bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of revascularized periosteal allografts for repairing bony defects: An experimental study
Authors: Liu Jian Yin , Wang Dan , Cheng Hsu Hsi
Published: March 2007

This is an experimental study on the potential of revascularized periosteal allografts for repair of bony defects. Beijing long‐eared white rabbits were used as donors and immunologically incompatible Chinchilla rabbits were used as recipients. The periosteum was stripped off from the femurs of the 6 donor rabbits and transplanted to bony defects of 1.2 cm over the radius of the 12 recipients using microsurgical anastomoses of the blood vessels. In the control group of 8 rabbits the same radial bony defects were produced without the transplantation of periosteal grafts. Immunosuppressants were administered after surgery. The animals were observed for 4 months using a series of radiography, histomorphology, fluochrome labelling and electron microscopy. Results revealed no bony healing of the defects in the control group, but 9 of the 12 defects healed in the experimental group. The results indicated revascularized periosteal allografts were able to form new bone and heal the 1.2 cm radial bone defect in rabbits. © 1994 Wiley‐Liss, Inc.
“Mini paddle” for monitoring the fibular free flap in mandibular reconstruction
Authors: Qattan Mohammed M. Al , Boyd J. Brian
Published: March 2007

The use of a “mini” skin paddle to monitor the fibular free flap for mandibular reconstruction is described. The paddle is easy to inset, can be excised later under local anesthesia, and yet is adequate for postoperative monitoring. © 1994 Wiley‐Liss, Inc.
Invited review: Different conduits in peripheral nerve surgery
Authors: Brunelli G. A. , Vigasio A. , Brunelli G. R.
Published: March 2007

A considerable amount of research is being undertaken regarding the possibility of bridging loss of nerve substance with different guiding tubes, in order to improve functional outcome, reduce the surgical time, and reduce damage at donor nerve sites. A review of the literature and personal research allows us to state that: for short gaps, biological tubes (autologous veins) may give good results and also allow chemotactic attraction with selective arrangements of motor and sensory axons. Gaps longer than 1 cm do not allow tropism and are associated with failure to support axonal regrowth. Artificial biodegradable conduits still show results that are controversial; they may give good results provided that the material of which they are made is perfectly tolerated. Empty tubes, longer than 8‐10 mm, besides being deprived of the chemotactic attraction, may collapse or be partially reabsorbed and replaced by scar. Probably in the near future biological or biodegradable tubes, containing lamininlike substances or muscle scaffold, will allow us to bridge increasingly large defects in nerves.
Experimental and clinical study of the effect of naftidrofuryl on the recovery from peripheral nerve lesions
Authors: Merle Michel , Gilbert Alain , Fredenucci Jean‐François , Petry Didier , Foliguet Bernard , Mosnier Michel
Published: March 2007

After primary repair of lesions of nerves and vessels, patients who were administered a vasoactive drug, naftidrofuryl, postoperatively, had a better functional recovery than untreated patients. Evidence for the favourable effect of the drug on nerve regeneration was first obtained from experiments in the rat. The sciatic nerve was transected and repaired with standard microsurgical techniques. Results were evaluated by electromyography and histology. Data indicated that treated animals had better motor responses and distal latency than untreated rats. Fibre counts showed a greater number of nerve fibres in the distal stump of treated animals. The clinical study was undertaken in cases of carpal tunnel syndrome with muscle atrophy. Assessment was performed by electrophysiology: motor and sensory conduction was studied. Data showed that all treated patients recovered totally or partially from the thenar atrophy they presented before operation, whereas thenar atrophy persisted in 37% of the patients receiving placebo. In conclusion, naftidrofuryl has an experimentally and clinically favourable effect on nerve regeneration and on muscle trophicity, but the mechanism of action of this drug is not known.
Cold (0°C) ischaemic tolerance of latissimus dorsi free flaps in rats: A macroscopic and morphological study
Authors: Werker Paul M. N. , Kon Moshe , Green Colin J. , Fryer Patricia R. , Franken Ralph J. P. M. , Overgoor Max L. E.
Published: March 2007

The purpose of this study was to define the cold (0°C) ischaemic tolerance (CIT) of the latissimus dorsi free flap in inbred rats. Flaps were isolated, stored at 0°C for periods of time ranging from 0 to 120 hr and then revascularised and reperfused for 14 days. Thereafter the CIT was assessed macroscopically, and by light microscopy. Electron microscopy was performed in flaps after 0 and 24 hr of reperfusion following a cold ischaemic interval ranging from 0 to 120 hr. From this preliminary study, it was concluded that the CIT was 48‐72 hr.
Compression neuropathy of the common peroneal nerve caused by a ganglion
Authors: Evans J. D. , Neumann L. , Frostick Simon P.
Published: March 2007

A case of compression of the common peroneal nerve caused by a ganglion herniating from the superior tibio‐fibular joint is reported. MR imaging was partially helpful in making the diagnosis. The patient has made an almost complete recovery 3 months after excision of the lesion. Early diagnosis and treatment is required to ensure recovery.
Routine monitoring in patients with free tissue transfer by laser‐doppler flowmetry
Authors: Mailaender Peter , Machens Hans‐Guenther , Waurick Rene , Rieck Bernd , Berger Alfred
Published: March 2007

The use of laser Doppler flowmetry (LDF) was tested in 108 consecutive patients, who underwent free tissue transfer at our institution between December, 1988, and June, 1990. Sixteen patients (14.8%) suffered vascular complications, which could be detected in all cases earlier by LDF than by clinical examination alone. LDF therefore prompted faster surgical intervention in these cases, allowing flap salvation in 9.3% (n = 10). Difficulties had to be noted in diagnosing venous thrombosis by means of the LDF due to sometimes unspecific alterations in LDF signals. Technical improvement of LDF might lead to a higher diagnostic accuracy if venous thrombosis occurs.
Reconstruction of intraoral mucosal defects with revascularized jejunal segments
Authors: Sheen Robert
Published: March 2007

The intraoral mucosa subserves a multitude of structural and functional roles. This paper details the importance of this within the context of reconstruction. The various methods are reviewed historically. Also, both the experimental and clinical basis for using revascularized jejunum as mucosal reconstruction are presented. © 1994 Wiley‐Liss, Inc.
Effect of tarsal tunnel decompression in the streptozotocin‐induced diabetic rat
Authors: Dellon A. Lee , Dellon Evan S. , Seiler William A.
Published: March 2007

The streptozotocin‐induced diabetic rat has changes in the hind‐foot walking track pattern that are progressive over time. The present study investigated the effect of microsurgical neurolysis of the posterior tibial nerve and its branches in the tarsal tunnel on this pattern. The tarsal tunnel decompression was done at the time of onset of diabetes. The results of the study confirmed the progressive pattern of track abnormalities in this rat model, P < .05. The results demonstrated that rats in which the tarsal tunnel had been decompressed at the onset of their diabetes did not develop the characteristically abnormal diabetic walking track pattern. Rather, the track patterns of the decompressed tarsal tunnel diabetic rats were not significally different fron a nondiabetic control population. © 1994 Wiley‐Liss, Inc.
Ultrarapid orthotopic technique for renal transplantation in the rat
Authors: Lopez‐Neblina Fernando , Toledo‐Pereyra Luis H. , Suzuki Shohachi
Published: March 2007

An effective and ultrarapid technique for kidney transplantation in the rat is introduced. In this manner, physiological and immunological parameters could be tested without difficulty in small animals such as the rat. Shorter periods of warm ischemia were achieved by rapid harvesting and anastomotic times using a combination of the sleeve technique for the artery, a cuff technique for the vein, and the over‐a‐stem technique for the ureter. In 20 rats, total vascular (artery and vein) anastomotic times were 5.35 ± 0.59 min, of which the artery was 4.30 ± 0.40 minutes and the vein was 1.05 ± 0.20 min. The ureter anastomotic time was 1.0 ± 0.1 min. The surgical complications were three ureteral stenoses. The 15 day survival was 100%. Plasma creatinine and histological findings at 24 and 30 days after transplantation were within normal limits with no evidence of ischemic damage. The advantage of this technique is its effectivity and simplicity that allows for reduced times of warm ischemia. This is the fastest technique published so far in the literature. We propose this technique to be employed in all studies of kidney transplantation and preservation in the rat. © 1994 Wiley‐Liss, Inc.
Improved technique for rodent microarteriography
Authors: Moskovitz Martin J. , Kanner Barry J. , Zhang Ling , Siebert John W.
Published: March 2007

We have developed new techniques in rodent microarteriography which provide excellent two‐plane views of the rat femoral artery. These techniques employ routine mammography film and equipment for imaging as well as standard intravenous catheters for vascular access. The use of mammographic equipment provides high quality, finely detailed, orthogonal X‐ray images. The elective outpatient nature of mammography allows microsurgical investigators convenient access to the necessary equipment without interfering with patient care. The standard intravenous catheters permit easy and inexpensive vascular access via the contralateral femoral artery. The technique avoids the more invasive thoracic and abdominal aortic approaches without compromising X‐ray image quality. Additionally, the same rat can be imaged multiple times if care is taken to repair the vascular access route. © 1994 Wiley‐Liss, Inc.
Vascularized periosteal bone graft from the supracondylar region of the femur
Authors: Doi Kazuteru , Sakai Kazuhiro
Published: March 2007

Free, vascularized thin corticoperiosteal grafts and small pe‐riosteal bone grafts harvested from the supracondylar region of the femur are described. These grafts are nourished from the articular branch of the descending genicular artery and vein. Thin corticoperiosteal grafts consist of periosteum with a thin layer of outer cortical bone and include the cambium layer, which has a better osteogenic capacity. This graft is elastic and readily conforms to the recipient bed configuration. Thin corticoperiosteal grafts were used to treat 11 patients with fracture non‐union of an upper extremity that had no massive bone defects. Early, rapid union occurred in all patients except three: one in which the anastomosed vessel became obstructed and two in which the internal fixation of the fracture was unsecured. The small bone grafts consist of periosteum, full thickness cortex, and the underlying cancellous bone. This graft can be successfully harvested without disturbing the vascularity, unlike the currently used vascularized bone grafts. This graft was used to treat three patients with avascular necrosis of the body of the talus and could prevent the necrotic talus body from progressive collapse in patients in early stages of the disease. One patient with an infectious bone defect of the first metatarsal bone was successfully treated by vascularized bone graft with an accompanying skin flap. © 1994 Wiley‐Liss, Inc.
Replantation of amputated facial tissues with microvascular anastomosis
Authors: Jeng Seng‐Feng , Wei Fu‐Chan , Noordhoff M. Samuel
Published: March 2007

A challenge to the microsurgeon is perfecting the technique of replantation of small pieces of facial tissue, mainly because of the extremely small size of the arteries as well as a lack of suitable veins for drainage. In the past 4 years, we have had seven cases of facial amputations, which included one scalp, two nasal tips, two ears, one lower lip, and one eyebrow. All of these patients were replanted/revascularized by microvascular anastomosis. Only two of the cases had suitable veins for anastomosis. Alternative techniques used for improving venous outflow were arterio‐venous fistula, chemical leeches, and pin pricks. Four of the cases were completely successful, two cases had partial loss of the replant, and one case failed due to absence of venous drainage. In facial amputation, an aggressive microsurgical attempt will result in more tissue surviving and a better cosmetic outcome than in any other reconstructive procedures. © 1994 Wiley‐Liss, Inc.
Study of microvascular polyester prosthesis in rat carotid arteries
Authors: Wang Min‐Sheng , Chen Zheng‐Rong , Chen Zhong‐Wei
Published: March 2007

The implantation of a microvascular polyester prosthesis (MPP) (internal diameter 1 mm, length 10 mm) in the carotid arteries was studied in 48 Sprague‐Dawley rats. The left carotid artery was resected to 7 mm in length and replaced with MPP by means of sleeve anastomoses. Postoperatively the patency was monitored with Doppler ultrasound at 24 and 72 hr, and at 1, 2, 3, 4, 8, and 12 weeks and was confirmed either by direct inspection intraoperatively or by angiography at the time of removal. At each monitoring time, all the throm‐bosed and some selected patent grafts were removed and prepared for scanning electron microscopy (SEM) study. The early patency rate was 100% within 24 hr, and the cumulative long‐term patency rate was 77.1% at 12 weeks. Rapid and complete endothelial lining (EL) restoration was demonstrated 3 weeks after operation, which provided a smooth and nonthrombogenic surface, and contributed to the long‐term patency. Ten of the 11 failed grafts occurred within 3 weeks, that is, before EL, due to thrombosis. These observations indicate that MPP can be successfully used as arterial conduits in rats, and an enhanced patency rate may be expected with the use of anticoagulants or endothelial cell seeding for prevention of early thrombosis. © 1994 Wiley‐Liss, Inc.
Technical considerations in two‐stage functioning free muscle transplantation reconstruction of both flexor and extensor functions of the forearm
Authors: Chuang David Chwei‐Chin , Strauch Robert J. , Wei Fu‐Chan
Published: March 2007

We report on two patients with severe injuries of the forearm who were reconstructed using functioning free muscle transplantation (FFMT) for individual replacement of flexor and extensor function. In both cases a two‐stage procedure was performed: The extensor reconstruction preceded the flexor reconstruction by 4–6 months. The extensor digitorum communis and flexor digitorum profundus were successfully reconstructed in both cases using bilateral gracilis FFMT. In one case the flexor pollicis longus and extensor pollicis lon‐gus were also reconstructed using the adductor longus in addition to the gracilis. Clinical follow‐up was a minimum of 2 years. Both patients achieved wrist control, excellent finger flexion, and metacarpophalangeal joint extension. One patient also had good interphalangeal finger extension, but the other developed a persistent claw deformity due to the lack of recovery of ulnar nerve function. Performing the extensor reconstruction prior to the flexor reconstruction theoretically allows a more rapid return of function and a shorter rehabilitation period than using the converse sequence. © 1994 Wiley‐Liss, Inc.
Phalloplasty for female transsexuals with sensate free forearm flap
Authors: Fang Rong‐Hwang , Lin Jin‐Teh , Ma Shiuh
Published: March 2007

One of the primary goals of phalloplasty on female to male transsexuals is to void while standing. However, achieving competence of the neourethra, sensation, and rigidity of the neophallus still present a challenge. Over a 5 year period (1988–1993), 56 phalloplasties using sensate free forearm flaps were performed for 56 primary female transsexuals. The urethrocutaneous fistula rate was 38/56 and one flap totally necrosed. However, when the flap was prefabricated with a tubed graft of vaginal mucosa for the 28 cases (the later part of the series), there were less complications and a lower fistula rate within this portion of the neourethra. Although the whole procedure was time consuming, it was worthwhile and patient satisfaction was high. © 1994 Wiley‐Liss, Inc.
In vivo analysis of microvascular reperfusion injury in striated muscle and skin
Authors: Menger Michael D. , Vollmar Brigitte
Published: March 2007

The use of intravital fluorescence microscopy in the models of the hamster dorsal skin fold chamber and the ear of the hairless mouse allows for the quantitative analysis of post‐ischemic microvascular reperfusion injury in striated muscle and skin. Prolonged periods of ischemia (4 hours in striated muscle and 6 hours in skin) are associated with (1) perfusion failure of nutritive capillaries at the onset of reperfusion (no‐reflow) and (2) activation, accumulation and microvascular adherence of white blood cells, formation of reactive oxygen metabolites and release of potent mediators (leukotrienes, platelet‐activating factor) with the consequence of increased microvascular permeability due to the loss of endothelial integrity, interstitial edema and cell damage (reflow‐paradox). Prophylactic and/or therapeutic regimens may, therefore, include improvement of capillary perfusion by hemodilution, and inhibition of leukocyte adherence, radical formation and mediator release by appropriate counteracting compounds, including anti‐oxidants, antibodies directed against adhesion molecules, leukotriene synthesis inhibitors and platelet‐activating factor receptor antagonists. © 1994 Wiley‐Liss, Inc.
Direct visualization and measurements of wound neovascularization: Application in microsurgery research
Authors: Kjolseth Dorthe , Kim Michael K. , Andresen Louise H. , Morsing Annie , Frank Johannes M. , Schuschke Dale , Anderson Gary L. , Banis Joseph C. , Tobin Gordon R. , Weiner Leonard J. , Hjortdal Vibeke E. , Barker John H.
Published: March 2007

Neovascularization or angiogenesis is an essential yet poorly understood component of the healing process. In wound healing research, there is a lack of models enabling quantitative and continuous measurements of wound neovascul‐arization. The hairless mouse ear wound model permits quantitative measurements of wound epithelialization and neovascularization continuously throughout the healing process. On the ears of male homozygous (hr/hr) hairless mice, standardized circular full thickness dermal wounds are produced; then, using vital microscopy, these two processes are directly viewed and measured at day 0 and every third day thereafter until these are complete. This model system and its application to clinically relevant situations are reviewed. © 1994 Wiley‐Liss, Inc.
Microcirculatory consequences of microvascular surgery
Authors: O'Shaughnessy Michael , Gu Jin‐Mei , Wyllie Frances , Acland Robert D. , Anderson Gary L. , Banis Joseph C. , Barker John H.
Published: March 2007

Although free tissue transfer success has been greatly improved by developments in operating microscopes, microsutures, microinstruments, and technique, free flap and replant failure remain a significant problem under certain adverse circumstances. The nature of these failures is often multifactorial and remains poorly understood. A greater understanding of the processes involved would provide the potential for greater pharmacological control of any adverse conditions prevailing and would thus offer the prospect of more effective adjunctive therapy in the presence of such adverse conditions. Research endeavors in this area have been hindered by the absence of good research models. The isolated rat cremaster muscle model is a recently developed model that simulates the conditions of free tissue transfer. Using this model, both thrombus formation and numerous microcirculatory parameters can be measured. The microcir‐culatory parameters studied to date include the formation of thromboembolism, capillary perfusion, vessel diameters, red blood cell velocity, leukocyte‐endothelium interaction, and microvascular leakage. The isolated rat cremaster muscle model addresses many of the shortcomings of earlier research models and offers the promise of answering at least some of the many unanswered questions relating to free flap and replant failure. © 1994 Wiley‐Liss, Inc.
Clinical use of the 3m 2.5 mm mechanical microcoupling device in free tissue transfer
Authors: Sasson Homayoun Nazarian , Stofman Guy M. , Berman Peter
Published: March 2007

The long‐term patency of the 2.5 mm mechanical microvascular anastomotic device (the Unilink system) was evaluated in 10 cases of free flap transfer in nine patients between July 1991 and July 1993. Flap survival indicated adequate patency to time of healing. All cases were considered critical end‐to‐end venous anastomoses, without a parallel conventional microvascular hand‐sewn anastomosis associated with the coupling device. The types of flaps used were seven rectus abdominous and one each of serratus anterior and lateral arm muscles and a free jejunum.

There were no postoperative complications requiring reexploration. The 2.5 mm device had a rate of 100% flap take with complete healing at an average of 15 months postoper‐atively. Selected Doppler flow studies depicted the coupler device in vivo with duplex scan verification of venous patency.

The 2.5 mm coupler is a versatile anastomotic device for vessels with a diameter of 2.4–3.2 mm. This expands the applicability of the UNILINK system for use in larger diameter vessels. © 1994 Wiley‐Liss, Inc.
Long‐term follow‐up of coverage of weight bearing surface of the foot with free muscular flap in a pediatric population
Authors: Harris Patrick G. , Letrosne Eric , Caouette‐Laberge Louise , Egerszegi E. Patricia
Published: March 2007

Between 1985 and 1991, 13 muscular free flaps with split thickness skin grafts (10 latissimus dorsi, 2 rectus abdominis, and 1 gracilis) were done in 12 patients to cover the weight bearing surface of the foot. Four open wounds were closed primarily and nine unstable scars were replaced with a free flap.

A retrospective analysis shows that over the short term the flaps provided a complete coverage of wounds, with a 100% survival of flaps, and permitted normal weight bearing ambulation starting at 1 month postoperatively. Long‐term results show deep pressure sensation but no light touch sensation. All patients are able to wear normal shoes. Six patients (seven flaps) required further surgery to close subsequent wounds on the flaps: Three hypertrophic scars with recurrent ulcerations needed scar revisions, one child presented a fistula through the flap due to underlying osteomyelitis, and one patient presented a friction wound on the lateral malleolus requiring thinning of the flap. Two flaps presented an area of pressure necrosis through the full thickness of the flap and had to be replaced with another free flap (fasciocutaneous sensate flap) over the heel area.

In conclusion, it seems that in the pediatric population, skin‐grafted muscular coverage of the weight bearing surface of the foot is a good alternative, even if more problems with hypertrophic scarring around the grafts have been found than in the adult population. In two cases, the flaps had to be replaced because of pressure necrosis over the calcaneus. Long‐term follow‐up of the sensate fasciocutaneous flaps will be needed to find out if they provide a better alternative for foot coverage. © 1994 Wiley‐Liss, Inc.
Fingertip replantation: Pre‐osteosynthesis vein graft technique
Authors: Ikeda Kazuo , Morikawa Seiji , Hashimoto Fumio , Tomita Katsuro
Published: March 2007

Since 1985 we have been performing replantation of amputated fingertips using a pre‐osteosynthesis vein graft technique. First, we locate an artery and vein at the distal part of the fingertip and perform a vein graft. After this, we perform osteosynthesis. Since there is sufficient vessel length, the anastomosis technique becomes easier than with the method previously used. In our department, between 1985 and 1990 we performed 11 Zone I replantations. Ten fingers survived and one failed. There were good results in seven cases and three had fair results. The pre‐osteosynthesis vein graft technique is a reliable technique for amputated fingertip replantation. © 1994 Wiley‐Liss, Inc.
Distal phalanx microsurgical replantation
Authors: Malizos Konstantinos N. , Beris Alexandros E. , Kabani Chalid T. , Korobilias Anastasios B. , Mavrodontidis Alexandros N. , Soucacos Panayotis N.
Published: March 2007

Replantation of a completely amputated part of the distal phalanx, which has a very small vessel size, has been reported by several authors with a varying rate of success. Drainage through venous anastomosis is not always possible. In 12 completely amputated fingers, at the level of, or more distal to, the distal interphalangeal joint, we attempted microsurgical replantation with a successful outcome in ten cases. Seven digits had one or two veins anastomosed. In five digits, an adequate size vein was not found, and the drainage was accomplished with provoked bleeding which was maintained for the 3 postoperative days at the expense of blood transfusion. In all successful cases the patients returned to their occupation in a mean of 9 weeks with very good or excellent functional results. © 1994 Wiley‐Liss, Inc.
Transpositional microsurgery in multiple digital amputations
Authors: Soucacos Panayotis N. , Beris Alexandros E. , Malizos Konstantinos N. , Vlastou Catherine , Soucacos Panayotis K. , Georgoulis Anastasios D.
Published: March 2007

In 34 of the 62 patients treated for complete multiple digital amputations, the severed part was not replanted in its anatomical position, but in the place of the most useful stump. This procedure is defined as transpositional digital microsurgery and refers to the transposition and replantation of any digit to another stump which plays a more significant role in the function of the hand. Twenty‐eight patients had transposition of a digit, while six patients underwent thumb transposition. All except six of the transposed digits survived, while all of the thumbs survived the surgical procedure. The cosmetic appearance of the hand with a transposed digit or thumb was acceptable to the patients. Two‐point discrimination was assessed to be 10–14 mm for the transposed digits, and the functional ability of the transplanted digit was comparable to digits which were replanted in their anatomical position. In conclusion, transpositional digital microsurgery remains a useful alternative for the treatment of multiple digit amputations, particularly in patients with severely damaged non‐replantable amputated parts. © 1994 Wiley‐Liss, Inc.
Vascularised bone grafts in the treatment of long bone defects
Authors: Xenakis Theodore H. , Malizos Konstantinos N. , Beris Alexandros E. , Vekris Marios , Georgoulis Anastasios D. , Soucacos Panayotis N.
Published: March 2007

Reconstruction of large bony defects of long bones was performed using vascularised fibular grafts in four patients at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Indications for grafting procedures in this small series had been the loss of bone due to the extensive resection of avascular and necrotic bone from septic pseudoarthrosis in three patients and congenital pseudarthrosis secondary to neurofibromatosis in a child. Primary skeletal union with graft hypertrophy occurred in three of the patients. The fourth patient had an asymptomatic nonunion at the proximal end of the graft. The result in each patient was the presence of a well‐aligned limb that had normal or nearly normal motion and acceptable length. © 1994 Wiley‐Liss, Inc.
Use of the latissimus dorsi flap in head and neck reconstructive microsurgery
Authors: Papadopoulos Othon N. , Gamatsi Irene E.
Published: March 2007

Reconstructive surgery of the head and neck has particularly benefited from the rapid developments in microsurgery. Resection of tumours from the head and neck which are associated with serious physical and psychological problems, or which often require multiple reconstructive procedures, can now be performed as a single‐stage procedure with good oncological and functional results. The present series reports on the treatment of 12 primary or recurrent malignant tumours of the head and neck using the latissimus dorsi musculocutaneous free flap. Complications consisted of two venous thromboses which required revision of the anastomoses. The oncological and functional results were good, while the aesthetic outcome was fair. We conclude that the latissimus dorsi muscle or musculocutaneous free flap is the method of choice to repair wide defects of the head and neck following the resection of malignant tumours. © 1994 Wiley‐Liss, Inc.
Successful treatment of venous congestion in free skin flaps using medical leeches
Authors: Soucacos Panayotis N. , Beris Alexandros E. , Malizos Konstantinos N. , Xenakis Theodore A. , Georgoulis Anastosios
Published: March 2007

Of 74 patients with extensive skin loss of the upper and lower extremities who were treated with free skin flaps, 20 patients presented with venous insufficiency within the immediate 6 to 12 hours following surgery. In 17 of these patients, the venous congestion after free tissue transfer was successfully treated with medical leeches. The remaining three skin flaps did not survive, despite leeching, as well as exploration and revision of the venous anastomoses. The results from this small number of patients with free skin tissue transfers are encouraging, suggesting that in the presence of venous congestion, the use of medicinal leeches is a desirable modality of treatment. © 1994 Wiley‐Liss, Inc.
Microsurgical reconstruction of large nerve defects using autologous nerve grafts
Authors: Daoutis Nicholas K. , Gerostathopoulos Nicholas E. , Efstathopoulos Demetrios G. , Misitizis Diamantis P. , Bouchlis George N. , Anagnostou Stratos K.
Published: March 2007

Between 1986 and 1993, 643 patients with peripheral nerve trauma were treated in our clinic. Primary neurorraphy was performed in 431 of these patients and nerve grafting in 212 patients. We present the functional results after nerve grafting in 93 patients with large nerve defects who were followed for more than 2 years. Evaluation of function was based on the Medical Research Council (MRC) classification for motor and sensory recovery. Factors affecting functional outcome, such as age of the patient, denervation time, length of the defect, and level of the injury were noted. Good results according to the MRC classification were obtained in the majority of cases, although function remained less than that of the uninjured side. © 1994 Wiley‐Liss, Inc.
Nerve grafting in peripheral nerve microsurgery of the upper extremity
Authors: Kalomiri Domna E. , Soucacos Panayotis N. , Beris Alexandros E.
Published: March 2007

The use of microsurgical techniques is essential in peripheral nerve surgery, in which dissection at the fascicular level is required. Magnification with an operating microscope allows for an accurate evaluation of the severity of the trauma to the nerve tissue and permits atraumatic interfascicular dissection. Fascicular or interfascicular dissection and repair with the use of nerve grafts was carried out in 220 peripheral nerve lesions of the upper extremity. Our results of nerve‐grafting in the upper extremity (median, ulnar, and radial‐nerves) indicate an inverse association between the age of the patient and the delay between injury and grafting. In addition, we found that nerve grafting without tension produces superior results over simple neurorrhaphy under tension and permits better axonal growth and nerve recovery. © 1994 Wiley‐Liss, Inc.
Combined transsylvian‐subtemporal exposure of cerebral aneurysms involving the basilar apex
Authors: Kopitnik Thomas A. , Batjer H. Hunt , Samson Duke S.
Published: March 2007

The surgical repair of cerebral aneurysms involving the apex of the basilar artery continues to undergo refinement and evolution. The inherent difficulty in accessing the basilar apex as well as the complexities of the microanatomy render this area a notoriously hazardous and technically challenging region in which to perform microsurgical clipping of cerebral aneurysms. Several operative approaches have been described and are constantly undergoing a state of evolution in the hopes of optimizing the exposure of the distal basilar artery and minimizing the inherent risks of surgery. The consistent decline in operative morbidity has paralleled improved understanding of the microvascular anatomy, both in this region and along the various corridors of approach. No single operative approach is universally superior, considering the wide variability of individual patient anatomy and vascular configurations. Each approach has strengths, weaknesses, and potential complications that must be considered in the thought process of planning an operative attack on a basilar apex aneurysm. Intimate familiarity with the microvasculature and the microsurgical anatomy of the region is an imperative prerequisite for the application of any surgical approach to this region. This paper outlines a detailed review of the microsurgical anatomy that is pertinent to microsurgery of aneurysms in this region, and describes an approach referred to as the combined transsylvian‐subtemporal approach. We have found this operative approach particularly useful in aneurysm surgery of the basilar apex but do not mean to imply that this single approach is suitable for all surgeons or all patients. This paper is designed to discuss an approach and microanatomic understanding that we find useful in the surgical treatment of aneurysms involving the basilar apex. © 1994 Wiley‐Liss, Inc.
Endoscopic techniques in neurosurgery
Authors: Harris Lewis W.
Published: March 2007

Endoscopic techniques have been utilized in neurosurgery for nearly a century. The history of application of these techniques is reviewed. Because of recent improvements in optics, microinstrumentation, and other associated technologies endoscopy has begun to have an impact on neurosurgery. Documented uses of these techniques are reviewed. Greater experience with the techniques, along with continued improvements in the technology, has the potential to result in broadened applications. These procedures can be performed quickly, safely, and effectively, and in selected applications may reduce tissue trauma, risks associated with surgery, hospital stays, and costs. Neuroendoscopy presents exciting possibilities for the future. © 1994 Wiley‐Liss, Inc.
Short‐term response of epiphyseal plate cell populations following selective devascularization and microsurgical revascularization
Authors: Bowen C. Vaughan A. , Bray Peter W. , Boyer Martin I. , Fowler J. David , Nolan Liana
Published: March 2007

The distal femoral epiphyseal plates of 21 8‐week‐old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow‐up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow‐up intervals. This study is another ‘building block’ experiment toward vascularized epiphyseal plate transplantation in humans. © 1994 Wiley‐Liss, Inc.
Venous flap—its classification and clinical applications
Authors: Fukui Akihiro , Inada Yuji , Maeda Masami , Mizumoto Shigeru , Yajima Hiroshi , Tamai Susumu
Published: March 2007

We previously reported pedicled venous flap survival using the rat model, as well as venovenous, arteriovenous, and arterialized flow‐through venous flap survival using the rabbit ear model. For this study, we utilized these flaps clinically. Five of seven pedicled venous flaps survived, displaying superficial necrosis. The others became partially necrotic; they were transferred after dissection of a long pedicle vein. Eight of nine venovenous flow‐through venous flaps survived; six displayed superficial necrosis. The nonsurviving flap became completely necrotic, possibly because only one donor vein and one recipient vein were used. Six of 10 arteriovenous flow‐through venous flaps survived. The remaining four became partially necrotic, possibly because only one vein was anastomosed for outflow. The arterialized flow‐through venous flap survived. The pedicled venous and venovenous groups studied seem likely to survive despite superficial necrosis. However, the draining vein should not be dissected more than 5 cm, and many draining veins should be anastomosed with recipient vessels. © 1994 Wiley‐Liss, Inc.
Experimental evaluation of small intestinal submucosa as a microvascular graft material
Authors: Prevel Christopher D. , Eppley Barry L. , McCarty Michael , Jackson J. Ryan , Voytik Sherry L. , Hiles Michael C. , Badylak Steven F.
Published: March 2007

The evaluation of porcine small intestine submucosa (SIS) in a microsurgical model was conducted using an interpositional graft in the rat femoral artery. The SIS grafts were fabricated from processed porcine material that was wrapped around a glass tube and oversewn longitudinally to produce a tubular structure. Of the 42 animals studied, 7 received grafts of untreated SIS (group I), 7 of the grafts were presoaked (PSH) in heparin (Group II), 7 animals were treated with systemic heparin prior to implantation of PSH‐SIS (group III), 7 animals received SIS grafts crosslinked to heparin (group IV), 7 animals received SIS grafts crosslinked to urokinase (group V), and 7 animals received untreated autologous epigastric vein grafts (group VI). Patency was assessed postoperatively and selected grafts were evaluated by histology.

All SIS grafts failed to maintain patency beyond the first postoperative hour. Histologic examination of the thrombosed graft surfaces revealed a smooth luminal surface with a thick layer of attached fibrin and platelets with a central occluding thrombus. The thickness of the induced fibrin layer appears to narrow intraluminal space significantly at the microvascular level.

While having excellent success at vessel diameters greater than 3 mm, and in a variety of nonporcine animal models without xenographic rejection, SIS in this model was thrombogenic despite a favorable surface morphology as demonstrated by SEM. Even with use of heparin and urokinase SIS graft thrombosis occurred. © 1994 Wiley‐Liss, Inc.
Bipolar coagulation at different energy levels: Effect on patency
Authors: Hood John M. , Lubahn John D.
Published: March 2007

Determining the extent of damage caused by bipolar coagulation at different levels is critical in microsurgery. If no significant damage occurs at known levels, this technique can be used instead of ligation, saving considerable time. One hundred eighty Sprague‐Dawley rats were divided into six groups of 30 each. The effects of bipolar coagulation were assessed at either 2 or 10.4 watts at the junction between the common femoral artery and a branch vessel. Three common clinical settings were used: branch coagulation without interruption of blood flow in the common femoral artery; branch coagulation with interruption of blood flow for 30 minutes; and branch coagulation with arterial anastomosis 3–5 mm distal to the branch. Control procedures without coagulation were performed on the contralateral vessels. The animals were re‐explored at 5–7 days. No differences occurred in patency of the coagulated vessels at 2 or 10.4 watts of delivered energy as compared with controls. Recanalization of the side branch occurred in approximately 80% (144/180) of specimens. Extensive damage to endothelium, tunica intima, and tunica media occurred for 1–2 mm around the site of the coagulated branch. The forceps pick‐up test demonstrated little difference in flow of the cauterized vessel compared with controls. However, the cauterized vessel had a clinically weaker pulse stream of the transected common femoral artery. Recanalization of the coagulated side branch commonly occurred with a fibrin cap at the end of the vessel. Manipulation of the branch vessel frequently caused rebleeding. Our study shows that bipolar coagulation can be used effectively if coagulation is located at least 2 mm from the main vessel. © 1994 Wiley‐Liss, Inc.
Prelamination: Defining the prefabricated flap—a case report and review
Authors: Pribaz Julian J. , Fine Neil A.
Published: March 2007

Modification of flaps prior to local or distant transfer has gained wide acceptance. The term prefabricated has been used to describe all possible modifications. In this article we introduce the term prelamination to refer to the implantation of tissue or other devices into a flap prior to transfer and suggest that prefabrication be restricted to the implantation of vascular pedicles. A case is presented illustrating these concepts. © 1994 Wiley‐Liss, Inc.
Review of postoperative pharmacological infusions in ischemic skin flaps
Authors: Knight Kenneth R.
Published: March 2007

No single drug has yet been found which can overcome the inflammatory and microvascular changes which occur in a skin flap after ischemia‐reperfusion. Nevertheless, the continued failure of approximately 7% of all free flap transfers clinically suggests that there may be a place for pharmacological intervention at the time of threatened flap failure. To date, plastic and reconstructive microsurgeons have been reluctant to use drugs because of the mass of conflicting evidence emanating from the plastic surgery literature. However, scientists and surgeons now have a clearer understanding of the problems arising in ischemia‐reperfusion. Multi‐acting drugs which can inhibit most of the important inflammatory changes would be the ideal. This review considers some of the historical developments in the pharmacological treatment of ischemic flaps in the past decade and looks to the future when pharmacological infusions may be part of the routine for salvaging failing skin flaps. © 1994 Wiley‐Liss, Inc.
Nitric oxide synthase inhibitors improve skin flap survival in the rat
Authors: Knox Laura K. , Stewart Alastair G. , Hayward Peter G. , Morrison Wayne A.
Published: March 2007

The ability of nitric oxide (NO) synthase inhibitors to reduce ischemia‐induced skin flap necrosis was assessed using a modified McFarlane flap in the rat. Flap survival was significantly improved in L‐NIO treated (86 ± 2%), L‐NAME‐treated (84 ± 2%), and aminoguanidine‐treated (76 ± 2%) animals compared to the saline‐treated group (54 ± 2%), P < 0.005. Inhibition of NO synthase significantly decreased the hyperemia and edema within the flaps at 24 hours post‐elevation. These findings suggest that endogenous NO production contributes to ischemic necrosis and that inhibition of NO synthase may prove useful in extending survival of tissues subjected to ischemia. © 1994 Wiley‐Liss, Inc.
Heterotopic vascularized growth plate transfer in juvenile dogs
Authors: Shigetomi Mitsunori , Morrison Wayne A. , O'Loughlin Kevin C. , Sakai Kazuhiro , Kuwata Noriyuki , Ohta Ichiro , Hayward Peter G. , Hurley John V. , O'Brien Bernard McC.
Published: March 2007

Prior animal studies of vascularized epiphyseal transfers placed growth plates in 2 bone systems where the independent growth of epiphyses and their response to altered stresses has been difficult to assess. This study assessed growth of vascularized ulnar epiphyses transferred to the ipsilateral humerus of 12‐week‐old puppies. Growth was permitted by a specially designed extensible plate. Control groups showed that humeral dissection, osteotomy and ostectomy alone do not stimulate growth. In 4 puppies initial growth of the transferred epiphysis was seen but late collapse and formation of bridging callus occurred so that overall humeral length at maturity was not significantly different from control humeri. Physical forces inherent in heterotopic transfer may preclude long term growth of transferred epiphyses particularly in sites of higher relative load. The extensible plate used here may be a useful device in the fixation of transferred epiphyses with growth potential. © 1994 Wiley‐Liss, Inc.
Microvascular reconstruction of the upper extremity with the rectus abdominis muscle
Authors: Rao Venkat K. , Baertsch Andrew
Published: March 2007

Large soft‐tissue defects of the upper extremity are difficult to reconstruct. Defects in 21 patients (15–75 years old) were treated by free tissue transfer of the rectus abdominis muscle. The defects were the result of trauma or resection of tumor and measured more than 15 × 15 cm. The muscle was transferred on the inferior epigastric pedicle and covered with a skin graft within 48 hours. All transfers were successful, and early soft‐tissue healing occurred. This procedure offers the advantages of easy positioning, large donor vessels, and a highly vascular soft tissue reconstruction. The long‐term functional and cosmetic results have been excellent. © 1994 Wiley‐Liss, Inc.
Accessory nerve neurotization in infants with brachial plexus birth palsy
Authors: Kawabata Hidehiko , Kawai Hideo , Masatomi Takashi , Yasui Natsuo
Published: March 2007

We report the surgical results of 13 accessory nerve neurotizations in brachial plexus birth palsy. The mean age at operation was 5.9 months. The accessory nerve was transferred to three C5 roots, to three C6 roots, to four posterior division of the middle trunks, to one musculocutaneous nerve, and to two suprascapular nerves. Sixty‐seven percent of the cases acquired M4 or more in the deltoid muscle, 88% in the infraspinatus muscle, and 100% in the biceps brachii muscle. Twenty‐five percent of the cases acquired M4 or more in the triceps brachii muscle and the wrist extensor muscles. These results were much better than formerly reported for adult cases by other authors. No functional compromise of the trapezius muscle was noted. The accessory nerve neurotization can be used safely and effectively in neurosurgical reconstruction of the brachial plexus palsy in infants. © 1994 Wiley‐Liss, Inc.