1/60. Single-vessel arteriovenous revascularization of the amputated ear.Successful single-vessel arteriovenous replantation of a completely amputated human ear is described. This result was followed by an experimental study using a rabbit model, to confirm that an amputated ear could survive replantation with only a single arteriovenous anastomosis. Fifteen animals were placed in one of two experimental groups: Group 1-arteriovenous replantation, no treatment (n = 6); and Group 2-arteriovenous replantation with medicinal leeching (n = 9). All ears demonstrated initial reperfusion of the replantation immediately following microanastomosis. Laser Doppler flow readings in the non-leeched replanted ears fell to zero by 8 hr and, by 12 hr, the non-leeched ears demonstrated signs of necrosis. All the leeched, replanted ears demonstrated perfusion and complete viability at the time of sacrifice. The case report, combined with the results from the experimental study, confirm that single-vessel arteriovenous replantation of an amputated ear is feasible.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/60. Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery.Vascular thrombosis remains a dreaded complication of any microvascular procedure, be it composite tissue transfer or replantation of amputated limbs or parts. Despite the tremendous advances in microvascular-related technologies and the accumulated surgical skills, failures caused by occlusion of anastomosed vessels remain a continuous source of frustration to all microsurgeons alike. Several anticoagulation and antiplatelet protocols have been proposed to be used in conjunction with microvascular surgery. More recently, thrombolytic drugs such as urokinase, streptokinase, and thrombolysin have been introduced, yet their systemic effect on hemostasis remains an undesirable side effect. We present our experience with local intra-arterial, intravenous, and soft-tissue injection of recombinant tissue plasminogen activator rt-PA in replantation surgery in three consecutive patients. Arterial thrombi are managed by intra-arterial rt-PA infusion with the catheter placed proximal to the arterial anastomosis. Venous thrombi are best lysed by infusing rt-PA in an engorged vein of the replanted limb. In replanted digits, direct intravenous infusion is not possible. In such situations, injection of rt-PA in the pulp soft tissues may result in successful salvage. We believe this agent also has a role in microvascular composite tissue transfer in preventing free flap failures as well as in salvaging failing flaps.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
3/60. Reconstruction of the upper portion of the ear by using an ascending helix free flap from the opposite ear.Reconstruction of partial, marginal defects of the ear has been a challenge. The ascending helix free flap based on superficial temporal vessels has been described and used solely to repair nose defects. We used reversed pedicle helical free flap for the repair of a major loss of the upper one-third of the opposite auricle. The method permits the transfer of tissue of the same quality with satisfactory cosmetic result. The equalization of the ears in dimension was accomplished with minimal donor-site deformity.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
4/60. Primary and secondary microvascular reconstruction of the upper extremity.Tissue defects of the upper extremity may result from trauma, tumor resection, infection, and congenital malformation. Restoration of anatomy and functional integrity may require microsurgical free flap transfer for coverage of bones, nerves, blood vessels, or tendons. Microsurgical tissue transfer also may be required prior to secondary reconstruction, such as tendon transfers or nerve or bone grafts. This article addresses indications for upper extremity reconstruction using microsurgical tissue transfer flap selection and strategies including primary and secondary reconstruction.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
5/60. Microsurgical replantation of sexual organs in three patients.OBJECTIVE: The present study deals with microsurgical replantation technique. MATERIAL AND methods: The technique was applied in 3 patients whose sexual organs had been accidentally cut off. RESULTS: necrosis of the sutured organs occurred in 2 cases. In 1 case, however, healing with proper miction and sexual function was achieved. Prolonged period (over 12 hours) from the accident to operation as well as the extensive injury of tissues with the vascular system crush were considered to be the main reason for failure. CONCLUSIONS: Microsurgical reconstruction of penis and testes with the use of vessel grafts prolonged the hypoxia which led to necrosis. Disturbances in vein blood outflow from the sutured organs contributed to this process as well. The third case resulted in success mostly due to quick intervention (5 h from injury) as well as to proper microsurgical reconstruction of vessels, nerves, and urethra. In addition suprapubic urine diversion was successfully applied and the urethra healed on the perforated catheter. Routine antibiotics as well as antithrombotic prophylactics were administered in all of the 3 cases.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
6/60. replantation of severed ear parts.We have used a technique whereby a severed ear part is sutured back into place on "shaved" areas on the medical surface of the remaining ear and on the corresponding retroauricular area. After 4 to 6 weeks, the ears are freed and the raw surfaces are skin grafted. We think that replantation of severed ear parts is justifiable, and we recommend this method whereby the supply of blood vessels is increased.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
7/60. Fingertip replantation using the subdermal pocket procedure.Restoration of finger length and function are the goals of replantation after fingertip amputation. methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. To increase the survival rates for composite grafts, the subcutaneous pocket procedure has been used as a salvage procedure. The subdermal pocket procedure, which is a modification of the subcutaneous pocket procedure, was used for replantation of 17 fingertips in 16 consecutive patients. Eight fingertips experienced guillotine injuries and the other nine fingertips experienced crush injuries. Revascularization of one digital artery without available venous outflow was performed for six fingers, and composite graft techniques were used for the other 11 fingers. The success rate was 16 of 17 cases. The difference in success rates for guillotine versus crush injuries was statistically significant. Comparison of patients with arterial anastomoses and patients without arterial anastomoses also indicated a statistically significant difference. Thirteen fingertips survived completely. One finger, demonstrating complete loss and early termination of the pocketing procedure, was amputated on the eighth postoperative day. Two fingers were partially lost because of severe crushing injuries. One finger demonstrated partial loss of more than one quarter of the fingertip, which required secondary revision, because the patient was a heavy smoker. The pocketing period was 8 /- 1 days (mean /- SD, n = 6) for the fingers revascularized with one digital arterial anastomosis and 13.3 /- 1.9 days (n = 10) for the fingers successfully replanted with composite graft techniques. The mean active range of motion of the interphalangeal joint of the three thumbs was 65 /- 5 degrees, and that of the distal interphalangeal joint of the other 11 fingers was 51 /- 11 degrees. The static two-point discrimination result was 6.4 /- 1.0 mm (n = 14) after an average of 11 /- 5 months of follow-up monitoring. Compared with other methods, the subdermal pocket procedure has the advantages of exact subdermal/subdermal contact, a shorter pocketing period, and more feasible observation. The method can offer an alternative salvage procedure for fingertip amputations with no suitable vessels available for microsurgical replantation.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
8/60. Successful auricle replantation via microvascular anastomosis 10 h after complete avulsion.OBJECTIVE: To report a case of successful total auricle replantation 10 h after complete amputation. MATERIAL AND methods: replantation was achieved by means of microvascular anastomosis and other therapies, and assisted by careful nursing. The patient's auricle was completely cut off with a sharp blade by an assailant, who retained it for 5 h. Having been retrieved, it was then preserved in ice for 5 h. Using microscopy, an artery and vein were found at the confluences of the upper and middle and lower and middle parts of the amputated auricle and head wound, respectively An end-to-end anastomosis was performed on these vessels. After operation, the following treatments were used: drainage; reopening of the drainage channels with a needle: flushing or soaking with heparin sodium solution; controlling infection and coagulation; increasing blood volume: dilating vessels; and special nursing. RESULTS: The replanted auricle survived with a normal contour and a very favorable esthetic appearance. CONCLUSIONS: The neat, uncontaminated wound margins and the fact that the amputated auricle was preserved in ice, even though it had been amputated 10 h before the operation, were prerequisites for successful auricle replantation. The microvascular anastomosis technique played a very important role in the survival of the amputated auricle. The postoperative treatment, observation and nursing were difficult but vital aspects of the procedure. The establishment of an effective venous return was a sign of the survival of the amputated auricle.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
9/60. Bilateral hand transplantation: bone healing under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone.PURPOSE: Little is known about bone healing after composite tissue transplantation that requires pharmacologic immunosuppression. Bone integration and callus development were assessed in bilateral hand transplantation. methods: In this study the course of callus development and callus maturation were assessed by color Doppler sonography and radiography in a double hand transplant and compared with forearm replantation. RESULTS: After hand transplantation, ingrowth of small vessels at the bone junction was observed at week 3, calcified callus became visible at month 4, and bone union was completed at month 11. A similar time course of bone integration was observed after replantation. Plating offered sufficient stability. A recipient periostal flap is thought to have improved blood supply and favored development and induction of callus. CONCLUSIONS: Bone healing after hand transplantation under immunosuppression with tacrolimus, mycophenolate mofetil, and prednisolone is identical to that after forearm replantation.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
10/60. Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction.BACKGROUND: Soft-tissue coverage in the lower extremity usually requires a flap with a long pedicle, low donor-site morbidity, and versatility in terms of shape and volume. The extended-pedicle free vastus lateralis muscle flap has previously been described for head and neck cancer, and it fulfills these requirements. methods: Twelve patients with lower extremity defects underwent reconstruction with an ipsilateral free vastus lateralis muscle flap. The flap included a segment of the distalmost part of the muscle, distal to the entry point of the motor nerve to the vastus lateralis, based on the descending branch of the lateral femoral circumflex vessels. Up to 20 cm of vascular pedicle with a large caliber was obtained. In three cases, a combined distal vastus lateralis and anterolateral thigh flap was used as a chimeric flap. RESULTS: All flaps were successful. infection developed in two cases and required flap reelevation and new wound debridement. There was no substantial subjective donor-site morbidity. CONCLUSIONS: Elevation of the flap can be performed with the patient in the supine position and is extremely fast and straightforward, without the added difficulty of anatomical variation or extensive intramuscular vascular dissection. The pedicle is long and of large caliber. Although the series is short, the authors conclude that this is a useful free flap for lower extremity reconstruction.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
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