Journal of reconstructive microsurgery
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J Reconstr Microsurg · Apr 1997
Review Historical ArticleHistorical and basic science review: past, present, and future of nerve repair.
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J Reconstr Microsurg · Nov 1996
Case ReportsMicrovascular and thrombolytic revascularization of an arm in a 32-week-gestation neonate: case report and review of the literature.
A 2300-g pre-term neonate with severe hyaline membrane disease experienced right forearm and hand ischemia following a brachial arterial line insertion. Limb salvage was achieved through combined microsurgical exploration and thrombectomy of the brachial and radial arteries, with postoperative regional infusion of tissue plasminogen activator (TPA) through the distal radial artery for 48 hr, to dissolve a thrombus within the small vessels of the hand. This report advocates combined surgical and regional thrombolytic therapy with tissue plasminogen activator as management for neonatal arterial thrombosis and limb ischemia.
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J Reconstr Microsurg · Aug 1996
Cutaneous blood-flow patterns in free flaps determined by laser Doppler flowmetry.
Accurate monitoring of tissue perfusion in microvascular surgery is paramount to flap survival. Many methods have been proposed for monitoring of flaps, but none have achieved widespread acceptance. The laser Doppler has been shown to be beneficial in monitoring flap perfusion. ⋯ Latissimus dorsi flaps also demonstrated a slow increase until about 80 hr postoperatively (LDI 9.8 +/- 10.65), indicating an increase in skin blood flow of almost 900 percent. Iliac-crest osteomyocutaneous free flaps had a slow increase in blood flow until approximately 70 hr postoperatively, when the LDI (5.5) increased, representing an increase in skin blood flow of over 500 percent. These changes in skin blood flow over time, seen with continuous laser Doppler measurements, depict the dynamic nature of skin blood flow and allow predictive patterns to be established, instead of single normal values, by which to gauge adequate flap perfusion.
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J Reconstr Microsurg · Jul 1995
Levator scapulae transfer and fascia lata fasciodesis for chronic spinal accessory nerve palsy.
A retrospective evaluation of the functional results after reconstructive treatment with levator scapulae transfer and scapulo-spinal fasciodesis by fascia lata slings for complete chronic trapezius palsy is presented. Five patients (ages 6 to 40 years) were operated on between 1988 and 1991 because of incapacitating pain and/or functional limitations. Treatment was recommended after failure to alleviate symptoms by a shoulder-girdle muscle-strengthening program or after unsuccessful nerve graft. ⋯ The last patient was not improved by the surgery. Levator scapulae transfer and scapulo-spinal fasciodesis by fascia lata slings, substitute for the function of the upper trapezius and enhance the function of the serratus anterior, thus helping to relieve pain and to improve shoulder function after chronic trapezius palsy. The procedure warrants consideration in patients who are not candidates for nerve repair and reconstruction.
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The aim of intravenous fluid therapy in microvascular surgery is to maintain intravascular fluid volume for optimal tissue blood flow and oxygen transport to all tissues, including the free transferred tissue. General problems include the prolonged surgical procedures, frequently resulting in hypothermia and peripheral vasoconstriction, which may affect blood flow to the transplanted tissue. The surgical wounds may also be extensive, and can cause profound and sometimes underestimated fluid and blood loss. ⋯ To optimize blood flow to the free flap, it is advisable to use moderate hemodilution. This facilitates the maintenance of high cardiac output and low peripheral vascular resistance. In addition, body temperature should be kept as close to normal as possible and, after completion of the microvascular anastomosis, arterial blood pressure should be kept near normal, to insure adequate perfusion pressure.