Several techniques were used to improve 0.3～0.5 mm microvascular anastomosis. These included (1) non-isolation of adventitia, (2) modified two—point anastomosis, (3) clamping only the inflow in veins anastomosis, (4) atraumatic measurement of vascular patency, (5) post operative stimulation by electromagnetic fields, which accelerated the healing of the vessels. The chance of patency following anastomosis in experimental group was significantly much greater than that in the control one (plt;0.001). We have have also used these techniques in 11 patients with fingers replantion or smaller lymphatic anastomosis. All of the operations were successful.
Objective To establish a modified mouse abdominal heterotopic heart transplantation model in order to increase the graft survival rate and reduce operative complications. Methods The heart was transplanted into the abdomen by anastomosing the donor ascending aorta and pulmonary artery to the recipient abdominal aorta and infrahepatic vena cava respectively. Hilar tissue was not alone ligated, meanwhile recipient lumbar vein was not ligated. Recipient abdominal aorta and infrahepatic vena cava were not isolated, but were liberated and obstructed simultaneously. Results Two hundred and twenty-nine formal transplantations were performed with the successful rate of 97.82% (224/229). The syngeneic graft survival time was more than 6 months. Complications: Aorta thrombus was found in 2 mice (0.87%), inferior vena cava thrombus in 1 mouse (0.44%), heart torsion in 4 mice (1.75%), hemorrhage in 4 mice (1.75%), crural paralysis in 2 mice (0.87%), intestinal obstruction in 1 mouse (0.44%), and no anesthetic accident happened. Conclusions The meliorated mouse abdominal heterotopic heart transplantation model is simple and reliable, which can reduce the operation time. Thus, the meliorated method provides a useful technique for immunologic transplantation research.
From 1979, a total of 5 cases of giant cell tumor of the lower end of radius were treated by segmental resection, and vascularized fibular head transplantation, and reconstruction of the inferior radio-ulnar joint. The bone healed within 2-3 months. The patients were followed for 5-10 years. There was no recurrence, nor distant metastasis, and the functional recovery of extremities was satisfactory.The clinical materials, the operative techniques and the assessment of the long-term results were introduced.
Since Oct. 1990, the 2nd metatarso-phalangeal joint and big-toe nail composite graft with the neuro-vascular bundle was transplanted to reconstruct the thumb in 4 cases. The transplants were all survived. The follow-up through 5 months, a comparatively good function and appearance were achieved.The applied anatomy, the surgical technique and the matters needing attention were detailed.
Standard venographies were pcrformed to evaluate the endothelial damage by the contrast medium. After different time intervals, the local veins were prepared for transmission and scanning electron microscopy (TEM and SEM) investigation. The veins were in a dilated state after the angiographies, which lasted for about two days. The endothelial damage was most severe 1 day after the venography. Besides the lesions of extensive endothelial tissurs, dcsquamations, and the exposure of subendothelial tissues, microthrombi somethimes were found. Healing occurred within 3 days. The results this study has also verifieed that it was more valuable to study venogqaphic effects on veins with TEM and SEM.
OBJECTIVE: To observe the architecture of elastic fiber of anastomosed artery. METHODS: The right femoral arteries of 60 Wistar rats were cut off transversely and end-to-end anastomosis were performed. On the 3rd, 7th, 14th, 21st, 30th and 90th days after operation, the anastomosed artery segments were harvested and fixed by 10% formalin. After routine processed, the architecture of elastic fiber of anastomosed artery was observed under scanning electronic microscope and was compared with that of normal artery. RESULTS: On the 3rd and 7th days after anastomosis, there was no the elastic fiber in the middle of the anastomosed area. From 14 to 90 days after anastomosis, the newborn elastic fiber connected the anastomosed area. The reconstruction of elastic fiber could be divided into quiescent stage, proliferation stage, and rebuilding stage. CONCLUSION: The reconstruction of elastic fiber occurs after arterious anastomosis and newborn elastic fiber originates from endoarterious layer. The structure of elastic fiber can return to normal 30 days after anastomosis.
Objective To introduce a new approach of neurotization to treatment of the shoulder syndrome after the radical neck dissection by using transpositional anastomosis of C7 posterior root and the spinal accessory nerve to reconstruct the function of trapezius muscle. Methods From March 1999 to February 2001, 10 patients underwent the neurotization during the radical neck dissection. In the operation, the apo-cranial part of spinal accessory nerve was preserved from the trapezius muscle (gt;3.0 cm in length) and anastomosed to C7 posterior root. Objective physical examinations and electromyography were conducted before and after operation.One, 6 and 12 months after operation the trapezius muscle function after the transpositional anastomosis was evaluated. Results One, 6 and 12 months after operation, the recovery rates of each part were as follows: 9.8%, 68.9% and 73.5% in upper part; 4.7%, 73.6% and 69.4% in middle part; and 6.2%, 70.5% and 70.3% in lower part. The range of abduction motion of upper arm in 7 cases (70%) exceeded 90°. The mean maximal abduction angle was more than 95°. Evaluation of the shoulder function showed that myoatrophy was mild and the disability of abduction was classified as grade Ⅱ in 7 cases and grade Ⅲ in 3 cases. Conclusion Transpositional anastomosis of the C7 posterior root to thespinal accessory nerve after radical neck dissection can well reconstruct the function of trapezius muscle. This approach provides a wide indication in comparison with the functional neck dissection without impairment of arm function afterthe cutting of C7.
ObjectiveTo investigate effect of sealing one-layer anastomosis in pancreaticojejunostomy in patients underwent pancreaticoduodenectomy. MethodsThe clinical data of 85 patients underwent pancreaticoduodenectomy in this hospital from January 2014 to May 2015 were collected. Of all the patients, 28 patients were underwent sealing onelayer anastomosis in pancreaticojejunostomy (sealing one-layer anastomosis group), 27 patients were underwent ductto-mucosa pancreaticojejunostomy (duct-to-mucosa anastomosis group), and 30 patients were underwent end-to-side invaginated pancreaticojejunostomy (end-to-side invagination group). The anastomosis time, time to pull out drainage tube, postoperative hospital stay, and incidence rate of postoperative pancreatic fistula were compared among these three groups. Results①The anastomosis time (min) of the sealing one-layer anastomosis group was significantly shorter than that of the duct-to-mucosa anastomosis group or end-to-side invagination group (12.51±2.96 versus 25.65±3.35, P < 0.05; 12.51±2.96 versus 23.73±5.27, P < 0.05).②The time to pull out drainage tube of the sealing one-layer anastomosis group was significantly shorter than that of the end-to-side invagination group (7.65±1.30 versus 11.15±3.47, P < 0.05).③The postoperative hospital stay had no statistical significances among these three groups (P > 0.05).④The incidence of pancreatic fistula was 3.57% (1/28), 7.41% (2/27), and 10.00% (3/30) among the sealing one-layer anastomosis group, duct-to-mucosa anastomosis group, and end-to-side invagination group respectively, which had no statistical differences among these three groups (P > 0.05). ConclusionSealing one-layer anastomosis in pancreaticojejunostomy might be a safe anastomosis, and it has advantages of simple operation and short operation time.
ObjectiveTo systematically review the efficacy and safety of nickel-titanium shape memory alloy compression anastomosis clip (Ni-Ti CAC) for gastrointestinal anastomosis. MethodsThe Cochrane Library, PubMed, Web of Knowledge and CBM databases were searched for the randomized controlled trials (RCTs) that investigated the efficacy and safety of Ni-Ti CAC versus surgical stapler for gastrointestinal anastomosis. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.2. ResultsEight RCTs involving 457 patients were included in the meta-analysis. The results of meta-analysis showed that, compared with the surgical stapler group, the Ni-Ti CAC group was superior in operation time (MD=-8.30, 95%CI-15.58 to-1.02, P=0.03), food intake (MD=-0.37, 95%CI-0.70 to-0.03, P=0.03), bowel movement (MD=-1.13, 95%CI-1.67 to-0.59, P < 0.000 1), passing gas time (MD=-0.30, 95%CI-0.55 to-0.06, P=0.01), and length of hospital stay (MD=-1.04, 95%CI-1.35 to-0.74, P < 0.000 01), with significant differences. No significant difference was found in anastomosis time (MD=-1.84, 95%CI-3.91 to 0.22, P=0.08). As for safety, no significant difference was found in anastomosis-related complications between both groups. ConclusionCurrent evidence shows that Ni-Ti CAC achieves better efficacy and safety in gastrointestinal anastomosis compared with surgical stapler.
ObjectiveTo explore the effectiveness of the free anastomosis cutaneous nerve double arterialized venous flap graft in repairing finger defect. MethodsBetween May 2010 and May 2013, 39 patients with finger defect were treated. There were 27 males and 12 females with an average age of 31 years (range, 17-45 years). The injury to admission time was 30-90 minutes (mean, 60 minutes). The causes included mechanical injury in 23 cases, crush injury in 11 cases, and other injury in 5 cases. The thumb was involved in 13 cases, the index finger in 11 cases, the middle finger in 9 cases, the ring finger in 4 cases, and the little finger in 2 cases. Skin soft tissue defect ranged from 2 cm×1 cm to 4 cm×2 cm. of them, 22 cases had tendon injury, 17 cases had tendon and phalanx injuries. The size of free anastomosis cutaneous nerve double arterialized venous flap ranged from 2.5 cm×1.5 cm to 4.5 cm×2.5 cm. The donor site was directly sutured. ResultsTension blister and swelling were observed at distal flap in 5 cases at 3-5 days after operation and were cured after symptomatic treatment; the other 34 flaps survived, and wound healed by first intention. Primary healing at donor site was obtained. The patients were followed up 6-12 months (mean, 9 months). The flap appearance and texture were good with two-point discrimination of 6-9 mm (mean, 7.5 mm). According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of Chinese Medical Association, the results were excellent in 35 cases and good in 4 cases. ConclusionThe free anastomosis cutaneous nerve double arterialized venous flap not only can ensure the flap blood supply, but also can obviously improve the sensory function of the flap, which greatly reduces the risk of postoperative flap atrophy, and can achieved satisfactory effectiveness.