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.
OBJECTIVE: To explore the relationship between the properties of compliance and the change of structure of components in anastomosed arteries. METHODS: The arterial pressure and diameter of femoral arteries of dogs were measured in vivo before and after arterial anastomosis in different time intervals to deduce the arterial compliance. The anastomosed arteries were removed and evaluated through light microscopic examination and various staining methods, the relative contents of elastin, collagen and smooth muscles were measured through image analysis system. RESULTS: The compliance of arteries was gradually decreased after anastomosis with peak-time on the 14th day. The content of elastin at different time had no significant difference, while the content of collagen increased gradually, the ratio of them was increased. CONCLUSION: The property of compliance of anastomosed arteries is closely related to the contents of the structural components.
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.
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.
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.
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.
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.
Objective To improve arterial anastomosis method for rat renal transplantation. Methods Renal transplantations were performed on 72 wistar rats. The donor superior mesenteric artery was end-to-end anastomosed to the recipient left renal artery by using of sleeve anastomosis technique. The external diameters of the vessels anastomosed were 0.60±0.05 mm (left renal artery) or 0.80±0.07 mm (superior mesenteric artery). The procedure consisted of a guidingsuture and two fixing sutures. The guiding suture was used to “telescope” therecipient left renal artery into the donor superior mesenteric artery about 2 millimetre. Two fixing sutures were applied 180°apart from each other and tied. Three sutures passed through all layers of the donor superior mesenteric artery andconstricted the vessel lumen, but only penetrated the adventitia of the recipient left renal artery. Results The time for arterial anastomoses was approximately 6 to 8 minutes. The renal grafts perfused very well after the recipient left renal artery clamp was removed. Complications included anastomotic hemorrhage(1 case) and thrombosis (1 case). Histologic examination of 34 grafts at different postoperative time ranging from 6 to 30 days revealed that renal artery was fully patent, with no evidence of ischemic injury. Conclusion The modified arterial sleeve anastomosis technique is simple and feasible regardless of experimentalcondition and can be easily performed.
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.
【Abstract】Objective To discuss the clinical significance of postoperative application of gastrointestinal decompression after anastomosis of lower digestive tract. Methods Three hundred and sixty-eight patients undergoing excision and anastomosis of lower digestive tract were divided into two groups: the group with postoperative gastrointestinal decompression and the group without it. The clinical therapeutic outcomes and incidences of complications were compared between the two groups. Results The volume of gastric juice in the decompression group was about 200 ml every day after operation. Both groups had a smaller abdomenal circumference before operation than after operation （P＜0.001）. No difference in the time of first passage of gas from anus and defecation after operation was found between the two groups. The incidence of complications in the decompression group was obviously higher than that of non-decompression group (28.0% vs. 8.2%, P＜0.001); the incidence of pharyngolaryngitis of the former was up to 23.1%. There was also no difference found between these two groups regarding the hospital stay after operation.Conclusion The present study shows that application of gastrointestinal decompression after excision and anastomosis of lower digestive tract cannot effectively reduce the gastrointestinal tract pressure and has no obvious effect on prevention from postoperative complications. On the contrary, it may increase the incidence of pharyngolaryngitis and other complications. Therefore, it is more beneficial for the recovery of patients without gastrointestinal decompression.