Rat tail replantation as a training model for microvascular procedures of digit replantation

In this study we sought to evaluate the potential of rat tail replantation as a tool for very-small-vessel microvascular anastomoses. We used 10 adult Sprague-Dawley rats. The tail was completely amputated 2.0-cm distal to the base of the tail. Then the tail was replanted with anastomoses of two superficial dorsal veins from both sides and one artery. All 10 replanted tails were pink, viable, and normal-appearing at all daily inspections performed from the first to the fourteenth postoperative days. This model can provide a training tool for the acquisition of superior microvascular surgical technique for the repair of very small vessels that stimulate digital replantation. © 1998 Wiley-Liss, Inc. MICROSURGERY 18:364–367, 1998     

The use of an afferent arteriovenous fistula in digit replantation surgery: a report of two cases

Two cases of successful digital replantation are presented in which arterial inflow was provided by a proximal arterial-to-distal venous anastomosis. This technique provides an alternative means for replantation when no suitable artery for anastomosis is available in the amputated part.     

断指(趾)再植628例体会

断指再植至今已有 34年的发展历程[1] 。其重要性越来越受到重视。我院自 1990年 1月到 1999年 1月断指 (趾 )再植 6 2 8例 ,现作一回顾性分析 ,旨在总结影响成活及功能恢复的几点体会。1　临床资料本组 6 2 8例中男 5 4 3例 ,女 85例 ;年龄 8～ 6 8岁 ,平均 30岁 ,其中断指 6 19例 ,断趾 9例。拇指 4 39例 ,食指 132例 ,中指 4 9例 ,无名指 8例。一指二段 4 3例。指末节离断 197例 ,中节 32 1例 ,近节 110例。其中指尖离断 8例。部分断指伴有不同程度指骨、指动脉、静脉、神经、肌腱及皮肤软组织缺损。断指缺血时间最短 2 0分钟 ,最长 8 5…     

Topical silicone gel: a new treatment for hypertrophic scars

A prospective, controlled clinical trial was designed to assess the efficacy of a new treatment of hypertrophic scars. Silicone gel sheeting was applied to 14 hypertrophic scars in 10 adults for 8 weeks. The treated scars and untreated, mirror-image or adjacent control scars were photographed, biopsy specimens were taken, and they were measured elastometrically before and after treatment. Photography and elastometry were repeated 4 weeks after treatment was discontinued. All the scars that had been treated for at least 12 hours a day were improved clinically after 4 weeks. There was further clinical improvement during the second 4 weeks of treatment. Elastometrically, the treated scars were improved significantly at 4, 8, and 12 weeks, compared with both their own treatment value and the control scars (p less than 0.05). Control scars were unchanged elastometrically. Clinical improvement persisted for at least 4 weeks after treatment was discontinued. The silicone gel sheeting was well tolerated, except for occasional transient rashes or superficial maceration--both of which resolved promptly when treatment was withdrawn. There was no histologic evidence of inflammation or foreign body reaction suggesting that silicone had entered the treated tissues. We conclude that this simple method of treating hypertrophic scar is efficacious, even in relatively chronic cases. The mechanism of action of silicone gel, which is apparently not related to compression, remains to be determined.     

负压封闭引流在毁损性断肢再植中的应用

目的 为扩大断肢再植的适应证,探讨负压封闭引流(VAC)在毁损性断肢再植中的应用. 方法 2000年11月～2006年6月,对24例26侧毁损性离断肢体重建骨骼结构,修复肌腱、神经,吻合血管或通过自体静脉移植恢复血液循环,对所遗留的大面积软组织缺损,运用VAC系统Ⅰ期封闭创面,Ⅱ期主要以中厚皮片移植或肌瓣、肌皮瓣转位修复. 结果随访7～20个月,再植肢体全部存活.8例再植处发生骨不连,行自体骨移植修复.12侧小腿离断中6侧发生马蹄内翻畸形,行三关节融合矫正.所有再植肢体均获得满意的外观和功能.结论 毁损性断肢可再植成活并恢复大部分功能,VAC可解决再植术中软组织缺损的难题.     

Video-intuboscopy: a new aid to routine and difficult tracheal intubation

Video-intuboscopy gives a video display of the view from the tip of the tracheal tube during conventional laryngoscopy, and was developed particularly to assist the immediate management of unexpected difficult intubation. A lightweight, malleable video-optical intubation stylet transmits the view from the stylet tip onto a monitor. It is inserted in the tracheal tube before starting anaesthesia, and the view from the tracheal tube tip enables the anaesthetist to verify tracheal tube position in the trachea. During difficult intubation the video view is used to guide the tracheal tube into the trachea. When used to allow confirmation of tracheal placement, the system did not interfere with conventional intubation procedures. The method showed the subglottic airway, gave immediate confirmation of tracheal tube position, and aided teaching and supervision. The method was used to guide intubation in two patients with unanticipated grade 3 laryngoscopic views. Intubation was simple, rapid and atraumatic, without the need for head, neck or laryngeal manipulation. Tracheal placement was instantly confirmed using the video view from the stylet tip. Clinical studies are required to define the value of this new intubation technique.      

Sonographically assisted percutaneous release of the a1 pulley: a new surgical technique for treating trigger digit

This study introduces a sonographically assisted percutaneous technique for releasing trigger digits which provides direct visualization of the release and avoids the risks of incomplete release and injury to adjacent neurovascular structures associated with other percutaneous release techniques. The "safe zone" and an estimate of the size of the A1 pulley were determined in a separate cadaver study. We then used these landmarks in a prospective clinical study of 107 digits in 83 consecutive patients treated by this technique. During the follow-ups of between 9 and 15 months, we evaluated 104 digits in 80 patients. Pain was absent in 101 digits (97%) and considerably improved in the other three (3%). All mechanical problems had been resolved and none recurred during follow-up. This technique allows the surgeon to see and monitor, precisely, the percutaneous division of the A1 pulley without open surgery and, therefore, to avoid the inherent risks of percutaneous and open surgical release.     

The flow-through free flap in replantation surgery: a new concept

The concept of flow-through circulation in free flaps was previously described as a one-staged technique for cover and revascularisation of ischaemic traumatized extremities. This paper describes the practical use of the concept in replantation surgery. Two clinical cases of hand replants are presented in which an uninterrupted flow was established through the selected free flap.     

Staged major limb replantation: a concept to minimize the risk in replantation of the lower extremity.

The replantation of large limb segments presents two major problems: first, a general danger to survival because of major accompanying injuries and additional ischemia-reperfusion injury; second, local soft-tissue damage at the amputation site. Successful replantation can be compromised by infection, vessel thrombosis, and disturbed bone healing. Possible risk reduction may be accomplished by the concept of a two-staged replantation. A brief primary emergency procedure involving bone resection, osteosynthesis, and revascularization (with the goal of limb survival) is followed by a second procedure within 72 hr after trauma, for final debridement, completing the osteosynthesis, nerve and tendon suturing, and soft-tissue coverage by free flaps. The advantages of the double procedure are demonstrated in 27 patients by comparison of two treatment groups. Group I comprised 15 patients with definitive primary care. In Group 2 (n = 12), the two-stage operation was performed. The second group showed a shorter duration of overall treatment, reduction of blood loss, and fewer infections.