 2° ischemia were 67% and 47% (ns). © 1994 Wiley‐Liss, Inc.
Microsurgical model of ischemia reperfusion in rat muscle: Evidence of free radical formation by spin trapping
Authors: De Santis Giorgio , Penelli Massimo
Published: March 2007

The purpose of developing the experimental model described in this study was to verify the hypothesis that free radicals are formed during ischemia‐reperfusion of skeletal muscle. Spin trapping technique, along with electron spin resonance spectroscopy (ESR), directly indicates the presence of reactive radicals, which are widely considered to be important in tissue injury. The experimental model was a rat pedicled rectus femoris muscle flap. The femoral artery and vein were cannulated to inject the “spin trap” and collect the effluent flow. The spin trap agent was phenyl‐t‐butyl nitrone (PBN) and Hank's balanced salt solution. Three injections and collections were made: a) before ischemia; b) after ischemia of 15, 30, 60, 120, and 180 minutes, but before blood flow had been restored; and c) after blood flow had been restored. No ESR signal was detected either before the ischemic period or after only 15 minutes of ischemia. PBN radical adducts were detected after 30, 60, 120, and 180 minutes of ischemia. A similar signal was detected when PBN was injected during reperfusion 10 minutes after the ischemic periods. The study demonstrated the presence of free radicals in an in vivo intact skeletal muscle ischemia‐reperfusion model. © 1994 Wiley‐Liss, Inc.
Experimental study on vascularized bone allografts for reconstruction of massive bone defects
Authors: Shigetomi Mitsunori , Doi Kazuteru , Kuwata Noriyuki , Muramatsu Keiichi , Yamamoto Hisashi , Kawai Shinya
Published: March 2007

To study the healing mechanism of vascularized bone allografts under short‐term as well as long‐term immunosuppression with cyclosporin A, experimental vascularized intercalary bone allograft transplantation was carried out between inbred rats using the tibiofibula graft model. Bone scintigram and radiographs were used as an indicator for early detection of rejection after transplantation and bone union. In vascularized bone allografts under long‐term immunosuppression with cyclosporin A, early bone union and continuous incorporation were similar to that observed in vascularized bone autograft transplantation. When administration of cyclosporin A was discontinued before completion of bone union, the graft was rejected and bone union was delayed. Apparent swelling on the operated limb associated with a decrease in bone scintigram uptake suggested the occurrence of rejection of the allograft. Vascularized bone allograft transplantation is useful for reconstruction of massive bone defects only if immunosuppressants are used and maintained at least until bone union is obtained. © 1994 Wiley‐Liss, Inc.
Drug mixture which improves survival of ischemic rabbit epigastric skin flaps
Authors: Lepore Diana A. , Knight Kenneth R. , Bhattacharya Surajit , Ritz Morris , Robbins Sonia P. , Sieg Peter , Morrison Wayne A. , O'Brien Bernard McC.
Published: March 2007

The chief aim of this study was to maximize flap survival by counteracting the pathophysiological changes occurring during ischemia‐reperfusion. Rabbit epigastric skin flaps given 21 hours of ischemia were infused intra‐arterially with selected drugs at the start of reperfusion. Compared with control infused ischemic flaps, which had a 33% survival rate on day 7 post‐ischemia, significant improvement was found with vasodilators nitrendipine (61%) and prostacyclin (65%) and the thrombolytic agent urokinase (65%); marginal improvement with the free radical scavenger desferrioxamine (53%); but no change with streptokinase (44%), heparin (21%), and ATP‐MgCl2 (35%). A drug mixture comprising all of these agents except streptokinase and urokinase produced 87% survival, suggesting an additive effect. Biochemical assays on skin homogenates and blood implicated oxygen free radicals, neutrophil infiltration, and thromboxane in flap failure. These results imply that multiple factors are responsible for ischemic flap failure and that a mixture of drugs needs to be infused to counteract all of the detrimental changes. © 1994 Wiley‐Liss, Inc.
Physiological and pathophysiological roles of nitric oxide
Authors: Stewart Alastair G. , Phan Long H. , Grigoriadis George
Published: March 2007

Nitric oxide (NO), identified as the biochemical messenger of endothelial‐dependent relaxation, is of obvious chemical simplicity, but the range and complexity of its biological actions are only now emerging. NO is an important determinant of vascular resistance, it reduces thrombogenicity of the vascular endothelium, contributes to non‐specific, host‐defence mechanisms, and is a neurotransmitter in the peripheral and central nervous systems. In addition to these physiological roles, there is now convincing evidence that excessive, prolonged production of NO contributes to tissue damage in septicemia, ischemia/reperfusion injury, and other inflammatory conditions. © 1994 Wiley‐Liss, Inc.
Nitric oxide synthase inhibitor, nitro‐iminoethyl‐L‐ornithine, reduces ischemia‐reperfusion injury in rabbit skeletal muscle
Authors: Phan Long H. , Hickey Michael J. , Niazi Zahid B. M. , Stewart Alastair G.
Published: March 2007

Nitric oxide (NO), originally identified as the mediator of endothelial‐dependent relaxation of vascular smooth muscle, is now known to also have cytotoxic effects under certain conditions. Thus, we have investigated the effects of inhibition of NO synthesis on ischemia/reperfusion injury in the rabbit rectus femoris muscle. Three and a half hours of ischemia and 24 hours of reperfusion resulted in a 56% loss of viability. In muscles receiving an infusion of the nitric oxide synthase inhibitor, L‐NIO (30 μM), the loss of viability was reduced to 15%. Post‐ischemic blood flow was increased in muscles receiving a saline infusion, whereas there was a marked decrease in blood flow for at least the first 60 minutes of reperfusion in muscles treated with L‐NIO (30 μM). The increase in myeloperoxidase levels (indicative of neutrophil accumulation) following 24 hours of reperfusion was attenuated with L‐NIO infusion by approximately 50% and the reperfusion‐induced edema was also attenuated in L‐NIO treated muscle. These findings suggest that endogenous NO production during ischemia/reperfusion injury may be deleterious to muscle survival. © 1994 Wiley‐Liss, Inc.
Cold stored femoral vessels as microvascular allografts: A preliminary study
Authors: Crowe Daniel M. , Mitchell Geraldine M. , Hurley John V. , Olivier Thomas V. , O'Loughlin Kevin , Morrison Wayne A.
Published: March 2007

Cold stored femoral arteries or veins have been reinserted successfully as autografts into rabbits. The present study examines whether grafting with cold stored vascular allografts is equally successful. Rabbit femoral arteries and veins were stored at 4°C for 4 weeks before insertion as allografts into unrelated animals. Three weeks after insertion into the femoral artery all venous allografts and 80% of arterial allografts were patent, but patency of both graft types declined over the next few weeks. A small number of cold stored venous allografts when inserted into the femoral vein occluded within 3 weeks.

No histological evidence of rejection was apparent. The findings suggest that cold stored vascular allografts could be used successfully as an arterial “prosthesis” to support free flaps where relatively short term patency is required until the flap can establish sufficient peripheral inset to survive in its own right. This technique could be applied when autologous veins are not available or not justified. © 1994 Wiley‐Liss, Inc.
Use of free interpositional vein grafts as pedicles for prefabrication of skin flaps
Authors: Wilson Yvonne T. , Kumta Samir , Hickey Michael J. , Hurley John V. , Morrison Wayne A.
Published: March 2007

Pedicles created from a long vein graft increase the scope and applications of prefabricated skin flaps. This study reports the survival and pattern of neovascularization of lower abdominal skin flaps in rabbits based on a pedicle formed by interposition of a long vein graft between the divided ipsilateral femoral artery and vein. Flaps were elevated 2–5 weeks after pedicle implantation and the surviving area quantitated and vascular patterns examined 1 week later. Only 8 out of 35 flaps were greater than 50% alive, the most frequent cause of flap failure being pedicle non‐patency. If the pedicle remained patent, complete flap survival was possible as early as 2 weeks after implantation. In non‐patent pedicles, recanalization or formation of a new vascular network may, given at least 4 weeks, be sufficient to ensure partial flap survival. The findings indicate that implantation of a long, skeletonized vein graft is an unreliable method of prefabrication of abdominal skin flaps in this model. © 1994 Wiley‐Liss, Inc.
Immediate and short‐term effect on arterial flow of clamping or stripping one vessel of a two vessel limb in a dog model
Authors: Olazabal A. E. , Morrison Wayne A. , O'Brien Bernard McC.
Published: March 2007

The effect on distal blood flow in a 2 vessel limb of clamping one of the vessels or resecting it over a length is not known. Commonly this situation occurs clinically, for example, following lacerations to the radial or ulnar artery or as a result of removing a radial or ulnar artery flap. In a dog model established to mimic these clinical circumstances, a 2 vessel limb was created in which one vessel carried two‐thirds of the total flow and the other one‐third. Electromagnetic flow recordings were taken to measure the changes in flow in one vessel when the other was clamped or resected. Contrary to expectation, when one vessel was occluded the flow in the opposite vessel both immediately and for the following 30 minutes increased but remained well below the combined flow of 2 unclamped vessels. No increased flow was recorded in the dominant vessel when the smaller vessel was clamped, while an approximately 25% increase in flow was recorded in the smaller vessel when the larger one was clamped. This represents a reduction in total distal blood flow of one‐half of the preclamping levels. Clamping of the vessel or its resection over a length resulted in the same degree of alteration in flow in the opposite vessel. The sacrifice of a dominant vessel in a 2 vessel limb whether by simple ligation or by radical stripping as for free tissue transfer significantly decreases distal flow in that limb at least in the immediate and short term. End‐to‐side anastomosis or reconstitution of the vessel would be recommended. On the other hand, use of the non‐dominant vessel would appear to be safe. © 1994 Wiley‐Liss, Inc.