British journal of plastic surgery
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Editorial Historical Article
The 50th anniversary of the British Journal of Plastic Surgery.
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The concept that end-to-side nerve coaptation can induce collateral sprouting was recently reintroduced by Viterbo. However, other authors have reported conflicting results with this technique of nerve repair. The current paper studies some of the variables affecting axonal regeneration following end-to-side repair. ⋯ The silicone tube contained soft tissue which was firmly attached to the side of the nerve and this was called the Attached Soft Tissue Segment (ASTS). Histological and electron microscopic examination showed no evidence of any nerve regeneration within the ASTS. The failure to demonstrate collateral sprouting within the ASTS may be explained by the absence of Schwann cells in the transplanted silicone tubes.
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The ability to assess viability of tissues by monitoring changes in oxygenation and perfusion during harvesting and following transfer of free and pedicled flaps is potentially important in reconstructive surgery. Rapid detection of a critical change in tissue oxygenation could enable earlier and more successful surgical intervention when such problems arise. In this study near infra-red spectroscopy (NIRS) was used to assess changes in tissue oxygenation, haemoglobin oxygenation and blood volume in a porcine prefabricated myocutaneous flap model in response to pedicle manipulations. ⋯ It can accurately identify different types of problems with the pedicle vessels. In addition its predictive capabilities would allow assessment of flaps buried deep to the skin. This monitor is excellent for surgical and intensive care unit monitoring since it is unaffected by light, portable and is extremely easy to use.