bluuebunny/crossref_metadata_2025_split huggingface dataset:
Major limb replantation in children
Authors: Beris Alexandros E. , Soucacos Panayotis N. , Malizos Konstantinos N. , Mitsionis Gregory J. , Soucacos Panayotis K. 
Published: March 2007

AbstractAfter 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

AbstractOsteonecrosis 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

AbstractA 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

AbstractSeveral 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

AbstractTwenty‐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

AbstractCongenital 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

AbstractOver 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

AbstractThe 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

AbstractAs 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

AbstractSeveral 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

AbstractTen 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

AbstractTotal 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

AbstractThe 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

AbstractWe 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

AbstractThe 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

AbstractThe 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

AbstractTo 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

AbstractThe 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

AbstractNitric 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.