Objective To investigate an improved large vascular reconstruction method in the canine liver transplantation and see whether it can shorten the anheptic time and thus reduce the harmful effects during the anhepatic phase. Methods Thirty-two mongrel dogs were enrolled and divided into two groups randomly:the donor group (n=16) and the acceptorgroup(n=16). The dogs in the acceptor group were divided into two groups, according to the different reconstruction methods: Group A using the magnetic rings for a large vein reconstruction in the canine liver transplantation (n=10), and Group B using a handsewing large vein reconstruction in the canine liver transplantation (n=6). The operation time, hemodymics change, anastomosis site, and survival were observed. Results The operation time was as follows: In Group A, the total operation time, the inferior vena cava anastomosistime, and the anheptic phase time were significantly shorter than those in Group B (3.24±0.49 h vs 4.12±0.51 h，5.89±2.27 min vs 28.33±6.04 min，3.89±0.73 min vs 12.16±3.72 min),with a significant difference between the two groups (Plt;0.01). The haemodymics changes were as follows: In Group A, MAP dropped during the anhepatic phase, but it soon recovered after reperfusion，and there was only 730.56±150.56 ml of fluid including the donor blood that needed to be transfused, with no pressor agent required. In Group B, blood pressure dropped during the anhepatic phase，but it slowly recovered，and there was 2241.67±390.78 ml of fluid. In Group A, all the stomas had no errhysis, twistor thrombus. The twisted stomas could be corrected by the revolving of the magnetic rings. The endangium at the site of anastomosis was smooth. In Group B, most of the stomas had errthysis. In Group A, 3 dogs survived for more than 7 days, 6dogs survived for 3-6 days, and 1 dog survived for only 12 hours. In Group B, 2 dogs survived for 3-6 days, 3 dogs survived for 1-2 days, and 1 dog survivedfor only 12 hours. Conclusion Using the magnetic rings for a large vascular reconstruction in the canine liver transplantation is an improvedmethod, which can simplify the anastomosis procedures and significantly shortenthe anheptic phase time. However, the magnetic rings have to be placed in the abdomen, so this method remains to be further improved.
The formation of an arteriovenous fistual for dialysis by routine interrupted sutures anastomosing the vein and artery is difficult to perform and time-consuming. A new method, telescopic adhesive anastomosis was studied and applied in 10 hemodialysis patients, who were in need of an arteriovenous fistula. The external diameter of the vessels anastomosed was 2.40 +/- 0.20 mm (radial artery) or 2.40 +/- 0.35 mm (cephalic vein). After thorough debridement of the vascular ends, the arterial end was put in the venous lumen. In order to fix the telescopic vessels, two stitches were applied 180 degrees apart from each other and tied. Each stitch was inserted from vein (penetrating the whole wall) to artery (just through the adventitia and partial thickness of the media vasorum). The distance from the stitch to the edge of the vein was 0.5 mm, and that of the artery was approximated to the external diameter of the vessle. The medical adhesive was then applied for sealing the anastomotic adventitia. Ten seconds were given for the solidification of the adhesive. The patients were followed up for 8 months. The patency rate was 100%, and the rate of blood flow was more than 300 ml/min (measured by ultrasonography). It was shown that this method could be managed easily and quickly, and the so-formed fistula would fulfill the need of hemodialysis.
OBJECTIVE: To investigate the hemodynamic changes of the end-to-end anastomosed arteries with nitinol clips. METHODS: Fifteen New Zealand rabbits were divided into anastomosis clip group, suture group and control group randomly. The carotid arteries were resected and end-to-end anastomosis were carried out with nitinol clips in anastomosis clip group and with traditional suture in suture group. The carotid arteries remained undamaged in control group. On the days of 3, 9, 21 and 30 postoperatively, mean blood velocity (Vm), pulsatility index (PI) and resistance index (RI) of anastomosed arteries were determined by Ultrasonography Doppler. RESULTS: On the days of 8 and 9 postoperatively, there were no significant differences of VM, PI and RI between two experimental groups (P gt; 0.05). On the days of 20 and 30 postoperatively, the differences of Vm and RI were significant (Vm: P lt; 0.01, P lt; 0.05: RI: P lt; 0.01, P lt; 0.05). The hemodynamic restoration of the anastomosis clip group was better than that of the suture group. CONCLUSION: The hemodynamics of arteries anastomosed with nitinol clips is better than that with traditional suture. This technique has practical value clinically.
Abstract In order to study the possibility of repairing bone defect by cryopreserved vascularized bone allograft, 8 dogs were divided into 2 groups. In the experimental group, 15% dimethylsulfoxide (DMSO) was used as a cryoprotective agent, the posterior segments of dog s rib, pedicled with intercostal vesseles, were cryopreserved by a two-step freezing procedure,stored in liquid nitrogen for 96 hours, and then transplanted as allografts to theiliac bone defects of recipients by vascular anastomosis. In the control group, the autografts were transplanted in the same procedure. Immunosuppersive agents were administrated postoperatively for 3 weeks. The specimens were analyzed by immune response monitoring (IL-2, T cell subsets), SPECT scanning, angiography and pathologic examination. The results showed that the allografts had good blood supply and active osteocyte metabolism, bone healing of the allografts was perfect at 3 months and no evidence of immunologic rejection. The process of bone healing of allografts should be further investigated.
Objective To investigate the effect of free anterolateral thigh adipofascial flap in correcting the hemifacial atrophy. Methods From January 1997 to May 2006, 35 patients suffering from hemifacial atrophy were corrected with microvascular anastomotic free anterolateral thigh adipofascial flap and other additional measures according to the symptoms of the deformities. There were 11 males and 24 females, aging 1547 years. The locations were left in 12cases and right in 23 cases. The course of disease was 4 to 28 years. Their hemifacial deformities were fairly severity. Their cheeks were depressed obviously. The X-ray films and threedimensinal CT showed the 28 patients’ skeletons were dysplasia. The size of adipofascial flap ranged from 8 cm×7 cm to 20 cm×11 cm. Donor sites weresutured directly. Results Recipient site wound of all patients healed by first intention. All adipofascial flaps survived. The donor sites healed well and no adiponecrosis occurred. Thirty-five cases were followed up for 6 months to 8 years. The faces of all patients were symmetry, and the satisfactory results were obtained. There were no donor site dysfunction. Conclusion The anterolateral thigh adipofascial flapprovides adequate tissue, easytosurvive, no important artery sacrificed and the donor scar ismore easily hidden. Combining with other auxiliary methods, it can be successfully used to correct the deformity of hemifacial atrophy.
Using 70 SD white rats, diveded in two groups at random, after the common carotid artery wa(?) exposed, anastomosis of the artery was done by whole-layer suture and suture without including the endothelial layer, respectively. The rate of patency of both groups immediately after operation was 100 percent, where as in late stage, 94 percent and 97 percent, respectively. From the histologic exam ination, it was found that in the group of whole-layer suture, the time required to cover the sutureline with endothelium was delayed and there was rupture of the clastic fibers.
OBJECTIVE: To explore an ideal way of small vessel anastomosis for microsurgery. METHODS: Anastomosis of both carotid arteries were performed in 20 rabbits. One side of the arteries were anastomosed with anastomotic clips, the other side of the arteries, as comparison, were anastomosed with suture. The vessels were harvested at first and 14th day after operation and were evaluated using operating microscope, light microscope and electronic microscope. RESULTS: The average anastomotic time for suture was about 15 minutes, while for the clips was 2 to 5 minutes. There were no difference in patency between the two techniques. Endothelialization at the anastomotic sites were both completed 14 days postoperatively. However, for the anastomotic clips, there were no endothelia damage and foreign bodies formation inside the vessels. CONCLUSION: This experiment has confirmed that the anastomotic clip’s procedure provides a very safe and easy way to perform anastomosis and reduce the incidence of thromboses.
The method of diversion of the arteryvein flow was used for vascular anastomosis in 12 cases undergoing replantation of the severed limbs(fingers)and free tissue transplantations. The results from this method were successful. The efficacy of this method of re-establishment of the blood circulation broadened the indications for replantation and also provided a method of choice in cases when there was impediment of the venous return during tissue transplantation.
OBJECTIVE To investigate the clinical result in repair of soft tissue defect with combined skin flap vascularized by pedicle on the one end and vascular anastomosis on the other end. METHODS From October 1990 to August 1995, 5 cases with soft tissue defect at the extremities and 1 cases with sacral bed sore were repaired by the combined skin flaps transfer, ranged from 15 cm x 30 cm to 16 cm x 70 cm in defect, among them, 5 cases with myocutaneous flap and 1 case with skin flap, and the size of the combined skin flaps was 15 cm x 40 cm to 12 cm x 80 cm. RESULTS All the flaps were survived with satisfactory effect. Followed up 3 to 6 years, there was no obvious complication. CONCLUSION Transfer of combined skin flaps vascularized by pedicle and vascular anastomosis is suitable to repair the soft tissue defect, especially in large area defect.