Facial reanimation by cross-facial nerve grafting: report of five cases.

Facial nerve repair is a dynamic reanimation technique. Direct nerve repair by suturing or grafting can provide good results within a specific time frame. Immediate nerve repair has been successful in cases of laceration injuries, but nerve grafting techniques are typically delayed when it is clear that direct suturing to the nerve trunk cannot be achieved without tension.

Hematomas requiring surgical evacuation following face lift surgery.

This study evaluates hematomas requiring surgical evacuation following a face lift. Twenty-three hematomas occurred with 1236 consecutive face lifts (1.86 percent).

Unrecognized injuries in patients referred for emergency microsurgery.

Replantation of amputated parts and emergency microvascular repair of injured extremities are the two most common applications of clinical microsurgery. A major complication of emergency referral of such cases is the existence of the other injuries unrecognized at the time of initial evaluation. We have reviewed this complication within a series of emergency microsurgical cases referred to this unit.

Thumb and finger reconstruction by toe-to-hand transfer.

Toe transplantation provides a means of restoring a thumb or finger in a single microsurgical procedure with tissues anatomically similar to those lost or absent. Although formidable, these toe transplantation procedures can be accomplished by experienced teams of microsurgeons with a high rate of success.

Clinical leech use in a microsurgical unit: the San Francisco experience.

One microsurgical unit's experience with leech application to 67 patients is surveyed. Five illustrative cases are presented to explain strategies of leech use, and plans for future research are discussed.

The use of medicinal leeches in microsurgery.

Medicinal leeches have been used to treat a variety of ailments for thousands of years. During the past decade the leech has become valuable for salvaging surgically uncorrectable venous insufficiency which is occasionally encountered after microsurgical free flap and replantation procedures. Leech anatomy and physiology are reviewed.

Microvascular transplantation of expanded free scalp flaps between identical twins.

Long-term follow-up of a previous free scalp transplant between identical twins is provided. A recent third transplant between these twins is presented in which donor flap expansion is used prior to transplantation, and the postoperative use of medicinal leeches is discussed.

Free-flap free flap.

We present a patient who sustained bilateral below-knee amputations that were treated with skin grafts as initial coverage. A latissimus dorsi free flap was later used as definitive coverage of one stump. Then at a subsequent operation a portion of the same latissimus dorsi free flap was reharvested, again as a free flap, and transplanted to cover the contralateral stump.

Thumb reconstruction--great toe transfer.

Thumb reconstruction has a long and exciting history spanning more than 100 years. Reflecting on the evolution of techniques, the problems encountered and solved, and the advancement of technologies, one is struck by the versatility of surgeons in their varied approaches to the restoration of the thumb. Philosophical differences over the relative advantages and disadvantages of each operation have fueled debate over the choice of technique, but a unifying concept in reconstruction "to replace the lost tissue with like tissue" must be sought.

An experimental model for ear reconstruction with moulded perichondrial flaps: a preliminary report.

Attempts to create a pinna by moulding cartilage fragments have been reported previously by Peer. The regenerative capabilities of perichondrium are well known. Combining these concepts, we succeeded in creating a cartilage pinna by implanting perichondrial flaps between the leaves of a methylmethacrylate mould.

Creation of neovascularised free flaps using vein grafts as pedicles: a preliminary report on experimental models.

In a rat model, based on the concept of neovascularisation, an interposition vein-grafted arterial-venous fistula pedicle was used to create neovascularised skin, muscle, and bone free flaps. The important feature of these flaps is that neovascularisation of the selected flap tissues was achieved with a vein graft, unlike earlier studies using local arteries and veins as pedicles. Within a few weeks sufficient neovascularisation developed to support free transfer of the flaps based on the implanted vein graft pedicle.

Antibiotic sensitivities of Aeromonas hydrophila cultured from medicinal leeches.

Increased use of medicinal leeches (Hirudo medicinalis) for the treatment of venous congestion in flaps and replanted parts has coincided with reports of soft tissue infections following leech application. We cultured the gullets of 20 medicinal leeches to re-examine the antibiotic sensitivities of Aeromonas hydrophila, the leech enteric organism associated with reported infections. These isolates reflected reported resistance to penicillin and first generation cephalosporins as well as sensitivity to gentamicin, tetracycline and chloramphenicol.

Neovascularized free cutaneous cartilage flap transfer with microsurgical anastomosis: an experimental model in the rabbit.

In preparation for this study in rabbits, preliminary trials were conducted in rats rather than rabbits because they are more economical and are believed to develop neovascularization more rapidly. Using modifications of techniques described by Duarte, the superficial inferior epigastric vessels were planted between the folded leaves of full-thickness grafts of rat ear cartilage. These preparations showed signs of neovascularization and new cartilage formation adjacent to the pedicle when harvested from the groin three weeks later.

Prefabricated sensate myocutaneous and osteomyocutaneous free flaps: an experimental model. Preliminary report.

Principles of neovascularization have been reported for the successful creation of a variety of muscle and bone free flaps. This study demonstrates a simple and effective technique for construction of prefabricated sensate myocutaneous and osteomyocutaneous free flaps in a rat model. These experiments were carried out in 20 Sprague-Dawley male rats.

Neovascularized bone, muscle, and myo-osseous free flaps: an experimental model.

Different techniques for creating neovascularized bone, muscle, and myo-osseous free flaps were examined and evaluated in an experimental model. Sprague-Dawley rats (n = 40) were divided into four equal groups: 1) cortical bone flap (clam flap); 2) cortical bone and muscle flap (clam-muscle flap); 3) cortical and cancellous bone chip flap (Marlex-mesh flap); and 4) cortical and cancellous bone chip flap (silicone-cone flap). After 3 1/2 weeks, when neovascularization of the flaps developed, they were reliably transferred as free flaps based on their neopedicles.

Prefabricated neovascularized free muscle flaps: pedicle variations.

Current techniques of free muscle transplantation with microvascular anastomosis have the disadvantages of limitation of available donor sites, loss of donor muscle function, and the possibility of donor site defect or deformity. Using modifications of a "secondary tissue flap" created by neovascularization of a given tissue, neovascularized muscle flaps with pedicle vessels were created by wrapping external abdominal oblique muscles around the superficial inferior epigastric blood vessels. Different pedicle types were examined to explore possible differences in neovascularization.

Neovascularized free fat flaps: an experimental model.

Using the concepts of neovascularization and microsurgical free transfer, two types of free fat flaps were developed in a rat model. The technique for construction of the flap was to use either a free fat graft or a pedicle fat flap that were then wrapped around a predetermined vascular bundle, subsequently to neovascularize the enveloping fat tissue. Once adequate neovascularization occurred, these flat flaps could then be harvested on a neopedicle consisting of the enveloped artery and vein.

Microvascular thermic sleeve anastomosis: a sutureless technique.

Microvascular thermic sleeve anastomosis performed with bipolar coagulation was investigated under experimental conditions. Patency rates of 100 percent for arteries (approximately 1.0 mm in external diameter) and 78 percent for veins (approximately 0.

Creating a free muscle flap by neovascularization: an experimental investigation.

Experimental free muscle flaps were created by inducing transmural neovascularization. Free muscle flaps were developed in Sprague-Dawley rats through a three-stage microsurgical procedure. In the first stage, a muscle strip from the external oblique abdominus muscle was elevated and folded around the superficial epigastric vessels.

Importance of vessel tension in end-to-end and end-in-end anastomoses.

Arterial end-in-end and end-to-end microanastomoses were done experimentally under natural tension and without tension. Intraluminal plastic casts were made at different postoperative time intervals, and the resulting stenosis at the site of anastomosis compared by lumen area measurements. Both anastomotic techniques revealed marked stenosis at the first hour postoperative, even when there was no tension applied to the vessels.

Reconstruction of mandibular and floor of mouth defects using the trapezius osteomyocutaneous flap.

The trapezius osteomyocutaneous island flap has evolved in postablative head and neck reconstruction as a versatile and hardy local flap which can provide intraoral lining, well-vascularized bone, and muscle bulk for the reconstruction of a complex defect. This investigative study examines the anatomy of 20 osteomyocutaneous flaps in 10 fresh cadavers and in 8 clinical patients. In our series, 80 percent (type I) of the major vascular pedicle arose from the thyrocervical trunk.

Customized prefabricated neovascularized free flaps.

Neovascularization of tissues into which a vascular pedicle has been implanted can result in the creation of a flap, or free flap, which is supported by those vessels as a neopedicle. This phenomenon allows the construction of customized prefabricated free flaps from tissue without restriction to naturally occurring vascular territories.