bluuebunny/crossref_metadata_2025_split huggingface dataset:
Primary shortening with secondary limb lengthening in severe injuries of the lower leg: A six year experience
Authors: Betz A. M. , Stock W. , Hierner R. , Baumgart R. 
Published: March 2007

AbstractMultiple secondary grafting procedures may be necessary in cases of complete or partial amputation of the lower limb if the aim is to preserve the initial limb length. The traditional concept of staged reconstruction often leads to a prolonged hospitalisation and a high complication rate, especially in cases with segmental nerve defects of more than one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a primary shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months after replantation, secondary limb lengthening is started, using an external or internal distraction device. Since 1985, 7 patients presenting with complete or partial amputation of the lower leg had been treated using this concept. The indications, operative technique, complications and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting. © 1993 Wiley‐Liss Inc.
Preventive haemostasis with an inflatable tourniquet for microsurgical distal arteriovenous fistulas for haemodialysis
Authors: Bourquelot Pierre D. 
Published: March 2007

AbstractThe creation of a distal arteriovenous fistula for haemodialysais is made easier by using preventive haemostasis with an inflatable tourniquet. Preventive haemostasis reduces the duration of the surgery and reduces the arterial spasm provoked by the dissection. When microsurgical techniques and preventive haemostasis are used, it is possible to create fistulas even in very small children. © 1993 Wiley‐Liss Inc.
Free flap survival improved by prostacyclin analogues
Authors: Frick Andreas , Baumeister Rudiger G. H. , Wohllaib Ulrich 
Published: March 2007

AbstractFree flap transplantations and replantations of extremities are threatened by venous occlusion in the postoperative course. In rats, free autogenous groin flaps were transplanted to the neck using microsurgical techniques. On the first postoperative day, the draining vein of the flap was temporarily clamped. In the control group there was always a total loss of the flaps by haemorrhagic necrosis. The intraarterial flap perfusion by lloprost during the clamping was able to diminish the ischaemic effects; 80% of the flaps survived. The systemic application of lloprost by intravenous infusion reduced the ischaemic effects in a similar way. Serious complications such as intraabdominal bleeding or bleeding in the donor area were seen after intravenous administration. Cicaprost had a similar protective effect on flap ischaemia after intravenous infusion. Flap survival was comparable to lloprost. Severe complications seemed to be less. Prostacyclin analogues were able to diminish damage of secondary ischaemia caused by venous occlusion. © 1993 Wiley‐Liss Inc.
Correction of hypoplastic thumb by free transfer of metatarsal bone: A case report
Authors: Schneider W. , Reichert B. , Pallua N. , Meyer H. 
Published: March 2007

AbstractA new form of correction of hypoplasia of the thumb is presented in a case of grade 3 thumb hypoplasia. The distal half of the second metatarsal together with its epiphyseal plate was used to lengthen the first metacarpal bone and improve thumb function. This method represents a promising alternative to pollicization in this type of thumb hypoplasia. © 1993 Wiley‐Liss Inc.
Further clinical use of the interposition arteriovenous loop graft in free tissue transfers
Authors: Angel Michael F. , Chang Bernard , Clark Norman , Wong Lesley , Ringelman Paul , Manson Paul N. 
Published: March 2007

AbstractThe use of an arteriovenous fistula (AVF) to afford vascular access for free tissue transfer is described in 11 consecutive patients from a 1 year period. The leg was the site of pathology in six cases, and a reversed saphenous AVF to the femoral vessels was created. In the remaining five cases, those in the head and neck and arm regions, the recipient vessels varied. The mean patient age was 37.7 years, and ten of 11 patients were male. Etiologies of defect were automobile accidents in six cases, neoplasm in three, and gunshot wound and electrical injury in one patient each. Mean ischemia time was 113 ± 15 min. Mean length of AVF was 27.3 ± 2.1 cm. All flaps survived. AVF was a useful technique in the current study. Several maneuvers were undertaken to minimize the risk of thrombosis. All patients were given aspirin prior to AVF creation. Patients received dextran 40 in the postanastomosis period for 5 days. Finally, every effort was made to create the AVF between large vessels, especially in the leg, to maximize blood flow. © 1993 Wiley‐Liss Inc.
The cephalic vein in microsurgery
Authors: Hallock Geoffrey G. 
Published: March 2007

AbstractA working knowledge of the venous anatomy is seldom emphasized but is an essential element in all microvascular procedures. The cephalic vein has been chosen here to serve as a model, since it is an important source for both afferent and efferent flow for flap transfers as well as in limb replantations. The better known, lower extremity superficial veins, especially as a source for long vein grafts, are not necessarily the best option. The cephalic vein represents the most versatile of the large superficial veins of the upper extremity and has numerous roles in microsurgery other than as a viable alternative for vein grafts. © 1993 Wiley‐Liss Inc.
New skeletal muscle model for the longitudinal study of alterations in microcirculation following contusion and cryotherapy
Authors: Smith Thomas L. , Curl Walton W. , Smith Beth Paterson , Holden Martha B. , Wise Thomas , Marr Albert , Andrew Koman L. 
Published: March 2007

AbstractThis preliminary report describes the use of a rat model developed to study in vivo the effect of anesthesia, contusion, and cryotherapy on skeletal muscle microcirculation by use of an implanted chamber. The diameters of arterioles and venules within the chamber were determined by photomicroscopy in the contusion study and by compound videomicroscopy in the anesthesia study; microvascular perfusion was determined by laser Doppler fluxmetry (LDF). Combined ketamine and xylazine anesthesia significantly reduced (P < 0.05) arteriolar and venular diameters by 32.4% and 37.8%, respectively, and average LDF measurements by 36.1%. Contusion significantly increased arteriolar diameters over baseline values (P < 0.05); cryotherapy did not alter arteriolar diameters but increased venular diameters (P < 0.05). It is hypothesized that this increase in venular diameter may, by increasing the surface area available for reabsorption, explain one mechanism by which cryotherapy decreases the edema of contusion. Use of this model should help to advance the understanding of microcirculatory dynamics following contusion and cryotherapy. © 1993 Wiley‐Liss Inc.
Effect of denervation on endothelium‐derived relaxing factor‐dependent relaxation in the rat cremaster muscle
Authors: Gazdag Andre , Chen Long‐En , Hagen Per‐Otto , Seaber Anthony V. , Urbaniak James R. 
Published: March 2007

AbstractEndothelium‐derived relaxation mediated primarily by endothelium‐derived relaxing factor/nitric oxide (EDRF/NO) is essential in the maintenance of vascular tone. However, little is known about the effects of denervation on EDRF‐mediated relaxation in the microcirculation after reimplantation. Using intravital videomicroscopy in the rat cremaster model, this study assessed the effect of acute and chronic denervation of the muscle, produced by severing the genitofemoral nerve, on EDRF‐mediated vasorelaxation. The results demonstrated that acetylcholine‐induced EDRF relaxation (10−6M) significantly relieved norepinephrine‐induced vasoconstrtction in small arteries (40–80 (μm diameter) in both the acute and chronic denervated muscles. There was no significant difference in the relaxant response between the denervated or innervated controls in each group or between the acute or chronic groups. This relaxation was prevented by methylene blue (10−4 M). These findings suggest that EDRF‐mediated relaxation in the microcirculation is not dependent on tissue innervation. Thus the use of potent endothelial dependent agonists may be of use in cases of vasospasm postreimplantation. © 1993 Wiley‐Liss Inc.
Effect of hypertension on arterial structure and wound repair at the microvascular anastomosis site using stroke‐prone spontaneously hypertensive rats (SHRSP)
Authors: Isogai Noritaka , Fujii Shunichiro , Tsukahara Takahiro , Kamiishi Hiroshi 
Published: March 2007

AbstractDifferent processes of microvascular wound healing under hypertension in comparison to normotension have been suspected. To explore these differences at the site of anastomotic wound repair, we performed microvascular anastomoses of the femoral arteries in 12‐week‐old, stroke‐prone hypertensive rats (SHRSP) whose maximum blood pressure reached 238 mm Hg and in normotensive age‐matched Wistar Kyoto (WKY) rats. Morphologic changes under hypertension were examined via light microscopy. The arrangement and number of endothelial cells were examined using the en face silver staining technique. The plasma activity levels of factor XIII were also measured in each group. Transitional healing at the microvascular anastomosis site was evaluated via scanning electron microscopy. The extent of endothelial migration over the exposed media around the needle holes was determined using a computerized graphic analysis system. Histologic cross sections demonstrated a thickened media, with altered shape and arrangement of the smooth muscle cell nuclei in SHRSP arteries compared with WKY arteries. En face silver staining showed small and spindle‐shaped endothelial cells with an irregular cell arrangement and distribution in SHRSP arteries relative to WKY arteries. Factor XIII was increased 36% over baseline in SHRSP rats post‐operatively; this was significantly higher than the increase in WKY rats (P < 0.05). Although both SHRSP and WKY arteries had similar wound healing responses to microvascular anastomosis, endothelial cell migration over the exposed media was significantly accelerated in the SHRSP rats. © 1993 Wiley‐Liss Inc.
Long‐term evaluation of nerve regeneration in a biodegradable nerve guide
Authors: Den Dunnen Wilfred F. A. , van der Lei Berend , Schakenraad Jeff M. , Blaauw Engbert H. , Stokroos Ietse , Pennings Albert J. , Robinson Peter H. 
Published: March 2007

AbstractNerve regeneration using artificial biodegradable conduits is of increasing interest. The aim of this study is to evaluate the regeneration and maturation of a nerve after long‐term implantation (2 years) of a biodegradable poly‐L‐lactide/poly‐e‐caprolactone (PLLA/PCL) copolymeric nerve guide in the sciatic nerve of the rat. After harvesting, we evaluated both the regenerated nerves and the controls, using light microscopy, transmission electron microscopy, and morphometric techniques. Remnants of biomaterial were still present after 2 years of implantation, but the foreign body reaction was very mild at this stage, due to the rounded shapes of the polymer debris. Morphometric analysis showed significant differences between the regenerated nerve and the normal sciatic nerve: the number of myelinated fibers is higher, and the mean fiber diameter of the myelinated fibers in the regenerated nerve is smaller. In conclusion, the results demonstrate that the new PLLA/PCL nerve guide can provide optimal conditions for regeneration and maturation of damaged nerves. © 1993 Wiley‐Liss Inc.
Reconstruction of congenital tibial pseudarthrosis by revascularized fibular transplants
Authors: Bos K. E. , Besselaar P. P. , van der Eyken J. W. , Taminiau A. H. M. , Verbout A. J. 
Published: March 2007

AbstractSeven patients with congenital Boyd type II pseudarthrosis of the tibia and fibula were treated with a revascularized osteocutaneous fibular graft from the contralateral side. Follow‐up ranged from 20 to 96 months (mean 67 months). All patients had previously undergone major surgery (mean three operations). Union was successful in all patients although three required further surgery. At follow‐up all patients were able to walk without external support. The results were classified as good in two cases and fair in five cases.The postoperative period was, however, often complicated by stress‐fracture and nonunion. Leg length discrepancy and valgus deformity are still unsolved problems in some cases. It seems probable that a primary reconstruction at an early age will prevent many of these subsequent problems. © 1993 Wiley‐Liss Inc.
Patency and healing of microvascular prostheses: A review of 10 years of experimental work in groningen
Authors: van der Lei B. , Robinson P. H. 
Published: March 2007

AbstractFrom 1982 onwards, in Groningen, The Netherlands, we have worked on the experimental evaluation and development of microvascular prostheses in rats and rabbits. In this review article a systematic overview of this experimental work is presented and the results are discussed with regard to the literature to come to a current state of the art on (experimental) microvascular grafting with prosthetic conduits. © 1993 Wiley‐Liss Inc.
Neither desferrioxamine nor lipoic acid enhances the cold ischaemic tolerance of epigastric free flaps in rats
Authors: Werker Paul M. N. , Kon Moshe , Green Colin J. , Franken Ralph J. P. M. , Overgoor Max L. E. 
Published: March 2007

AbstractThis study was designed to test the ability of pre‐ and postischaemic administration of desferrioxamine (DFX), a combination of a preischaemic single passage perfusion with hypertonic citrate solution (HCA) and postischaemic administration of DFX, and pre‐ and postischaemic administration of lipoic acid (LA) to enhance the cold (0°C) ischaemia tolerance in epigastric free flaps in inbred rats. The ischaemic intervals varied between 0 and 120 hr. The area of flap survival 2 weeks after revascularisation as a percentage of original flap size was recorded as an exponent of ischaemic tolerance. None of the treatment regimens was able to increase flap area survival. Histologically, there were no major differences between the different treatment regimens. © 1993 Wiley‐Liss Inc.
Vein graft conduits versus conventional suturing in peripheral nerve reconstructions
Authors: Heijke Guda C. M. , Klopper Pieter J. , Dutrieux Richard P. 
Published: March 2007

AbstractPositive results of tubulization in peripheral nerve reconstruction have been established in animals by many investigators. Clinically, tubulization by means of a venous tubulus is accepted as a reliable technique, but histological results are not known and functional analysis is limited. The aim of this investigation was to study the histological effect of venous tubuli in peripheral nerve reconstruction.In 20 rabbits the saphenous nerves were transected and anastomosed. In ten rabbits (series 1) a venous tubulus was placed around the nerve suture. In another ten rabbits (series 2) a venous tubulus was sutured over a 3 mm nerve gap. Conventional suturing was done in ten contralateral saphenous nerves (series 3, controls). Epineurial stitching was performed. The healing was studied after 3 months and after that histological analysis was performed by means of monoclonal antibody staining.The results of our experiments show that covering a nerve anastomosis with a venous tubulus did not enhance healing in comparison to the conventional end‐to‐end anastomosis, but in contrast evoked extensive fibrous tissue, thereby hampering regeneration of axons. © 1993 Wiley‐Liss Inc.
Addressing the ideal requirements by free flap phalloplasty: Some reflections on refinements of technique
Authors: Joris Hage J. , De Graaf Floris H. 
Published: March 2007

AbstractIdeally, in phalloplasty one should aim at 1) a one‐stage procedure that can be predictably reproduced, 2) creation of a competent neo‐urethra to allow for voiding while standing, 3) return of both tactile and erogenous sensibility, 4) enough bulk to tolerate the insertion of a prosthetic stiffener, and 5) a result that is aesthetically acceptable to the patient. We consider 6) minimal scarring or disfigurement, and 7) no functional loss in the donor area further requirements for any ideal procedure. Thanks to ongoing refinements, microsurgical free flap phalloplasty techniques lead to the best results, both functionally and cosmetically. These refinements are presented and discussed, as are our experiences applying them. © 1993 Wiley‐Liss Inc.
Late salvage of a ”︁free flap„ phalloplasty: A case report
Authors: Noordanus Robert P. , Joris Hage J. 
Published: March 2007

AbstractThree weeks after radial forearm free flap phalloplasty, a 28‐year‐old female‐to‐male transsexual presented with ischaemia of the neophallus. A salvage procedure was started 7 hours after onset of ischemia. Thrombectomy of the arterial pedicle did not result in venous return of the arterial inflow. Perfusion of the flap with streptokinase restored venous return. Flap perfusion was confirmed by intraoperative direct angiography of the neophallus. Six months after this salvage procedure, the flap is doing well and tactile sensibility has occurred. © 1993 Wiley‐Liss Inc.
”︁Impossible„ reversed radial forearm free flap in microsurgical reconstruction
Authors: Bauland Constantmn G. , van Twisk Reinier , Bos Michael Y. , Nicolai Jean‐Philippe A. 
Published: March 2007

AbstractThe reversed radial forearm free flap is described and patient histories are presented to illustrate its unique reconstructive versatility. The valvular orientation of the deep and superficial forearm veins should theoretically oppose the reversed flow in this flap, but the venous flow is not compromised. In comparison to the anterograde forearm free flap the vascular pedicle is longer and the donor defect generates less functional and cosmetic complications because it is located on the proximal forearm. In a review of the literature anatomical details of the venous drainage are presented. Different opinions on reverse flow in forearm flaps are discussed and a new theory is proposed. © 1993 Wiley‐Liss Inc.
Salvage of a through‐knee amputation level using a free fillet of sole flap
Authors: van der Wey Leo Peter , Polder Theo W. 
Published: March 2007

AbstractA young adult male sustained a compound crural fracture with a 15 cm defect of tibia and fibula, and an extensive soft‐tissue loss of the lower leg and knee joint. A free fillet of sole flap was raised on the amputated foot and transferred to the soft‐tissue defect around the femoral condyles in order to prevent an above‐knee amputation. Intact vascularisation and sensation of the flap were secured by microsurgical anastomoses of the popliteal and posterior tibial vessels and the sciatic and tibial nerves. The patient was rehabilitated rapidly with a prosthesis. At the 12‐month follow‐up, he demonstrated excellent „foot”︁ sensibility, stable soft‐tissue coverage of the stump, and an optimal functional result. © 1993 Wiley‐Liss Inc.
Micro‐Anastomosis of 0.3‐0.4 mm vessels after cold ischemia using a rat model of toe‐to‐thumb transplantation
Authors: Chaopricha Werayudth , Chen Long‐En , Seaber Anthony V. , Bossen Edward , Urbaniak James R. 
Published: March 2007

AbstractAnastomoses of vessels of less than 0.5 mm in diameter remain a challenge from the technical aspect. Clinically such anastomoses are necessary for replantation of the distal digit in adults and whole digits in children. Survival data for replantation of these parts after prolonged ischemia have not yet been reported. Since a rat foot has an anatomic structure similar to the human hand, we used 40 rats as models of toe‐to‐thumb transplantation to study the survival rates of transplanted toes after various periods of cold ischemia (4°<C) of the amputated part. While a 100% success rate was achieved following immediate transplantation of the amputated digits (control group), the survival rates were 87.5, 75, 75, and 62.5% after transplantation of digits cooled for 24, 48, 72, and 96 hours, respectively (groups 2–5). No exact ischemic time limit was demonstrated. The results suggest that, in this model, optimal digital replantation results are achievable even after a 24 hour period of cooling preservation. © 1993 Wiley‐Liss Inc.
Circumferential choledochoplasties with autologous venous and arterial grafts
Authors: Flati Giancarlo , Flati Donato , Porowska Barbara , Rossi Giorgio , Francavilla Sandro , Santoro Emanuele , Carboni M. 
Published: March 2007

AbstractCircumferential choledochoplasties with vascular grafts have rarely been attempted either experimentally or in clinical practice.In this study, choledochoplasties using autologous venous and arterial grafts were performed in rats. Sixty‐four rats were randomly selected into five treatment groups: A) venous interpositional graft replacement of a choledochus gap without a stent; B) venous graft with prolene stent; C) venous graft with polyethylene stent; D) arterial graft; E) a control group with simple resection between ligatures in the choledochus.The operative mortality in treatment groups B, C, D, and E, was 0, and 13% in group A. At 12 weeks follow‐up, all the rats in group E had died, whereas, 52.2% (P <.05) of the rats in group A, 30% of the rats in group B, 57% of the rats in group C, and 92.8% of the rats in group D survived treatment.Surviving animals were sacrificed at 3 months for further examination. The morphology and caliber of the common bile duct of these rats were normal in 25% of the rats in group A, 33% of the rats in group B, 25% of the rats in group C, and 84.6% of the rats in group D.Proximal dilations were found in the rats presenting with abnormal morphology. The dilations were less marked in the group treated by arterial choledochoplasties.Laboratory and clinical cholestatic parameters were within normal ranges in the presence of common bile duct dilations less than four times the normal duct caliber. Electron microscopic examination of the venous and arterial graft at 3 months follow‐up revealed a fibrous ring composed of collagen fibers, fibroblasts, and remnants of elastic fibers. Regenerated ductal epithelium encompassed both types of grafts. Epithelialization was more pronounced in venous grafts as compared to arterial grafts. Biliary epithelium was able to colonize the venous grafts and resume cell specialization and function as in normal biliary epithelium.The most satisfactory results were obtained using venous grafts with stents or by using arterial grafts. © 1993 Wiley‐Liss Inc.