Journal of reconstructive microsurgery
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J Reconstr Microsurg · Apr 2000
Biography Historical ArticleJames R. Learmonth: the first peripheral nerve surgeon.
The life and education of James R. Learmonth are reviewed. His experimental and clinical activities place him historically as the first surgeon to devote himself to peripheral nerve surgery.
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J Reconstr Microsurg · Apr 2000
Clinical TrialIndications and limitations of angiography before free-flap transplantation to the distal lower leg after trauma: prospective study in 36 patients.
The necessity for routine angiography in evaluation of the vasculature of recipient legs prior to microsurgical free-tissue reconstruction still remains controversial. This prospective study was designed to determine the indications and limitations of angiography pertinent to this issue. The protocol consisted of palpation of dorsalis pedis and posterior tibial artery pulsation and lower-limb angiography prior to surgery, as well as intraoperative observation of the posterior tibial, anterior tibial, and peroneal arteries. ⋯ In none of the cases with at least one palpable pedal pulse (33), did preoperative angiography add relevant information which led to a plan change in the free-flap transfer. However, in two cases, severe scarring and fibrosis required an intraoperative change of the recipient vessel in one case, and a change of the anastomosis level and use of a vein graft, in the other case, although the angiography had demonstrated normal vascularity in both. The authors conclude that preoperative angiography is indicated only when both pedal pulses are not palpable, and that normal preoperative angiography does not guarantee the presence of vessels suitable for anastomosis.