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.

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.

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.

Swimmer's nose deformity.

This is the first published report of the swimmer's nose deformity. This common athletic deformity has a characteristic, asymmetric dorsolateral nasal hump that progressively develops over years during a competitive swimming career and persists after cessation of the sport. The cause is thought to be bone and soft tissue remodeling in response to repetitive trauma chronically inflicted by a swimmer's goggles during the water reentry phase of breathing.

Great toe-to-thumb microvascular transplantation after traumatic amputation.

The thumb is a vital part of the hand. After traumatic loss of the thumb, hand function diminishes considerably. The loss of the great toe, on the other hand, although unsightly, is not a considerable functional loss to the foot.

Ring avulsion: injury pattern, treatment, and outcome.

Ring avulsion injury is classically believed to be one of the most challenging for the reconstructive surgeon. Injury patterns include a spectrum from laceration to complete amputation, with differential magnitude of injury to soft tissue, tendon, joint complex, and bone. Although ring avulsion injury can result in devastating functional and aesthetic loss to the hand, fear of even greater functional loss has made replantation a relative contraindication for this complex injury.

Perfusion, viability, and pedicle dependence in acute and delayed rat island skin flaps.

Purpose: Although surgical delay phenomenon has been widely investigated, its pathophysiology has not been fully elucidated.

Methods: In 25 Spraque-Dawley rats, an 8 x 8 cm2 epigastric skin flap consisting of 4 vertical zones A through D (farthest from vascular pedicle) was outlined. All animals were perfused twice with colored fluorescent microspheres: immediately before and after flap elevation (Acute, n = 10) and before and after pedicle ligation on POD 8 (Delayed, n = 15).

Induction of tolerance to composite tissue allograft in a rat model.

The goal of this study was to establish a rat model that can be used to determine the variables in influencing induction of tolerance to composite tissue allografts. An anti T-cell depleting agent (R73) and 15-deoxyspergualin were given in different doses and schedule to four groups of Lewis rats receiving a limb transplant from Brown-Norway donors. Graft survival prolongation was maximal combining a single dose of R73 and a 20-day administration of 15-deoxyspergualin.

Detection of perfusion disturbances in digit replantation using near-infrared spectroscopy and serial quantitative fluoroscopy.

Purpose: The postoperative monitoring of digit replants continues to be a challenge. Current objective methods of digit monitoring have not been adopted widely because of their complexity or lack of sensitivity. Because tissue oxygen tension correlates directly with vascular inflow, a device that tracks changes in tissue oxygenation may be useful to monitor the perfusion and viability of digits after revascularization.

Oral administration of L-arginine decreases necrosis of the epigastric skin flap in the rat.

Background: We investigated the effect of prolonged oral arginine administration on tissue necrosis and perfusion in the rat skin flap.

Methods: Twenty-five Sprague-Dawley rats had an 8 x 8 - cm epigastric skin flap elevated and were divided in 2 groups, l-Arginine and Control, which respectively received oral 6% l-arginine solution or water for 8 days postoperatively. On postoperative day 8, area of flap necrosis was measured, and the animals were perfused systemically with 15-microm colored fluorescent microspheres before (blue) and after (yellow-green) ligation of the flap pedicle.

The effect of single administration of vascular endothelial growth factor or L-arginine on necrosis and vasculature of the epigastric flap in the rat model.

Objectives: Vascular endothelial growth factor (VEGF) and nitric oxide (NO) produce vasodilation, induce angiogenesis, and improve survival of surgical flaps. We used the rat epigastric skin flap to study the effect of a single intra-arterial dose of VEGF or L-arginine, a substrate for NO production, on flap regional necrosis and pedicle dependence of flap perfusion.

Methods: In 30 Sprague-Dawley rats an 8 x 8 cm2 skin flap, consisting of four vertical zones marked A through D (right to left), based on the proximal right inferior epigastric vessels was raised.

Composite tissue allografting (CTA).

Composite tissue allografting (CTA) is a relatively new term that appears with increased frequency in the medical and surgical literature. The recent successful allografts, or homotransplantations, of hands has sparked a resurgence of research, both experimental and clinical. Plastic surgeons have long been interested--particularly in the field of skin grafts for extensive burns and wounds--but have been replaced by the organ transplant teams and immunogeneticists.

Effect of sequence, timing of vascular anastomosis, and clamp removal on survival of microsurgical flaps.

The effects of the timing and order of clamp removal in microsurgical transplants were studied in rat groin skin flap and rat latissimus dorsi muscle flap models. Forty rats were divided into four groups. In Group 1, the arterial pedicle of the skin flap was anastomosed first, and the clamp was released after the anastomosis was completed.

Cross-facial and functional microvascular muscle transplantation for longstanding facial paralysis.

Functional results continue to improve with advancing microsurgical techniques and monitoring to detect and correct problems within minutes [47]. However, failures do occur, even when one can project a 98% survival for the transplant. Figs.

Effect of cryopreservation on patency and histological changes of arterial isogeneic and allogeneic grafts in the rat model.

Vascular grafting is used frequently in the management of length discrepancies between blood vessels. Cryopreservation permits vascular graft storage and aids availability; however, long-term patency of cryopreserved arterial allografts is not well established. Fifty Fisher and 55 Wistar rats were used in the study.

Use of a venous flap from an amputated part for salvage of an upper extremity injury.

The authors describe a patient in whom a large arterialized venous flap was harvested from a nonreplantable part after partial hand amputation. A 9 x 6-cm segment of dorsal hand skin was transplanted acutely in an artery-vein-vein fashion to cover exposed bone, joints, and reconstructed tendons. The flap provided durable coverage, and at 1 year the patient regained 94% total active motion at the index finger and 99% total active motion at the long finger.

The harvest and clinical application of the superficial peroneal sensory nerve for grafting motor and sensory nerve defects.

Potential donor nerves for autografting are finite and usually limited to cutaneous nerves of the extremities. The superficial peroneal nerve is the major lateral branch of the common peroneal nerve that innervates the peroneus longus and brevis muscles and provides sensation to the lateral aspect of the lower leg and the dorsal foot. It has generally been overlooked as a potential donor of nerve autografts.

Present Status of Microsurgical Replantation.

The replantation of amputated parts has stimulated the imagination of writers since antiquity. It was not until the successful replantation of an arm by Malt and a hand by Chen Chung Wei in 1953 that these fables became reality. The simultaneous development of the field of microsurgery permitting the repair of one millimetre vessels made possible the replantation of structures fed by these small vessels such as fingers, ears, noses, lips, scalps and penises.