bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of regeneration across a vascularized versus conventional nerve graft: Case report
Authors: Mackinnon Susan E. , Kelly Louise , Hunter Daniel A. 
Published: March 2007

AbstractA histological and functional comparison of regeneration across a vascularized and conventional nerve graft was carried out in a clinical case. The two branches of the medial antebrachial cutaneous nerve were used to neurotize the median nerve at the wrist. The superficial branch of the radial nerve (vascularized nerve graft) and a conventional sural nerve graft were used as the interposition grafts between the two branches of the medial antebrachial cutaneous nerve and the median nerve. This nerve grafting procedure was carried out in two stages. The proximal neurorrhaphy was carried out 7 months prior to the distal nerve repair. Biopsies were taken from the distal portions of the vascularized radial sensory nerve and the conventional sural nerve at the time of the second procedure. Histological evaluation demonstrated superior regeneration across the vascularized nerve graft. Subjectively, the patient described better sensory recovery in the territory innervated by the vascularized nerve graft. Sensory testing in the two territories demonstrated better sensibility in the territory innervated by the vascularized nerve graft.
Microsurgical arterialization for vascular impotence
Authors: Wagenknecht L. V. 
Published: March 2007

AbstractOut of 400 patients with erectile lesions, Doppler flowmetry in combination with nitroglycerin stimulation showed a decreased penile arterial blood flow in 42 males. Dynamic cavernosography and cavernosometry showed a concomitant increase of venous drainage in 38 of them. Phalloarteriography in 22 males demonstrated an occlusion of the interna pudendal artery in 21. In 15 patients penile arterialization was done by interposition of a saphenous vein‐graft between the iliac artery and the deep dorsal penile vein. In four of these patients an additional venous leak was treated during the same operation by ligation of the internal iliac veins. Two years postoperatively, two of three of the patients are doing well. Failures in five included four diabetic neurovascular lesions and one postoperative priapism.
Epididymal microsurgery: Current techniques and new horizons
Authors: Southwick Graeme J. , Temple‐Smith Peter D. 
Published: March 2007

AbstractSurgical treatment for obstructive azoospermia was introduced about 30 years ago with the development of Bayle's vasoepididymal fistula technique (Bayle: Enc Med Chir 41:435, 1966). More recently this has been replaced by single tubule end‐to‐end microvasoepididymal bypass procedures with improved success rates. We describe the use of animal models in the development and application of a modified end‐to‐end microanastomosis technique in which the vas deferens is attached to a single surface convolution of the ductus epididymidis. In comparison with other microvasoepididymostomy (micro‐VE) procedures, this technique results in less postoperative scarring and allows for easier access to the epididymis in those patients requiring subsequent epididymal surgery. With this procedure 60% of patients produced spermatozoa after operation, and 10% of 102 patients have so far achieved pregnancies. For patients, such as those with congenital absence of the vasa deferentia, whose infertility cannot be corrected by microvasoepididymal surgery, we describe a microaspiration procedure that can be used to collect spermatozoa from the epididymis for use in in vitro fertilization (IVF). This procedure has a low success rate at present, with an 18% fertilization and 3% pregnancy rate per cycle. Improvements in treatment procedures for aspirated sperm samples, such as the use of motility stimulators and in vitro maturation by coculture with epididymal tubule segments before IVF, may enhance the success for this technique. Microinjection of sperm collected by epididymal microaspiration into oocytes may be an alternative method of treatment for these patients in the future. Two procedures (microepididymoepididymostomy and the vas bridge bypass) that are currently being modelled in the rabbit may provide new directions for epididymal microsurgery and for examining epididymal function. Although the two methods are technically more difficult than standard micro‐VE procedures, preliminary studies are encouraging and suggest a future role for these techniques in treating obstructive azoospermia. Such techniques make use of the epididymis distal to the obstruction site and may be particularly important in improving the success of surgery for obstructive azoospermic patients with high‐level obstructions in whom sperm quality following micro‐VE surgery is often poor.
New directions in male reproductive microsurgery
Authors: Gilbert Bruce R. , Goldstein Marc 
Published: March 2007

AbstractDuring the past decade, microsurgery has become a urologic subspecialty. Historically, vascular and vasal anastomosis have formed the foundation of genitourinary microsurgery. With the advent of improved instrumentation and the interest of devoted urologic microsurgeons, a multitude of new applications of microsurgery in urology have developed. In this paper, we discuss some of the new directions in male reproductive microsurgery.
Heterotopic renal transplantation in the rat: An advanced microsurgical training exercise
Authors: Korber Kenneth E. , Kraemer Bruce A. 
Published: March 2007

AbstractMicrosurgical training programs have instructed trainees from many surgical specialties with the expansion of these techniques into all areas of clinical surgery and experimental research. Most programs employ the rat femoral vessel model in microsurgical training. A more complex and less frequently used model, the rat renal transplantation procedure, can be used for advanced training in microsurgical and microurological techniques and offers several advantages over other microsurgical models. In the heterotopic renal transplant model, the left kidney from a donor rat is transferred to the inguinofemoral region of a syngeneic recipient. The method of revascularization can be varied from end‐to‐end repairs of vessels of equal diameter to those of unequal diameter. In addition to the variety of possible vascular repairs, an advantage of this model over others is that the kidney graft can be harvested by a technician, thus reducing the time commitments of the trainee. This model is ideal for microsurgeons, immunologists, and urologists, since it affords the opportunity for developing technical skills while preparing an experimental model that can be used for further research. We describe the model, the operative techniques, and the variations one can employ in performing the vascular repairs.
A technique for replantation of the finger tip
Authors: Tsai Tsu‐Min , McCabe Steven J. , Maki Yutaka 
Published: March 2007

AbstractThe finger‐tip replantation technique reported here has evolved over 15 years. Indications for surgery include both strong patient desire and specialized use of the finger tip. Palmar flaps are elevated as full‐thickness skin grafts to avoid injury to palmar veins. Arteries and palmar digital veins are repaired using an open‐vessel technique. Postoperative care varies from immediate discharge with follow‐up to inpatient care using surgical leeches or continuous bleeding as a method of drainage should venous congestion develop. The survival rate of 26 finger tips replanted using this technique between 1981 and 1987 was 69%. Two‐point discrimination returned in 75% of patients, and 25% had two‐point discrimination of less than 5 mm. The distal interphalangeal joint retained an average range of motion of 56°. Appearance was excellent, and patient satisfaction was high.
A microvascular anastomotic device: Part i. a hemodynamic evaluation in rabbit femoral arteries and veins
Authors: Blair William F. , Steyers Curtis M. , Brown Thomas D. , Gable Ronald H. 
Published: March 2007

AbstractThis study quantitatively assesses the hemodynamic consequences of inserting a 1.5‐mm polyethylene anastomotic device in both small arteries and veins. The device was placed in 20 rabbit femoral arteries and 20 femoral veins. Using 20‐MHz pulsed ultrasonic Doppler velocimetry techniques, blood flow was measured in 5 immediate postoperative intervals and at the 24‐hour and 3‐week postoperative intervals. In arteries, volumetric flow (Q) was not statistically different in any postoperative interval; maximum spatial velocity (Vmax) was significantly increased in the immediate postoperative intervals but was not different at 24 hours or 3 weeks. In veins, significant decreases in Q and increases in Vmax occurred in the immediate postoperative intervals, but differences were not noted at the 24‐hour or 3‐week intervals. The results of this study indicate that the hemodynamic consequences of anastomosing small vessels with a polyethylene device are minimal and that this mechanical technique is an effective method for experimental microvascular repairs.
A microvascular anastomotic device: Part II. A Histologic Study In Arteries And Veins
Authors: Blair William F. , Steyers Curtis M. , Morecraft Robert J. , Maynard Jerry A. 
Published: March 2007

AbstractThis study analyzes the histology associated with the polyethylene ring‐pin device. The device was placed in 20 rabbit femoral arteries and 20 femoral veins. Specimens were harvested at 24‐hour and 3‐week postoperative intervals and were analyzed using light, scanning electron, and transmission electron microscopy. Generally, the reparative process in the arteries and veins was similar. In 24‐hour artery and vein specimens, the endothelial cells were absent, the media tapered within the device, but smooth muscle cells (SMC) remained partially viable. In 3‐week specimens, the device junction was well healed and reendothelialized. Subintimal hyperplasia was present, the internal elastic lamina was not reconstituted, and the SMCs were partially viable. Small vascular channels formed at the device junction, and small venous valves were noted near the device. Macrophages lined the margins of the device. The early reparative process proceeds favorably, by histologic criteria, after vessel repair with the polyethylene ring‐pin device.
Neointima formation in expanded polytetrafluoroethylene vascular grafts with different fibril lengths following implantation in the rat aorta
Authors: Hess Frits , Steeghs Suzanne , Jerusalem Christoph 
Published: March 2007

AbstractExpanded polytetrafluoroethylene (PTFE) prostheses with fibril lengths of 30 and 60 μm were implanted in the rat infrarenal aorta. Sequential scanning electron and light microscopic studies of the prostheses after implantation demonstrated a different pattern of endothelialization. Prostheses with a fibril length of 60 μm had a continuous multilayered neointima at week 25 postimplantation, whereas prostheses with a 30‐μm fibril length had a discontinuous and single layer of endothelium after the same interval. It was concluded, therefore, that a prerequisite for the development of a lining in a vascular prosthesis is for the inner surface of the prosthesis to have adequate pores for effective anchoring of the invading endothelioid cells. Expanded PTFE prostheses with an internodular distance of 60 μm provided sufficient anchoring possibilities for invading endothelioid cells to form a continuous neointima.
Experimental nerve reconnection: Importance of initial repair
Authors: de Medinaceli Luis , Seaber Anthony V. 
Published: March 2007

AbstractWe believe that the randomness of sprout regrowth is the cause of most poor experimental and clinical functional results after nerve repair. We have elaborated a technique of repair, called “nerve reconnection” aiming to minimize randomness of regrowth. This technique enhances the precision of repair by minimizing physical and chemical damage to the stumps and by ensuring stress‐free stump abutment. In this study, the reconnection technique was compared to the conventional microsuture method. First, both techniques were tested as the primary method of repair. A method of behavioral evaluation, the sciatic functional index, was used to assess the results. The reconnection groups consistently showed satisfactory functional results, even after two successive procedures. In contrast, only one‐third of the animals in the suture groups reached satisfactory functional levels. In the second part of the study, animals with unsatisfactory results after primary suture were reoperated in an attempt to improve the poor results of initial surgery. The secondary procedures used were either the reconnection technique or conventional microsuture. All secondary procedures failed to improve poor preexisting functional conditions. These findings stress the importance of the original “blueprint” of the nerve and the necessity of maintaining this unique pattern during initial repair.
Treatment of skin and median nerve defects with peroneal neurofasciocutaneous flap
Authors: Fukui Akihiro , Inada Yǔji , Tamai Susumu , Mizumoto Shigeru 
Published: March 2007

AbstractA large neurofasciocutaneous flap that consisted of a peroneal flap and a segment of sural nerve was used in the simultaneous reconstruction of a large soft tissue and nerve defect caused by a crushing injury of the distal forearm. A 10×15 cm peroneal flap, including a 10 cm segment of sural nerve, was successfully transferred to an 8×12 cm skin defect, reconstructing a 5 cm defect of the median nerve. Two years after repair, the opponens pollicis muscle showed good contraction, although palmar abduction of the thumb remained poor. Static two‐point discrimination was 20 mm on the pulp surface of both thumb and index finger and 15 mm on the middle finger.
Vascularized iliac osteocutaneous flap based on the deep circumflex iliac vessels: Experience in 13 cases
Authors: Minami Akio , Ogino Toshihiko , Itoga Hideya 
Published: March 2007

AbstractWe have carried out 13 vascularized iliac osteocutaneous flaps (VIOF) based on the deep circumflex artery (DCIA) and accompanying veins for cases with compound skin and bone defects. Ten of 13 cases obtained bony union at both ends of the iliac crest with only VIOF. Two of the remaining 3 cases obtained bony union at one end only with the VIOF but united at another end with an additional conventional bone grafting procedure. The final case, a traumatic bone defect of the tibia, failed to obtain bony union at either end of the iliac segment. In 5 of 11 patients in which an osteocutaneous flap was used, complete skin flap survival occurred. Of the remaining 6, one flap went on to complete necrosis, and five flaps were complicated by superficial or partial necrosis. The incidence of flap complications was analysed according to the size of flap. Five flaps with complete survival averaged 6.8 × 10.6 cm in size; however, five flaps with superficial or partial necrosis averaged 10.0 × 15.8 cm. These results suggest that the maximal safe skin flap dimension from the DCIA supply alone is probably 10×15 cm.
Use of small‐caliber polytetrafluoroethylene (gore‐tex ®) grafts in microsurgical training
Authors: Korber Kenneth E. , Kraemer Bruce A. 
Published: March 2007

AbstractWe present the use of polytetrafluoroethylene (PTFE) graft material as a microsurgical training model that better simulates live vessel repairs. PTFE grafts have mechanical advantages over polyethylene or silicons tubing in that they better mimic the “feel” of an arterial vessel wall, thus allowing the student to perfect counterpressor maneuvers before attempting live vessel repairs. Saving the PTFE “repairs” for later comparison and study provides the student with positive feedback that is not possible with living models. This cost‐effective model has helped to shorten our directed teaching program and has reduced the use of laboratory animals.
Enhancement of peripheral nerve regeneration by pharmacological activation of the cyclic amp second messenger system
Authors: Klein Howard W. , Kilmer Suzanne , Carlsen Richard C. 
Published: March 2007

AbstractThis paper reviews the history of attempts to study peripheral nerve regeneration, focusing upon pharmacologic agents that may prove to be useful clinically. In particular, forskolin is described as a model for such an agent, and its mechanism of action, as a stimulator of the cyclic AMP second messenger system, is described.
Relationship between sensibility and ability to read Braille in diabetics
Authors: Nakada Mayumi , Lee Dellon A. 
Published: March 2007

AbstractTwenty‐five vision‐impaired diabetics received an evaluation of sensibility. Each subject had received 2 years of instruction in braille reading at the Konan Rehabilitation Center prior to the sensibility testing. Sensibility evaluation consisted of cutaneous pressure threshold measurements with the Semmes‐Weinstein monofilament and evaluation of moving and static two‐point discrimination with Disk‐Criminator™. The ability to read braille was graded by the braille‐teaching instructors as good, fair, and unable. The results of the evaluation of sensibility demonstrated that the value of the cutaneous pressure threshold did not correlate with the ability to read braille. Moving and static two‐point discrimination were found to correlate highly (P <.001) with the ability to read braille at a level of fair or good. No patient in this study with a moving two‐point discrimination value of 4 or more or a static two‐point discrimination value of 5 or more was able to read braille even at the fair level of ability.
Results of primary nerve repair in the upper extremity
Authors: Mailänder P. , Berger A. , Schaller E. , Ruhe K. 
Published: March 2007

AbstractThe results of primary repair of peripheral nerve injury in the upper extremity are reported for 143 nerves in 120 patients, with a mean follow‐up of 24 months. Normal values for static and moving two‐point discrimination were established and related to the person's age. Sensory reeducation was employed routinely in the postoperative rehabilitation program. Moving two‐point discrimination recovered to a better level in 61%, the same level in 38%, and a worse level in 1% than static two‐point discrimination after nerve repair. Results for digital, median, ulnar, and radial nerve repairs are reported.
Intravascular thrombosis in skeletal muscle microcirculation after ischemia
Authors: Hartsock Langdon A. , Seaber Anthony V. , Urbaniak James R. 
Published: March 2007

AbstractThis study was undertaken to elucidate the role of thrombosis in blood vessels less than 0.1 mm in diameter in skeletal muscle after an ischemic episode. Capillaries were examined after normothermic ischemia using intravital video microscopy of the cremaster muscle of an anesthetized rat. Histologic sections of the cremaster muscle and silicone rubber intravascular casts were also analyzed. Our model demonstrates that, after 3 hours of warm ischemia, up to two‐thirds of capillaries are clotted, as is most of the venous system. Our findings also indicate that capillaries may reopen during 30 minutes of reperfusion. These findings suggest that ischemia may cause thrombosis in the microvasculature of skeletal muscle but the thrombosis appears to be partially reversible.
Quantitative fluorimetric effects of leeching on a replanted ear
Authors: Anthony James P. , Lineaweaver William C. , Davis James W. , Buncke Harry J. 
Published: March 2007

AbstractLeeching is used to relieve venous congestion in microscopically replanted tissues. A quantitative description of the effects of leech application on tissue perfusion has not been reported. We report a case of an ear replantation in which venous congestion was consistently improved with leeching. In four instances, quantitative fluorimetry, which indicated impaired circulation and prompted leech application, showed restoration of normal circulation patterns following leech application. The fluorometric studies suggested that arterial inflow improved and venous congestion was relieved.
Laser‐doppler versus fluorometry in the postoperative assessment of a cutaneous free flap
Authors: Durlik M. , Benichoux R. , Mainard D. , Merle M. 
Published: March 2007

AbstractTo find the optimal means for monitoring the vascularity of a cutaneous free flap in the postoperative period, we have experimentally compared laser‐Doppler velocimetry and fluorometry. Using the rat groin model, five groups were evaluated: 1. flap isolation without division of the pedicle vessels (island flap); 2) flap isolation, division, and repair of the pedicle artery and vein (free flap); 3) flap isolation, with ligation of the pedicle artery immediately or 1 hour later; 4) flap isolation, with ligation of the pedicle vein immediately or 1 hour later; 5) flap isolation, with ligation of the pedicle artery and vein immediately or 1 hour later. The laser‐Doppler processes the signal by combination of the root mean square and differential amplification. The fluoroscan gives an index in relation to the fluorescence of a control area. The results obtained with both methods correlated well with findings in clinical situations. However, the laser‐Doppler readings were more rapid and sensitive than those with fluorometry. We suggest that laser‐Doppler velocimetry is a superior means of monitoring the vascular status of a free tissue transfer or digital replant.
Sutureless microvascular anastomosis using the THC:YAG laser: A preliminary report
Authors: Bass Lawrence S. , Treat Michael R. , Dzakonski Carl , Trokel Stephen L. 
Published: March 2007

AbstractLaser anastomosis of the rat carotid artery was performed using a new midinfrared laser, the pulsed thulium‐holmium‐chromium:YAG (THC:YAG) laser (2.15 μm). Solid silicone stents made stay sutures unnecessary for coaptation of vessel edges during laser bonding. Grossly, the laser anastomoses displayed minimal thermal distortion of the vessel contour and no tissue carbonization. Of the 30 anastomoses performed, 27 were patent and 3 had separation of the weld shortly after the approximator clamp was released. Mean anastomotic time was 4 min 48 sec. Mean bursting pressure for the 9 vessels tested was 400 mm Hg. Thrombosis did not occur at any time during our examination of these anastomoses. Fusion of collagen fibers in the media was confirmed histologically. Unlike the CO2 laser, the THC:YAG is transmissible through flexible silica fibers, which greatly facilitates delivery of the laser in a microsurgical operative field. The THC:YAG provides shallower absorption depth than Nd:YAG and argon lasers but somewhat deeper tissue penetration than CO2. For microvessels, this intermediate absorption results in full‐thickness fusion of the media, with minimal thermal damage to vascular tissue adjacent to the anastomosis.
Lack of portal‐venous hypertension after an arterioportal fistula in the rat
Authors: Benito Milagros , del Pino Juan Gonzalez , Hernandez Lucia , Pardo Juan Diez 
Published: March 2007

AbstractThe hepatic effects of an end‐to‐side arteriovenous fistula between the right renal artery and the portal vein were studied in rats. Fifty rats underwent surgery and were studied 3, 12, 24 weeks and 1 year later. Another 15 rats were used as controls. Rats did not have any portohepatic abnormality. Portal and caval pressure were measured, and the liver was evaluated histologically. No statistically significant differences were achieved between the control portal (10.37 M‐1 0.29 cm H2O) and vena cava pressures (1.22 M‐1 0.19 cm H2O) and those of the experimental groups. The overall liver architecture remained unchanged. A progressive enlargement of the intrahepatic portal and hepatic veins was noted. No hypertrophy of the fibrous tissue into the portal triads, hypertrophy of the muscularis of the portal vein radicals, or wall sclerotic thickening was seen. The forward overflow compensatory mechanisms are discussed.