Histoacryl glue in microvascular surgery

The use of Histoacryl glue in the performance of microvascular anastomosis was examined in a rat model. An improvement in efficiency as noted by the decreased ischemic time and diminished bleeding with clamp removal was noted. Histological examination of the anastomosis at one and three weeks revealed a mild foreign body type inflammatory response to glue and suture material with no media necrosis and only minimal fibrointimal proliferation.     

Evaluation of polytetrafluoroethylene micrografts in microvascular surgery

Interposition grafts are an important and invaluable technique in free microvascular tissue transfer as they extend the vascular pedicle to allow it to reach undisturbed donor vessels away from the surgical or traumatic site. Autologous vein has been the most commonly used material for interposition grafting, but it has significant disadvantages. Nonautologous grafts are readily available and could certainly remedy most of the autologous graft disadvantages. This study was designed to (1) evaluate the patency of expanded polytetrafluoroethylene (PTFE) grafts in a simple microvascular vessel repair and (2) evaluate the survival of microvascular free flaps using PTFE arterial interposition grafts. The inferior epigastric vein or PTFE was used to reconstruct the femoral artery in 10 animals (20 sides) in a simple vessel repair model and in 20 animals in a groin free flap model. All epigastric vein grafts were patent at 1 week in the vessel repair group. Only five in the PTFE vessel repairs were patent. Nine of 10 free flaps were viable in the free flap group with epigastric vein interposition. All of the 10 free flaps with PTFE interposition failed. There was a statistically significant difference in vessel patency between PTFE grafts in the vessel repair and free flap models. Our data show that PTFE microvascular grafts are a poor substitute for vein grafts in the vessel repair and free flap animal models. We also found that simple vessel repair is not an acceptable model to study manipulations intended for free tissue transfer.     

Transpetrosal surgery techniques

The complex anatomy of the region necessitates thorough study if transpetrosal surgery is to be performed with minimal patient morbidity. Furthermore, by using flexibility, a team approach, and preoperative planning, the surgical procedure can be tailored to the patient, rather than fitting the patient to a fixed surgical procedure. Finally, minimizing patient morbidity is equivalent to preservation of cranial nerves and crucial vascular structures. Close surveillance and judicious postoperative radiotherapy following cytoreductive surgery provides improved patient outcomes compared with radical surgery that results in cranial nerve deficits.     

Surgical techniques in cochlear implants

Cochlear implants have a remarkable history and a promising future. As the cochlear implant has evolved, so has the surgical technique. This review encompasses a history of the cochlear implant, a summary of the evolution of the implant incision and the methods used to secure the device and the electrode, the cochleostomy versus round window debate, and a discussion of the validity of intraoperative tests. Advanced technology, new surgical techniques, and refining established techniques are hallmarks of cochlear implant surgery. Advancements, including image-guided surgery, hearing preservation with full insertion, and telemetry-based advanced programming, are expected to be standard in the future.     

Thrombolysis in microvascular surgery using tissue-type plasminogen activator

Thrombosis at the microanastomotic site is the primary cause of free flap failure. Tissue-type plasminogen activator, a potent thrombolytic agent, effectively lyses vessel thromboses. This study examined the efficacy of tissue-type plasminogen activator in a microvascular model using a modified vascular inversion graft in rabbits. Seventeen rabbits underwent this procedure with formation of thromboses in all but one inversion graft. Ten rabbits were locally infused with 1 mg of tissue-type plasminogen activator over a period of 4 hours; 6 control rabbits received normal saline infusions. Blood flow across the graft was reestablished in all 10 rabbits receiving tissue-type plasminogen activator and in none of those with normal saline infusions. Systemic fibrinolysis was not significantly altered. We conclude that local infusion of tissue-type plasminogen activator is effective in lysing thromboses that may occur at the venous microvascular anastomotic site without significant activation of systemic fibrinolysis.     

神经内镜下微血管减压术治疗三叉神经痛

目的总结3年多来在神经内镜下微血管减压术治疗三叉神经痛（trigeminal neuralgia,TN）58例的经验体会。方法经乙状窦后进路在神经内镜下进入桥小脑角区,检查三叉神经根及周围区域有无异常血管或其他病灶压迫情况,对责任血管进行分移减压或神经感觉支部分切断、垫片、分解粘连、切除肿瘤等治疗。结果 58例TN者术中发现三叉神经根有责任血管压迫者55例（94.83%）,部分为多动脉或动静脉双重压迫;在血管压迫的同时伴有蛛网膜粘连者19例,3例为单纯的重度蛛网膜粘连。术后均痊愈出院,随访1～4年（平均2.6年）56例,其中2例术侧耳鸣伴听力下降,6例面部浅感觉减退。无疼痛复发者。结论神经内镜的全景化,高分辨率视野有助于准确判定三叉神经的责任血管,可检查手术显微镜难以窥见的盲区。准确判断分移减压是否彻底,垫片位置是否合适,有助于提高疗效,减少并发症。     

Suturing techniques in endolaryngeal surgery

In the past 15 years surgery of the endolarynx has been greatly expanded. This development has been the product of three main factors: technological advancements such as the microcautery, improved knowledge about the healing properties of the endolarynx, and new surgical techniques. These types of approaches are being increasingly used in the treatment of complex reconstructive procedures of the larynx. An integral part of these new procedures are special suturing techniques. At present suturing techniques are being used to fulfill a number of requirements, including approximation and lateralization of anatomical structures for operative or exposure purposes, intraoperative retraction of endotracheal tubes, closure of wounds and securement and fixation of skin grafts, intralaryngeal molds, and interfacing Silastic® sheeting materials. With amazing simplicity the above requirements can be met if a few basic steps are comprehended and followed.     

Current techniques in tonsil surgery

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO(2) laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.