| 1. |
- Hansson, Thomas, et al.
(författare)
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Inferior functional sensory regeneration after suture of sciatic neurotomy in newborns compared with mature rats
- 1996
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Ingår i: Microsurgery. - 0738-1085 .- 1098-2752. ; 17:5, s. 268-271
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Tidskriftsartikel (refereegranskat)abstract
- It is generally believed that nerve injuries in children regenerate better than those which occur in adults. However, there are no functional experimental studies that support this belief. This study evaluates the functional regeneration of polymodal C-fibres after nerve regeneration in newborn and mature rats 3 months after unilateral sciatic nerve neurotomy and suture. The distribution of polymodal C-fibres was tested by measuring the Evans blue-stained area in the skin after antidromic nerve stimulation. In the newborn group of regenerated animals showed that functional C-fibres were present in a significantly (P<0.05) smaller area than found in the adult group. We conclude that the functional regeneration of C-fibres is superior in mature rats compared with newborns, 3 months after regeneration.
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| 2. |
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| 3. |
- Arnbjörnsson, Einar O.
(författare)
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Sodium hyaluronate as an aid in microvascular surgery
- 1986
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 7:4, s. 166-167
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this study was to compare the suture of a microvascular anastomosis with and without the aid of sodium hyaluronate. The divided femoral arteries of ten Sprague‐Dawley rats were sutured using sodium hyaluronate on one side. Operating time, bleeding, and patency rates were studied and compared. No significant differences were found in the measured parameters. However, the clinical impression is that the use of sodium hyaluronate facilitates the suture of a microanastomosis.
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| 4. |
- Coelho, Ruben, et al.
(författare)
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Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap : A case report.
- 2017
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Ingår i: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 37:6, s. 684-688
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Tidskriftsartikel (refereegranskat)abstract
- Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.
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| 5. |
- Cristóbal, Lara, et al.
(författare)
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Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects : Surgical technique and clinical outcomes
- 2017
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Ingår i: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 37:6, s. 479-486
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area.METHODS: Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function.RESULTS: There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one.CONCLUSION: Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.
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| 6. |
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| 7. |
- Driessen, Caroline, et al.
(författare)
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Usefulness of a template-based anterolateral thigh flap for reconstruction of head and neck defects.
- 2020
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 40:7, s. 776-782
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: One of the challenges in head and neck reconstruction is to have an adequate understanding of the three-dimensionalities of the defects created after resections due to the high variability of clinical scenarios. Consequently, it is essential to design the flap to match the requirements of the defect in order to facilitate the insetting and to achieve a successful outcome. The anterolateral thigh flap (ALT) is a robust and versatile flap commonly used in head and neck reconstruction. In this study the authors use a hand-made template as a tool to customize ALT flaps and its variations to fit more accurately the different shapes, volume, and components of the resulting defects. The aim of this study is to describe in detail this surgical approach and present the clinical experience in 100 consecutive cases using a template-based ALT flaps in head and neck reconstruction.METHODS: A retrospective review was performed on all microvascular head and neck reconstruction cases between January 2013 and December 2017 in our institution where a template-based ALT flap design was performed. We describe in detail the surgical technique used and present the clinical outcomes. In addition, we analyzed the use of different designs of the ALT flaps including different flap components in relation to the location of the defect.RESULTS: One hundred reconstructions for head and neck defects were performed in 97 patients. Seven types of ALT free flaps were performed: fasciocutaneous (46%), suprafascial (8%), adipofascial (9%), vastus lateralis muscle (3%), composite fasciocutaneous/adipofascial (9%), chimeric flaps (21%), and vascularized nerve grafts (4%). Oropharyngeal and periauricular defects were mostly reconstructed with fasciocutanoues design. In more complex three-dimensional defects such as skull base or midface defects, a chimeric flap was selected. In all cases the used of template facilitated the insetting of the free flap. The total flap loss was 2%.CONCLUSIONS: Customization of ALT flaps using intraoperative templates is a useful method for flap design which facilitates fitting of the flap to a variety of defects in head and neck reconstruction.
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| 8. |
- Ellabban, Mohamed A., et al.
(författare)
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Virtual planning of the anterolateral thigh free flap for heel reconstruction
- 2022
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Ingår i: Microsurgery. - : WILEY. - 0738-1085 .- 1098-2752. ; 42:5, s. 460-469
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Tidskriftsartikel (refereegranskat)abstract
- Purpose three dimensional (3-D) virtual planning is an example of computer assisted surgery that improved management of composite tissue defects. However, converting the 3-D construct into two dimensional format is challenging. The purpose of this study was to assess 3-D virtual planning of complex heel defects for better optimized reconstruction. Patients and methods a prospective analysis of 10 patients [9 male and 1 female; mean age = 27.9 years] with post-traumatic heel defects was performed. Heel defects comprised types II (three patients) or III (seven patients) according to Hidalgo and Shaw and were managed using anterolateral thigh (ALT) free flap adopting 3-D virtual planning of the actual defect which was converted into a silicone two dimensional mold. The mean definitive size of the defects was 63.4 cm(3). Functional, aesthetic, and sensory evaluations of both donor and recipient sites were performed 1 year after surgery. Results Six patients received thinned ALT (mean size = 139 cm(3)) while four patients received musculofasciocutaneous ALT flap (mean size = 199 cm(3)). One flap exhibited partial skin flap necrosis. Another flap was salvaged after re-exploration secondary to venous congestion. The mean follow-up was 20.2 months. The Maryland foot score showed 4 excellent, 5 good, and 1 fair cases. The mean American Orthopedic Foot and Ankle hind foot scoring was 76.3 (range: 69-86). All patients regained their walking capability. Conclusions 3-D virtual planning of complex heel defects facilitates covering non-elliptical defects while harvesting a conventional elliptical flap with providing satisfactory functional outcomes and near-normal contour, volume, and sensibility.
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| 9. |
- Enajat, Morteza, et al.
(författare)
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A single center comparison of one versus two venous anastomoses in 564 consecutive diep flaps : Investigating the effect on venous congestion and flap survival
- 2010
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 30:3, s. 185-191
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Tidskriftsartikel (refereegranskat)abstract
- Background: Venous complications have been reported as the more frequently encountered vascular complications seen in the transfer of deep inferior epigastric artery (DIEA) perforator (DIEP) flaps, with a variety of techniques described for augmenting the venous drainage of these flaps to minimize venous congestion. The benefits of such techniques have not been shown to be of clinical benefit on a large scale due to the small number of cases in published series. Methods: A retrospective study of 564 consecutive DIEP flaps at a single institution was undertaken, comparing the prospective use of one venous anastomosis (273 cases) to two anastomoses (291 cases). The secondary donor vein comprised a second DIEA venae commitante in 7.9% of cases and a superficial inferior epigastric vein (SIEV) in 92.1%. Clinical outcomes were assessed, in particular rates of venous congestion. Results: The use of two venous anastomoses resulted in a significant reduction in the number of cases of venous congestion to zero (0 vs. 7, P = 0.006). All other outcomes were similar between groups. Notably, the use of a secondary vein did not result in any significant increase in operative time (385 minutes vs. 383 minutes, P = 0.57). Conclusions: The use of a secondary vein in the drainage of a DIEP flap can significantly reduce the incidence of venous congestion, with no detriment to complication rates. Consideration of incorporating both the superficial and deep venous systems is an approach that may further improve the venous drainage of the flap.
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| 10. |
- Enajat, Morteza, et al.
(författare)
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The deep inferior epigastric artery perforator flap for autologous reconstruction of large partial mastectomy defects
- 2011
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 31:1, s. 12-17
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Tidskriftsartikel (refereegranskat)abstract
- Background: Breast conservation surgery in the treatment of early stage breast cancer has become increasingly utilized as a means to avoiding mastectomy. While partial mastectomy defects (PMDs) may often be cosmetically acceptable, some cases warrant consideration of reconstructive options, and while several reconstructive options have been described in this role, a series of deep inferior epigastric perforator (DIEP) flaps has not been reported to date. Methods: A cohort of 18 patients undergoing PMD reconstruction with a DIEP flap were included. Patient-specific data, operation details, cosmetic results, and complication rates were assessed. Oncologic outcomes, in particular recurrence rates, were also evaluated. Results: In our series there were no cases of partial or total flap necrosis, and overall complications were low. There were two cases of wound infection (both had undergone radiotherapy), managed conservatively, and one case of reoperation due to hematoma. There were no cancer recurrences or effect on oncologic management. Cosmetic outcome was rated as high by both patients and surgeon. The results were thus comparable with other reconstructive options. Conclusion: Although autologous reconstruction has an established complication rate, our results suggest that the DIEP flap may be of considerable value for delayed reconstruction of selected larger partial mastectomy defects.
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| 11. |
- Enajat, Morteza, et al.
(författare)
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Thermal injuries in the insensate deep inferior epigastric artery perforator flap : case series and literature review on mechanisms of injury
- 2009
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 29:3, s. 214-217
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Forskningsöversikt (refereegranskat)abstract
- With the increasing use of the deep inferior epigastric artery perforator (DIEP) flap, complications that are particularly rare (less than 1%) may start to become clinically relevant. During DIEP flap harvest, cutaneous nerves innervating the flap are necessarily sacrificed, resulting in reduced sensibility This impaired sensibility prevents adequate thermoregulatory reflexes, like vasodilatation, sweating, and protective behaviors, leaving the reconstructed breast considerably more susceptible to thermal insult. We present four DIEP flap cases who sustained postoperative thermal injury to the reconstructed breast. All four cases were operated on between 2001 and 2008, over the course of 600 DIEP flaps in our unit (an incidence of 0.7%). The injuries occurred between 2 and 18 months after reconstruction. Two patients sustained thermal injury while sunbathing, one while staying in a warm environment, and one sustained the injury while taking a shower. No flap losses ensued, but these were not without morbidity. A literature review discusses other similar cases in the literature and describes the mechanisms for these findings. As a majority of patients will regain both fine-touch and heat sensation by 3 years postoperatively, it is pertinent that prophylactic measures be instituted during this period, such as the avoidance of sunbathing and the use of cooler shower temperatures for the first 3 years postoperatively. While performing sensory nerve coaptation is the gold standard for maximizing the success of sensory regeneration, this is not always sought and the 0.7% incidence of thermal injury we have encountered suggest the role for greater consideration of such injury.
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| 12. |
- Gösseringer, Nina, et al.
(författare)
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Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction : Experience in a Swedish Medical Center
- 2017
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 37:5, s. 416-420
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:The aim of this study is to evaluate how the number of senior microsurgeons, performing autologous microvascular breast reconstruction together, influences operating time and postoperative complications.METHODS:A retrospective study was carried out in one hundred consecutive patients who underwent unilateral delayed deep inferior epigastric perforator flap reconstruction at a single institution. All patients followed our institution's surgical protocol and were divided into groups depending on the number of senior microsurgeons that simultaneously performed the procedure. Operating time and complications were compared between the groups.RESULTS:Sixteen of the patients were operated by one single microsurgically trained specialist, 64 by two and 20 by three specialists. The mean operating time for the one microsurgeon's group was 286 ± 84 min, for the two-microsurgeons' group 265 ± 57 min and for the three-microsurgeons' group 251 ± 59 min. There was a trend of decreasing operating times when more microsurgeons performed surgery together, however the difference between groups was not statistically significant (P = 0.251). Total flap failure rate was 2% (2/100). Both cases occurred in the group operated by one single microsurgeon (2/16) compared with two microsurgeon's group (0/64) and three microsurgeon's group (0/20; P < 0.005).CONCLUSIONS:By optimising the surgical experience available during microvascular breast reconstruction, operating time can be reduced and efficiency improved. In the current setting, two microsurgically trained surgeons achieved optimal operation flow with the lowest complication rate.
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| 13. |
- Jensson, David, et al.
(författare)
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Oculo-zygomatic nerve transfer for facial synkinesis : An anatomical feasibility study
- 2019
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 37:7, s. 629-633
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patients with severe oro-ocular synkinesis often present with concomitant inefficient smile excursion on the affected site. In theory, oculo-zygomatic nerve transfer may decrease synkinesis and improve smile by redirecting nerve fibers to their target muscle. The aim of this study was to explore the feasibility of nerve transfer in human cadavers between a caudal branch innervating the orbicularis oculi to a cephalad branch innervating the zygomaticus major muscles.METHODS: Eighteen hemi-faces were dissected. Reach for direct coaptation of a caudal nerve branch innervating the orbicularis oculi muscle to a cephalad nerve branch innervating the zygomaticus major muscle was assessed. Measurements included total number of nerve branches as well as maximum dissection length. Nerve samples were taken from both branches at the site of coaptation and histomorphometric analysis for axonal count was performed.RESULTS: The number of sub-branches to the orbicularis oculi muscle was 3.1 ± 1.0 and to the zygomaticus major muscle 4.7 ± 1.2. The maximal length of dissection of the caudal nerve branch to the orbicularis oculi muscle was 28.3 ± 7.3 mm and for the cranial nerve branch to the zygomaticus major muscle 23.8 ± 6.5 mm. Transection and tension-free coaptation was possible in all cases but one. The average myelinated fiber counts per mm2 was of 5,173 ± 2,293 for the caudal orbicularis oculi branch and 5,256 ± 1,774 for the cephalad zygomaticus major branch.CONCLUSION: Oculo-zygomatic nerve transfer is an anatomically feasible procedure. The clinical value of this procedure, however, remains to be proven.
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| 14. |
- Lorenzo, Andrés R, et al.
(författare)
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Design and creation of an experimental program of advanced training in reconstructive microsurgery
- 2006
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 26:6, s. 421-428
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Tidskriftsartikel (refereegranskat)abstract
- In this study, we design an experimental protocol for the purpose of enhancing performance in training in microsurgery. It is based on five free tissue transfer exercises in rat (epigastric cutaneous flap, saphenous fasciocutaneous flap, epigastric neurovascular flap, saphenous muscular flap, and hindlimb replantation), which simulate the principal clinical procedures of reconstructive microsurgery. The first part of the study consists of an anatomical review of the flaps of 5 rats and in the second part we have carried out the free transfer of flaps on 25 rats divided into 5 groups. To differentiate between them, we have created a mathematical function, referred to as difficulty in a microsurgical exercise, which has enabled us to establish a scale of progression for training, ranging form the easiest to the most difficult. As a conclusion, we believe that this protocol is a useful instrument as it allows for a more precise assessment of microsurgical capacity due to enhanced accuracy in the reproduction of global procedures and the fact that the quantification of progress in training is based on clinical monitoring after 7 days.
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| 15. |
- Lundberg, Jonas, 1961, et al.
(författare)
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Improved energetic recovery of skeletal muscle in response to ischemia and reperfusion injury followed by in vivo 31P-magnetic resonance spectroscopy.
- 2002
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Ingår i: Microsurgery. - 0738-1085 .- 1098-2752. ; 22:4, s. 158-164
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Tidskriftsartikel (refereegranskat)abstract
- It is of great clinical interest to improve postischemic tissue recovery during microsurgical transfers. The effect of singlet oxygen energy (SOE) as photon illumination at 634 nm on rat skeletal muscle during ischemia and postischemic reperfusion was investigated noninvasively and continuously by in vivo 31P-magnetic resonance spectroscopy (31P-MRS). A model of pedicled rat rectus femoris muscle was used, where phosphorous metabolites were followed before onset of ischemia (control), after 4 h of ischemia, and after 1 h of reperfusion. Two groups were studied: one control group (n = 10), and one SOE-treated group (n = 10). Blood perfusion was measured by laser Doppler flowmetry (LDF) during the study. After 4 h of ischemia, ATP levels were 72% and 51% of normal control values in the illuminated group and the control group, respectively (P < 0.05). After 1 h of postischemic reperfusion, phosphocreatine (PCr) recovered to 79% and adenosine triphosphate (ATP) to 71% in the illuminated group, whereas in the control group, the recovery was 57% and 51%, respectively (P < 0.05). It is concluded that singlet oxygen energy has a beneficial effect on the energy state of skeletal muscle during ischemia and postischemic reperfusion. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:158–164 2002
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| 16. |
- Lutz, Barbara, 1960-, et al.
(författare)
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Morphological and functional evaluation of leg-muscle reinnervation after coupler coaptation of the divided rat sciatic nerve
- 2005
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 25:3, s. 235-240
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Tidskriftsartikel (refereegranskat)abstract
- Mechanical couplers are successfully used for microvascular venous anastomoses. The advantages include a simple and fast technique and a high patency rate. Couplers offer a secluded coaptation site, and might also be of use in peripheral nerve repair. The present study was designed to investigate coupler coaptation of the rat sciatic nerve, evaluating the number and locations of motor and sensory neurons projecting to the selected muscles as well as stimulation-induced muscle contraction force. Adult rats underwent either suture or coupler repair after left sciatic nerve transection. In all rats, the experimental side was compared to the healthy right side. Evaluation after 20 weeks included retrograde labeling of motoneurons and dorsal root ganglion neurons projecting to the tibial anterior muscle and to the tibial posterior muscle, histology, muscle contraction force (tibial anterior muscle and gastrocnemius muscle), and a pinch reflex test. The results show that the suture and the coupler groups did not differ significantly regarding the examined parameters, except for discrete signs of nerve compression at the coaptation site after coupler repair due to fibrous tissue ingrowth. However, this did not impair axonal regeneration. Importantly, axonal outgrowth from the repair site to the surrounding tissue was not observed after coupler coaptation, but it was observed after suture repair. These results suggest that couplers may be of value for repair of nerves in adjacency to avoid axonal crisscrossing between nerves during regeneration. © 2005 Wiley-Liss, Inc.
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| 17. |
- Mani, Maria, et al.
(författare)
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Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients.
- 2018
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 38:2, s. 143-150
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Slim women are not always considered candidates for bilateral autologous breast reconstruction. The study aims to assess the volume considerations and complications of deep inferior epigastric perforator (DIEP) flap in bilateral breast reconstruction among slim patients.METHODS: All patients undergoing bilateral DIEP breast reconstruction at the Royal Marsden Hospital, London, September 2007-March 2015, were reviewed. Flap weight was compared to mastectomy weight (weight ratio) and complications were recorded. Subgroup analyses according to Body Mass Index (BMI) were performed.RESULTS: One-hundred seventy patients (340 flaps) were included. There were 42 in the slim-group (BMI <25) (84 flaps), 70 in the traditional (BMI = 25.0-29.9) (140 flaps), and 58 in the obese (BMI >30) (116 flaps). There were no significant differences in reconstruction weight ratio between the slim and the traditional groups (1.04 ± 0.31 versus 0.95 ± 0.38, p = .267). When comparing the slim to obese group the ratio was lower for the obese group, inferring that a larger reconstruction was performed (p = .016). Complications was less frequent in the slim group compared to the traditional and the obese groups (31% compared to 50% and to 53% (p = .060 and p = .021, respectively). Donor-site specific complications did not differ between groups (29% 26% and 29%; p = .823 and .830, respectively).CONCLUSION: The DIEP flaps may be a safe option for bilateral breast reconstruction among patients with BMI <25 without sacrifice in volume or increase in donor-site complications; low BMI does not in itself contraindicate bilateral DIEP breast reconstruction.
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| 18. |
- Mani, Maria, et al.
(författare)
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Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients
- 2016
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 36:7, s. 552-558
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: For slim patients eligible to breast reconstruction, clinical concerns exist on availability of adequate amount of donor tissue to restore breast volume and challenges in donor-site closure, when using the deep inferior epigastric perforator (DIEP) flap. The purpose of the current study is to analyze whether the DIEP flap can provide adequate volume for breast reconstruction in slim patients, without increased complication rates or prolonged hospital stay.PATIENTS AND METHODS: All patients receiving a unilateral DIEP breast reconstruction at the center 2007-2010 were included (n = 171). The patients were analyzed in subgroups of delayed and immediate reconstruction and of BMI. Complications were analyzed according to Clavien-Dindo. Flap weight was compared to mastectomy specimen weight among immediate reconstructions (n = 91).RESULTS: There was no difference in specimen to flap weight ratio between the different BMI-groups (BMI <25, 25-29.9 and >30: 0.81, 0.87 and 0.96 respectively, P = 0.360. Overall complication rate was 43.1% (BMI <25); 43.0% (BMI 25-29.9): and 70.0% (BMI >30) (P = 0.018). The results were similar for both the immediate and the delayed reconstructions. Length of hospital stay was similar in the different BMI groups. Delayed donor-site healing was higher in patients with BMI <25; 17.2%, compared to patients with BMI 25-29.9; 11.8%, but lower than for patients with BMI >30; 29.7% (P = 0.033).CONCLUSION: The DIEP flap provides adequate volume for unilateral breast reconstruction in slim patients, both in immediate and delayed settings. However, in delayed reconstructions slim patients need to be informed about the increased risk of donor-site complications.
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| 19. |
- Mendiratta, Dhruv, et al.
(författare)
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Educational quality of YouTube content on brachial plexus injury and treatment
- 2024
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Ingår i: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; :1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: While surgical literature exists on birth-related brachial plexus injury (BPI), there are not validated sources of information on BPI for patients, which can impact patient autonomy and decision-making. With YouTube as a popular source for patients to research diagnoses, this study aims to evaluate the quality of information regarding BPI and its treatment available on the platform.Materials and Methods: BPI YouTube videos were screened independently by two reviewers. Videos were categorized by source: (1) academic, government, and non-profit organizations; (2) private practices, companies, and for-profit organizations; (3) independent users. Each video was evaluated for reliability, credibility, and quality using the modified DISCERN criteria (scale, 0–5), Journal of the American Medical Association (JAMA) criteria (scale, 0–4), and Global Quality Scale (GQS; scale, 1–5). Surgical treatment videos were analyzed by the senior author using a modified “treatment” DISCERN criteria (scale, 8–40). Non-English videos were excluded from this study. Analysis of variance tests were used to compare means.Results: One hundred and fifteen videos were selected for final analysis. The mean modified DISCERN score was 3.26; JAMA was 2.31; GQS was 3.48. Videos were subdivided according to source. Group 1, 2, and 3 had 45, 24, and 46 videos, respectively. Modified DISCERN score was greater for Group 1 than Group 2 (3.58 vs. 3.04, p <.001) and Group 3 (3.58 vs. 3.07, p <.001). JAMA score was greater for Group 1 than Group 2 (2.63 vs 2.15, p =.041) and Group 3 (2.63 vs. 2.08, p =.002). GQS score was greater for Group 1 than Group 2 (3.93 vs. 3.31, p =.031) and Group 3 (3.93 vs. 3.13, p <.001). Of the 34 videos (44.7%) that mentioned treatment, the DISCERN score was 14.32.Conclusion: The videos analyzed were found to have moderate reliability, credibility, and quality. The reliability of information regarding treatments for BPI was poor. Healthcare providers should supply additional information on treatment of BPI.
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| 20. |
- Mendiratta, Dhruv, et al.
(författare)
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Rehabilitation protocols in neonates undergoing primary nerve surgery for upper brachial plexus palsy : a scoping review
- 2024
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Ingår i: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 44:3
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Forskningsöversikt (refereegranskat)abstract
- Introduction: Surgical management is recommended in patients with severe neonatal brachial plexus palsy (NBPP) within the first 6 months of age to regain best possible function. Rehabilitation post-surgery remains relatively unexplored. This is a scoping review that explores, which rehabilitation modalities exist and how they vary for different microsurgical approaches in NBPP.Materials and Methods: A systematic search was conducted to include articles about upper trunk obstetric brachial plexus nerve microsurgery in pediatric patients that made mention of rehabilitation protocols. The aims of rehabilitation modalities varied and were grouped: “passive” movement to prevent joint contracture or stiffness, “active” or task-oriented movement to improve motor function, or “providing initial motor recovery”. Surgical approach was described as either exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). Technique was categorized into transfers and non-transfers.Results: Thirty-six full-text articles were included. Initiation of rehabilitation was 22.26 days post-surgery. Twenty-eight studies were EBP, and six were NTwoRE. Of studies classifiable by aims, nine were “passive”, nine were “active”, and five were “providing initial motor recovery”. Only 27.7% of EBP studies mentioned active therapy, while 75.0% of NTwoRE studies mentioned active therapy. The average age of patients in the EBP procedure category was 7.70 months, and NTwoRE was 17.76 months. Within transfers, the spinal accessory to suprascapular group was more likely to describe an active shoulder exercise therapy, whereas contralateral C7 group was more likely to describe “initial motor recovery”, especially through the use of electrostimulation. All articles on electrostimulation recommended 15–20-minute daily treatment.Conclusion: Information on rehabilitation is limited post-nerve surgery in NBPP. However, when mentioned, the aims of these therapies vary with respect to surgical approach and technique. The type of therapy to employ may be a multifaceted decision, involving factors such as patient age, initial deformity, and goals of the care team.
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| 21. |
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| 22. |
- Rodriguez-Lorenzo, Andres, et al.
(författare)
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Endoscopic assisted insetting of free flaps in anterior skull base reconstruction : A preliminary report of five cases
- 2020
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 40:4, s. 460-467
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionFree vascularized tissue may provide a robust reconstruction after anterior skull base surgery. We report our technique and outcomes of the endoscopic inset of free flaps in anterior skull base reconstructions.MethodsBetween 2016 and 2018, endoscopic tumor removal and reconstruction of anterior skull base pathology was performed in five patients aged 20–72 years old (four male, one female). The tumors included three neuroblastomas, a carcinoma, an adenoma, and a melanoma. The median size of the defect was 3.7 × 6.6 cm. Transmaxillary access was gained through the upper sulcus and an anterior and medial maxillectomy. The flap inset was facilitated by the endoscope. The donor vessels were tunneled through the sinus and through the cheek to the facial vessels without the use of the endoscope.ResultsIn three cases a vastus lateralis flap was used, in one case an adipofascial ALT flap and in one case an adipofascial radial forearm flap. Separation of intracranial and sinonasal spaces was confirmed by radiological and endoscopic examinations. There was no flap failure and one case with partial necrosis. One of the flaps needed to be trimmed as it obliterated the nasal cavity and in one of the cases the flap was repositioned postoperatively. Two cases had infectious complications. The mean follow‐up of the patients was 13.8 months.ConclusionsEndoscopic assisted inset of a free flap in the anterior skull base was feasible in the five cases we present. A dedicated, multidisciplinary approach is mandatory for surgical innovation like this.
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| 23. |
- Rodriguez-Lorenzo, Andres, et al.
(författare)
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Fibula osteo-adipofascial flap for reconstruction of a cervical spine and posterior pharyngeal wall defect
- 2014
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 34:4, s. 314-318
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Tidskriftsartikel (refereegranskat)abstract
- When reconstructing combined defects of the cervical spine and the posterior pharyngeal wall the goals are bone stability along with continuity of the aerodigestive tract. We present a case of a patient with a cervical spine defect, including C1 to C3, associated with a posterior pharyngeal wall defect after excision of a chordoma and postoperative radiotherapy. The situation was successfully solved with a free fibula osteo-adipofascial flap. The reconstruction with a fibula osteo-adipofascial flap provided several benefits in comparison with a fibula osteo-cutaneous flap in our case, including an easier insetting of the soft tissue component at the pharyngeal level and less bulkiness of the flap allowing our patient to resume normal deglutition.
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| 24. |
- Rodriguez Lorenzo, Andres, et al.
(författare)
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Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation : cadaver feasibility study
- 2012
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 32:4, s. 309-313
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Tidskriftsartikel (refereegranskat)abstract
- Background: The collected experience from facial allotransplantations has shown that the recovery of sensory function of the face graft is unpredictable. Unavailability of healthy donor nerves, especially in central face defects may contribute to this fact. Herein, the technical feasibility of transferring the supraorbitary nerve (SO) to the infraorbitary nerve (IO) in a model of central facial transplantation was investigated. Methods: Five heads from fresh cadavers were dissected with the aid of 3× loupe magnification. Measurements of the maximum length of dissection of the SO nerve through a supraciliary incision and the IO nerve from the skin of the facial flap to the infraorbital foramen were performed. The distance between supraorbital and infraorbital foramens and the calibers of both nerves were also measured. In all dissections, we simulated a central allotransplantation procedure and assessed the feasibility of directly transferring the SO to the IO nerve. Results: The average maximum length of dissection for the IO and SO nerve was 1.4 ± 0.3 cm and 4.5 ± 1.0 cm, respectively. The average distance between the infraorbital and supraorbital foramina was 4.6 ± 0.3 cm. The average calibers of the nerves were of 1.1 ± 0.2 mm for the SO nerve and 2.9 ± 0.4 mm for the IO nerve. We were able to perform tension-free SO to IO nerve coaptations in all specimens. Conclusion: SO to IO nerve transfer is an anatomically feasible procedure in central facial allotransplantation. This technique could be used to improve the restoration of midfacial sensation by the use of a healthy recipient nerve in case of the recipient IO nerves are not available secondary to high-energy trauma.
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| 25. |
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| 26. |
- Rozen, Warren M., et al.
(författare)
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Postoperative monitoring of lower limb free flaps with the Cook-Swartz implantable Doppler probe : A clinical trial
- 2010
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 30:5, s. 354-360
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Tidskriftsartikel (refereegranskat)abstract
- Background: Free flaps to the lower limb have inherently high venous pressures, potentially impairing flap viability, which may lead to limb amputation if flap failure ensues. Adequate monitoring of flap perfusion is thus essential, with timely detection of flap compromise able to potentiate flap salvage. While clinical monitoring has been popularized, recent use of the implantable Doppler probe has been used with success in other free flap settings. Methods: A comparative study of 40 consecutive patients undergoing microvascular free flap reconstruction of lower limb defects was undertaken, with postoperative monitoring achieved with either clinical monitoring alone or the use of the Cook-Swartz implantable Doppler probe. Results: The use of the implantable Doppler probe was associated with salvage of 2/2 compromised flaps compared to salvage of 2/5 compromised flaps in the group undergoing clinical monitoring alone (salvage rate 100% vs. 40%, P = 0.28). While not statistically significant, this was a strong trend toward an improved flap salvage rate with the use of the implantable Doppler probe. There were no false positives or negatives in either group. One flap loss in the clinically monitored group resulted in limb amputation (the only amputation in the cohort). Conclusion: A trend toward early detection and salvage of flaps with anastomotic insufficiency was seen with the use of the Cook-Swartz implantable Doppler probe. These findings suggest a possible benefit of this technique as a stand-alone or adjunctive tool in the clinical monitoring of free flaps, with further investigation warranted into the broader application of these devices.
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| 27. |
- Rozen, Warren M, et al.
(författare)
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The efficacy of postoperative monitoring : A single surgeon comparison of clinical monitoring and the implantable Doppler probe in 547 consecutive free flaps
- 2010
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 30:2, s. 105-110
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Tidskriftsartikel (refereegranskat)abstract
- Background: An important element in achieving high success rates with free flap surgery has been the use of different techniques for monitoring flaps postoperatively as a means to detecting vascular compromise. Successful monitoring of the vascular pedicle to a flap can potentiate rapid return to theater in the setting of compromise, with the potential to salvage the flap. There is little evidence that any technique offers any advantage over clinical monitoring alone. Methods: A consecutive series of 547 patients from a single plastic surgical unit who underwent a fasciocutaneous free flap operation for breast reconstruction [deep inferior epigastric artery perforator (DIEP) flap, superficial interior epigastric artery l flap, or superior gluteal artery perforator (SGAP) flap] were included. A comparison was made between the first 426 consecutive patients in whom flap monitoring was performed using clinical monitoring alone and the subsequent 121 patients in whom monitoring was achieved with the Cook-Swartz implantable Doppler probe. Outcome measures included flap salvage rate and false-positive rate. Results: There was a strong trend toward improved salvage rates with the implantable Doppler probe compared with clinical monitoring (80% vs. 66%, P = 0.48). When combined with the literature (meta-analysis), the data prove statistically significant (P < 0.01). There was no statistical difference between the groups for false-positive rates. Conclusion: Flap monitoring with the implantable Doppler probe can improve flap salvage rates without increasing the rate of false-positive takebacks.
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| 28. |
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| 29. |
- Smit, Jeroen M., et al.
(författare)
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Clinical experience with the nasolabial fold as receptor site in microvascular reconstruction
- 2007
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 27:7, s. 608-611
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Tidskriftsartikel (refereegranskat)abstract
- We report our experience using the vessels at the nasolabial fold as receptor site in free tissue transfer in head and neck reconstructions; a site that proved more convenient than the submandibulary site in selected cases. Six cases as well as the dissection technique of the nasolabial fold are reported. No complications occurred during or post surgery and in all cases the vessels were of adequate diameter for an end to end anastomosis. The advantages this site offers are discussed.
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| 30. |
- Smit, Jeroen M., et al.
(författare)
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Early reintervention of compromised free flaps improves success rate
- 2007
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 27:7, s. 612-616
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND AIM: To develop a protocolized monitor schedule in microvascular free flap reconstruction, we investigated a possible correlation between the outcome and the interval between clamp release and start of revision. MATERIALS AND METHODS: All the charts of patients treated between 2000 and 2006 with a free flap were evaluated. The patients who underwent a flap revision were further analyzed. RESULTS: A total of 608 free flaps were evaluated; 69 of these flaps were revised. Most vascular complications took place within the first 24 h; the latest complication was observed 8 days after surgery. After 6 days post surgery, the number of revisions decreased considerably. With regard to the salvaged flaps the mean time to start the revision was 46.5 h (SD 39). With regard to the failed revisions, the mean time to start the revision was 82.0 h (SD 47). This difference proved significant (P = 0.006). CONCLUSION: Our data shows that the majority of anastomotic failures occur within the first 24 h. Thereafter, the frequency of failures decreases. We also found that the time between initial reconstruction and start of the salvage procedure influences the outcome of the revision negatively.
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| 31. |
- Smit, Jeroen M., et al.
(författare)
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Multilayer reconstructions for defects overlying the Achilles tendon with the lateral-arm flap : Long-term follow-up of 16 cases
- 2012
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 32:6, s. 438-444
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Tidskriftsartikel (refereegranskat)abstract
- Defects of the Achilles tendon and the overlying soft tissue are challenging to reconstruct. The lateral-arm flap has our preference in this region as it provides thin pliable skin, in addition, the fascia and tendon can be included in the flap as well. The aim of this report is to share the experience the authors gained with this type of reconstruction. The authors report the largest series in the published reports today. Patients and methods: A retrospective review was performed of all patients treated between January 2000 and January 2009 with a lateral-arm flap for a soft-tissue defect overlying the Achilles tendon. Results: In the reviewed period, 16 soft-tissue defects overlying the Achilles tendon were reconstructed, with a mean follow-up of 63 months. In three cases, tendon was included into the flap and in two, a sensory nerve was coapted. Fifteen cases (94%) were successful, one failed. In seven cases, a secondary procedure was necessary for thinning of the flap. Conclusion: The lateral-arm flap is a good and safe option for the reconstruction of defects overlying the Achilles tendon. (c) 2012 Wiley Periodicals, Inc. Microsurgery, 2012.
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| 32. |
- Srinivasan, Nivetha, et al.
(författare)
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Surgical timing in neonatal brachial plexus palsy : A PRISMA-IPD systematic review
- 2022
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Ingår i: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 42:4, s. 381-390
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Forskningsöversikt (refereegranskat)abstract
- Background: Neonatal brachial plexus palsy (NBPP) is a serious complication of high-risk deliveries with controversy surrounding timing of corrective nerve surgery. This review systematically examines the existing literature and investigates correlations between age at time of upper trunk brachial plexus microsurgery and surgical outcomes.Methods: A systematic screening of PubMed, Cochrane, Web of Science, and CINAHL databases using PRISMA-IPD guidelines was conducted in January 2020 to include full-text English papers with microsurgery in upper trunk palsy, pediatric patients. Spearman rank correlation analysis and two-tailed t-tests were performed using individual patient data to determine the relationship between mean age at time of surgery and outcome as determined by the Mallet, Medical Research Council (MRC), or Active Movement Scale (AMS) subscores.Results: Two thousand nine hundred thirty six papers were screened to finalize 25 papers containing individual patient data (n = 256) with low to moderate risk of bias, as assessed by the ROBINS-I assessment tool. Mallet subscore for hand-to-mouth and shoulder abduction, AMS subscore for elbow flexion and external rotation, and MRC subscore for elbow flexion were analyzed alongside the respective age of patients at surgery. Spearman rank correlation analysis revealed a significant negative correlation (ρ = −0.30, p <.01, n = 89) between increasing age (5.50 ± 2.09 months) and Mallet subscore for hand-to-mouth (3.43 ± 0.83). T-tests revealed a significant decrease in Mallet hand-to-mouth subscores after 6 months (p <.05) and 9 months (p <.05) of age. No significant effects were observed for Mallet shoulder abduction, MRC elbow flexion, or AMS elbow flexion and external rotation.Conclusion: The cumulative evidence suggests a significant negative correlation between age at microsurgery and Mallet subscores for hand-to-mouth. However, a similar correlation with age at surgery was not observed for Mallet shoulder abduction, MRC elbow flexion, AMS external rotation, and AMS elbow flexion subscores.
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| 33. |
- Vejbrink Kildal, Villiam, et al.
(författare)
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Selective ansa cervicalis nerve transfer to the marginal mandibular nerve for lower lip reanimation : An anatomical study in cadavers and a case report
- 2023
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Ingår i: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 43:2, s. 142-150
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Tidskriftsartikel (refereegranskat)abstract
- Background:Donor nerve options for lower lip reanimation are limited in patients undergoing oncological resection of the facial nerve. The ansa cervicalis nerve (ACN) is an advantageously situated donor with great potential but has not been examined in detail. In the current study, the anatomical technical feasibility of selective ACN to marginal mandibular nerve (MMN) transfer for restoration of lower lip tone and symmetry was explored. A clinical case is presented.Methods:Dissections were conducted in 21 hemifaces in non-embalmed human cadavers. The maximal harvestable length of ACN was measured and transfer to MMN was simulated. A 28-year-old male underwent ACN-MMN transfer after parotidectomy (carcinoma) and was evaluated 12 months post-operatively (modified Terzis' Lower Lip Grading Scale [25 observers] and photogrammetry).Results:The harvestable length of ACN was 100 & PLUSMN; 12 mm. A clinically significant anatomical variant ( "short ansa ") was present in 33% of cases (length: 37 & PLUSMN; 12 mm). Tensionless coaptation was possible in all cases only when using a modification of the surgical technique in "short ansa " cases (using an infrahyoid muscle nerve branch as an extension). The post-operative course of the clinical case was uneventful without complications, with improvement in tone, symmetry, and function at the lower lip at 12-month post-operative follow-up.Conclusions:Selective ACN-MMN nerve transfer is anatomically feasible in facial paralysis following oncological ablative procedures. It allows direct nerve coaptation without significant donor site morbidity. The clinical case showed good outcomes 12 months post-operatively. A strategy when encountering the "short ansa " anatomical variant in clinical cases is proposed.
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| 34. |
- Wadström, J, et al.
(författare)
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An in vivo method for studies of traumatic vasospasm.
- 1990
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Ingår i: Microsurgery. - 0738-1085 .- 1098-2752. ; 11:3, s. 197-203
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Tidskriftsartikel (refereegranskat)abstract
- A study was undertaken to develop a model for investigations of traumatically induced vasospasm. The left ear of the rabbit was denervated under short anesthesia. With the animal under light sedation, spasm of the central ear artery was repeatedly induced with a clip applying forceps. To evaluate the vasospasm, the vessel was transilluminated with cold light, and the internal diameter was continuously measured. The spasm was assessed in terms of its duration, intensity (reduction of initial diameter) and severity (integrated change in diameter over time). Repetitive application of the forceps on the same vessel segment shortened the spasm duration. With prolonged pinch duration, the spasm duration was lengthened. The preparation was stable for at least 3 hours. This model was effective for manipulating small vessels and producing spasm and is of potential value for studying the treatment of vasospasm by topical local intra-arterial and systemic methods.
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| 35. |
- Wadström, J, et al.
(författare)
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Nervous influence on traumatic vasospasm in the rabbit ear artery.
- 1991
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Ingår i: Microsurgery. - 0738-1085 .- 1098-2752. ; 12:2, s. 89-95
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Tidskriftsartikel (refereegranskat)abstract
- The effects of partial denervation, partial denervation with additional nervous blockade with bupivacaine, and total denervation achieved by amputation and replantation of the ear on traumatic vasospasm were studied in the rabbit. The central ear artery was exposed and compressed in a standardized fashion. The inner diameter was determined by in vivo microscopy using transillumination with cold light. The resulting spasm was assessed in terms of its duration, intensity (reduction of initial diameter), and severity (integrated change in diameter over time). None of the types of denervation had any influence on the vasospasm. The results suggest that the vasospasm is a local phenomenon of the vascular smooth muscle and is not modified by the nervous system.
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| 36. |
- Wagstaff, Marcus J. D., et al.
(författare)
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Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps
- 2009
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 29:8, s. 626-629
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Tidskriftsartikel (refereegranskat)abstract
- Perineal and posterior vaginal wall reconstruction following abdominoperineal and local cancer resection entails replacement of volume between the perineum and sacrum and restoration of a functional vagina. Ideal local reconstructive options include those which avoid functional muscle sacrifice, do not interfere with colostomy formation, and avoid the use of irradiated tissue. In avoiding the donor site morbidity of other options, we describe a fasciocutaneous option for the reconstruction of the perineum and posterior vaginal wall. We present our technique of superior and inferior gluteal artery perforator (SGAP or IGAP) flaps to reconstruct such defects. Fourteen patients between 2004 and 2008 underwent 11 SGAP and three IGAP flaps. There were no flap failures or partial flap losses and no postoperative hernias. All female patients reported resumption of sexual intercourse following this procedure. Our experience in both the immediate and delayed setting is that this technique produces a good functional outcome with low donor-site morbidity.
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| 37. |
- Whitaker, Iain S., et al.
(författare)
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Peritoneo-cutaneous perforators in deep inferior epigastric perforator flaps : a cadaveric dissection and computed tomographic angiography study
- 2009
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 29:2, s. 124-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cutaneous perforators that do not originate from the deep inferior epigastric artery (DIEA) are rare, but may significantly affect operative outcome. Peritoneal-cutaneous perforators have been described as a source for augmenting the blood flow to a deep inferior epigastric perforator (DIEP) flap, however if unrecognized, may compromise flap survival. METHODS: We reviewed 375 DIEA perforator (DIEP) flaps (325 with preoperative CTA and 50 cadaveric dissections) to investigate the incidence of this anomaly. RESULTS: We detected this variation in 3/325 (1%) of DIEP flaps following preoperative computed tomography. In 1/50 (2%) of the cadaveric specimens, a peritoneal-cutaneous perforator was found and injected with lead oxide contrast. It was shown to fill the cutaneous veins of the majority of the lower abdominal integument. CONCLUSION: Peritoneal-cutaneous perforators are rare anatomical variations (4/375: 1.1%) that may have significant ramifications for surgery utilizing the vasculature of the abdominal wall. CTA was significantly able to detect this anomaly and aid operative planning. Preoperative CTA helps to safely identify individual vascular anatomy including rare variations.
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| 38. |
- Zdolsek, Johann, 1960-, et al.
(författare)
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Are mechanical microvascular anastomoses easier to learn than suture anastomoses?
- 2005
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 25:8, s. 596-598
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Tidskriftsartikel (refereegranskat)abstract
- Sutured anastomoses of small vessels are considered difficult to learn. Mechanical anastomosis systems allow a more rapidly performed anastomosis. In order to compare the process of learning to perform sutured and mechanical microvascular anastomoses, two surgeons, with limited microvascular experience, performed 30 aortic and 30 femoral vein anastomoses in 30 Wistar rats. The methods compared were conventional suture, vascular closure system (VCS), and microvascular anastomotic coupler system (MAC). There were no intersurgeon differences regarding patency or time to perform anastomoses. The average time to perform a suture anastomosis was 39 min (patency 80%). Anastomoses with the VCS system took 24 min (patency 25%), whereas the MAC couplers took 13 min to perform (patency 95%). There was a significant learning effect with sutures, but no obvious reduction in time to perform MAC coupler or VCS clip anastomoses was seen. MAC couplers were easiest to use, and allowed us to perform rapid anastomoses with high patency. © 2005 Wiley-Liss, Inc.
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| 39. |
- Zhang, Cheng-Gang, et al.
(författare)
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Phrenic nerve transfer in the treatment of brachial plexus avulsion : an experimental study of nerve regeneration and muscle morphology in rats.
- 2004
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Ingår i: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 24:3, s. 232-240
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Tidskriftsartikel (refereegranskat)abstract
- The regeneration of motor and sensory neurons and the morphological changes of the target muscle after phrenic nerve transfer were investigated in adult rats. Six months following nerve transfer, 326.0 +/- 16.31 phrenic motoneurons regenerated into musculocutaneous nerve, which is not different from the normal number of phrenic motoneurons. The regenerated motoneurons exhibited a 14% nonsignificant hypertrophy. Of the dorsal root ganglia (DRG) neurons, 255.8 +/- 45.26 regenerated, which was significantly lower than the number of normal phrenic DRG neurons. The regenerated phrenic DRG neurons showed a 24% close-to-significant atrophy. The target muscle fiber morphology changed considerably after reinnervation. The present results suggest that the phrenic nerve has very good regenerative ability in terms of its motoneurons and a relatively insufficient sensory neuronal regeneration.
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| 40. |
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