Microsurgery
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Ischemic preconditioning (IP) is defined as a brief period of ischemia ("preclamping") followed by tissue reperfusion, thereby increasing ischemic tolerance for a subsequent longer ischemic period. Several studies showed the effectiveness of classic local IP by preclamping the flap pedicle. There are two temporally and mechanically different types of IP: acute preconditioning, which is induced by preclamping the flap pedicle briefly before flap ischemia, and late preconditioning, induced by a preclamping procedure 24-48 h before flap ischemia. ⋯ The exact mechanism of "classic" as well as remote IP is not yet finally determined, although several studies demonstrated that endogenous nitric oxide plays an important role. In summary, the use of a tourniquet to induce limb ischemia before flap ischemia could provide a new, alternative, noninvasive remote IP protocol, although late remote IP might be effective only in muscle flaps. However, the possible future clinical application for late IP is elective flap surgery, whereas acute remote IP could even be used in emergency flaps.
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Comparative Study
Functional outcome and quality of life of Gustilo IIIB open tibial fractures requiring free tissue transfers: a report of eight cases.
Eight patients with type IIIB open tibial fractures requiring free tissue transfers were retrospectively reviewed. The functional outcome was evaluated by using a scoring system developed by Puno et al. (Microsurgery 17:167-173, 1996). Short Form 36 (SF-36) was used as a measurement of individuals' quality-of-life (QOL) scores. ⋯ Treated cases showed an acceptable QOL, considering the results of the T-GH. The mental QOL was higher than the physical QOL. In severe open tibial fractures, it is difficult to obtain a good or excellent functional outcome, even with reconstruction using free tissue transfers.
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Comparative Study
Longitudinal intrafascicular electrodes in collection and analysis of sensory signals of the peripheral nerve in a feline model.
The purpose of this study was to evaluate the value of utilizing longitudinal intrafascicular electrodes (LIFEs) in collecting and analyzing sensory signals from the peripheral nerve. The longitudinal intrafascicular electrodes were made of 25-microm Teflon-insulated Pt/Ir wire and implanted into the fascicle of the superficial peroneal nerves in a feline model. The sensory signals at rest status and induced with various stimulations were recorded. ⋯ The functional spectrum analysis showed that the frequency of action potential increased when the stress stimulation was applied. In conclusion, LIFEs can sensitively collect sensory signals and provide a good interface to analyze sensory information from peripheral fasciculi. These data provide useful information for further study of control of electronic prostheses.
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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. ⋯ 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.