History of Microsurgery: The Legacy of Harry J. Buncke, MD.

A historical review of the history of Microsurgery including the important influence and contributions of Harry J. Buncke MD considered by many to be the "Father of Microsurgery". An chronological list of Historic Replants and "Free Flap" and microvascular transplants is included.

Narrative review of the history of microsurgery in urological practice.

The clinical need for magnified visualization during surgery spurred the evolution of microscope and microsuture technology. Innovative surgeons across various surgical specialties recognized the importance of utilizing and advancing these technologies. Operative microscopy allows human dexterity to perform beyond direct visual limitations.

Evidence-Based Approach to Timing of Nerve Surgery: A Review.

Events causing acute stress to the health care system, such as the COVID-19 pandemic, place clinical decisions under increased scrutiny. The priority and timing of surgical procedures are critically evaluated under these conditions, yet the optimal timing of procedures is a key consideration in any clinical setting. There is currently no single article consolidating a large body of current evidence on timing of nerve surgery.

A Multicenter Matched Cohort Study of Processed Nerve Allograft and Conduit in Digital Nerve Reconstruction.

Purpose: Biomaterials used to restore digital nerve continuity after injury associated with a defect may influence ultimate outcomes. An evaluation of matched cohorts undergoing digital nerve gap reconstruction was conducted to compare processed nerve allograft (PNA) and conduits. Based on scientific evidence and historical controls, we hypothesized that outcomes of PNA would be better than for conduit reconstruction.

Peripheral nerve repair throughout the body with processed nerve allografts: Results from a large multicenter study.

Background: Peripheral nerve damage resulting in pain, loss of sensation, or motor function may necessitate a reconstruction with a bridging material. The RANGER® Registry was designed to evaluate outcomes following nerve repair with processed nerve allograft (Avance® Nerve Graft; Axogen; Alachua, FL). Here we report on the results from the largest peripheral nerve registry to-date.

Recovery of Motor Function after Mixed and Motor Nerve Repair with Processed Nerve Allograft.

Background: Severe trauma often results in the transection of major peripheral nerves. The RANGER Registry is an ongoing observational study on the use and outcomes of processed nerve allografts (PNAs; Avance Nerve Graft, AxoGen, Inc., Alachua, Fla.

Digit Tip Injuries: Current Treatment and Future Regenerative Paradigms.

Over the past several decades there has been a profound increase in the understanding of tissue regeneration, driven largely by the observance of the tremendous regenerative capacity in lower order life forms, such as hydra and urodeles. However, it is known that humans and other mammals retain the ability to regenerate the distal phalanges of the digits after amputation. Despite the increased knowledge base on model organisms regarding regenerative paradigms, there is a lack of application of regenerative medicine techniques in clinical practice in regard to digit tip injury.

Fluoroquinolone-Associated Tendinopathy of the Hand and Wrist: A Systematic Review and Case Report.

Background: Fluoroquinolone use has been known to be associated with tendinopathy and tendon rupture for over 30 years. Hand and wrist involvement has been reported rarely, yet without early recognition and withdrawal of the fluoroquinolone, there is potential for significant morbidity.

Methods: We searched Medline using a comprehensive search strategy for fluoroquinolones and tendinopathy of the hand and wrist, and provide a case report of a possible levofloxacin-related tendon rupture in a patient with a previous mutilating hand injury.

Outcomes of short-gap sensory nerve injuries reconstructed with processed nerve allografts from a multicenter registry study.

Background: Short-gap digital nerve injuries are a common surgical problem, but the optimal treatment modality is unknown. A multicenter database was queried and analyzed to determine the outcomes of nerve gap reconstructions between 5 and 15 mm with processed nerve allograft.

Methods: The current RANGER registry is designed to continuously monitor and compile injury, repair, safety, and outcomes data.

Microsurgical ear replantation-is venous repair necessary?-A systematic review.

Background: A common postoperative observation after microsurgical ear replantation has been venous congestion necessitating alternate modes of decongestion, frequently in conjunction with blood transfusion. A comprehensive literature search was performed to assess the relationship between mode of vascular reconstruction and postoperative outcome as well as postoperative transfusion requirement after microsurgical ear replantation.

Methods: The search was limited to cases of microsurgical ear replantation following complete amputation.

Long-term results and costs of muscle flap coverage with Ilizarov bone transport in lower limb salvage.

Objectives: To determine long-term outcomes and costs of Ilizarov bone transport and flap coverage for lower limb salvage.

Design: Case series with retrospective review of outcomes with at least 6-year follow-up.

Setting: Academic tertiary care medical center.

Functional outcome following nerve repair in the upper extremity using processed nerve allograft.

Purpose: Reconstruction of peripheral nerve discontinuities with processed nerve allograft has become increasingly relevant. The RANGER Study registry was initiated in 2007 to study the use of processed nerve allografts in contemporary clinical practice. We undertook this study to analyze outcomes for upper extremity nerve repairs contained in the registry database.

Processed nerve allografts for peripheral nerve reconstruction: a multicenter study of utilization and outcomes in sensory, mixed, and motor nerve reconstructions.

Purpose: As alternatives to autograft become more conventional, clinical outcomes data on their effectiveness in restoring meaningful function is essential. In this study we report on the outcomes from a multicenter study on processed nerve allografts (Avance® Nerve Graft, AxoGen, Inc).

Patients And Methods: Twelve sites with 25 surgeons contributed data from 132 individual nerve injuries.

Subdivision of the sural nerve: step towards individual facial reanimation.

Long term facial paralysis is a serious affliction and upsetting for the patient. Dynamic facial reanimation has become the treatment of choice. Various techniques that use different donor muscles have been developed since the first functional muscle transplant for facial paralysis more than 30 years ago.

From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses.

Accomplishing successful microvascular anastomoses is undoubtedly one of the most critical steps in performing free tissue transfer. However, the ideal technique has often been a subject of debate. Therefore, our objective was to review the current literature in an attempt to find objective evidence supporting the superiority of one particular technique.

Refining outcomes in dorsal hand coverage: consideration of aesthetics and donor-site morbidity.

Background: With high success rates, flap survival should no longer be the sole criterion in judging success in dorsal hand and wrist reconstruction. The authors sought to determine the best flap for dorsal hand coverage in terms of aesthetic appearance, donor-site morbidity, and minimization of revision surgery.

Methods: A retrospective review of all free flaps for dorsal hand and wrist coverage from 2002 to 2008 was performed.

Simultaneous double second toe transplantation for reconstruction of multiple digit loss in traumatic hand injuries.

The objective of this study is to review a single institution's 10-year experience of simultaneous double second toe transplantations for reconstruction of traumatic hand injuries. Eleven cases of traumatic hand injuries treated with simultaneous double second toe transplantation for digital reconstruction were retrospectively reviewed. All patients sustained traumatic injury resulting in multiple digit loss not amenable to replantation.

A recommended protocol for the immediate postoperative care of lower extremity free-flap reconstructions.

The success of lower extremity microsurgical reconstructions may be compromised postoperatively secondary to several factors, including thrombosis, infection, bleeding, and edema. To address edema, surgeons may use protocols for gradually dangling and/or wrapping the affected extremity. Such protocols vary widely among surgeons and are typically based on training and/or prior experience.

Great toe transplant versus thumb replant for isolated thumb amputation: critical analysis of functional outcome.

Background: Thumb replantation following thumb amputation is the standard of care. When replantation is impossible, microneurovascular great toe transplantation is a well-established option.

Methods: A retrospective review was conducted to evaluate functional outcome following isolated thumb replantation or great toe transplantation for thumb reconstruction.

Use of circular external fixation to maintain foot position during free tissue transfer to the foot and ankle.

Limb salvage techniques of traumatized extremities using free-tissue transfer and microsurgical techniques have become standard reconstructive methods. To our knowledge there is no published data on the incidence or likelihood of equinus following free tissue transfer about the ankle, although in our experience we have perceived an unacceptable incidence of equinus following free tissue transfers about the ankle and therefore initiated prophylactic ring fixation across the ankle. Fourteen patients were placed in circular external fixation spanning the ankle at the time of free tissue transfer for a mean of 12 weeks (Median 7 weeks, Range 6-28 weeks).

Management of exposed total knee prostheses with microvascular tissue transfer.

Introduction: Exposure of a knee endoprosthesis represents a limb-threatening condition, requiring long-term antibiosis, irrigation, and serial debridement to avoid knee arthrodesis or amputation. Although traditional orthopedic surgical doctrine mandates removal of exposed hardware under a dehisced wound, salvage of exposed prostheses using local muscle flap coverage has been reported. However, the complex three-dimensional geometry of the soft tissue surrounding the knee as well as the requirement for sustained local tissue levels of antibiotics to re-sterilize the hardware suggest that microvascular tissue transfer may constitute an advantageous means of wound coverage, increasing both limb and prosthesis salvage rates.

Index finger salvage with replantation and revascularization: revisiting conventional wisdom.

Replantation/revascularization of severely injured single digits is controversial, especially at the index position. Conventional wisdom is that these digits if salvaged will ultimately worsen residual hand function and they should be amputated. Twenty-eight cases of such index salvages were reviewed to test this hypothesis.

The Dixie Cup technique for salvaging limb length and preserving nerve continuity in the mangled lower extremity.

The mangled lower extremity posses a difficult problem for the reconstructive surgeon. We describe a novel technique for preserving limb length and maintaining nerve continuity in a severely injured lower extremity. This specific example of fixating the viable, sensate distal foot tissues onto the proximal tibia was vital in maintaining optimal limb length.