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Microsurgical Techniques in Reconstructive Surgery

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Plastic and Reconstructive Surgery

Abstract

The surgeons began to investigate the possibilities of vascular anastomosis in experimental and clinical settings in the beginning of 20th century. Although some techniques have been described, the major advances in microsurgery are made following induction of operating microscope. Basically, microsurgery can be described as performing surgical procedures under magnification (loupe or operating microscope). During the last 50 years, microsurgical techniques have been developed and the basic principles for a successful microsurgical operation are defined. In this chapter; basic concepts in microvascular surgery such as vessel injury and regeneration and tissue ischemia and reperfusion are reviewed, technical factors that affect the outcome of microsurgical procedures are outlined, and anastomosis types and techniques in microvascular surgery are summarized.

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References

  1. Rickard RF, Hudson DA. A History of vascular and microvascular surgery. Ann Plast Surg. 2014;73:465–72.

    Article  CAS  PubMed  Google Scholar 

  2. Lidman D, Daniel RK. The normal healing process of microvascular anastomoses. Scand J Plast Reconstr Surg. 1981;15:103–10.

    Article  CAS  PubMed  Google Scholar 

  3. Harashina T, Fujino T, Watanabe S. The intimal healing of microvascular anastomoses. Plast Reconstr Surg. 1976;58:608–13.

    Article  CAS  PubMed  Google Scholar 

  4. Lidman D, Lyczakowski T, Daniel RK. The morphology and patency of arterial and venous microvascular anastomoses throughout the first post-operative year. A histological study. Scand J Plast Reconstr Surg. 1984;18:187–92.

    Article  CAS  PubMed  Google Scholar 

  5. Thurston JB, Buncke HJ, Chater NL, Weinstein PR. A scanning electron microscopy study of micro-arterial damage and repair. Plast Reconstr Surg. 1976;57:197–203.

    Article  CAS  PubMed  Google Scholar 

  6. Acland RD. Microvascular anastomosis: a device for holding stay sutures and a new vascular clamp. Surgery. 1974;75:185–7.

    CAS  PubMed  Google Scholar 

  7. Gold HK, Gimple LW, Yasuda T, Leinbach RC, Werner W, Holt R, Jordan R, Berger H, Collen D, Coller BS. Pharmacodynamic study of F(ab’)2 fragments of murine monoclonal antibody 7E3 directed against human platelet glycoprotein IIb/IIIa in patients with unstable angina pectoris. J Clin Invest. 1990;86:651–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Wolff KD, Stiller D. Ischemia tolerance of free-muscle flaps: an NMR-spectroscopic study in the rat. Plast Reconstr Surg. 1993;91(3):485–91.

    Article  CAS  PubMed  Google Scholar 

  9. Douglas B, Weinberg H, Song Y, Silverman DG. Beneficial effects of ibuprofen on experimental microvascular free flaps: pharmacologic alteration of the no-reflow phenomenon. Plast Reconstr Surg. 1987;79(3):366–74.

    Article  CAS  PubMed  Google Scholar 

  10. Grace PA. Ischaemia-reperfusion injury. Br J Surg. 1994;81(5):637–47.

    Article  CAS  PubMed  Google Scholar 

  11. Pang CY. Ischemia-induced reperfusion injury in muscle flaps: pathogenesis and major source of free radicals. J Reconstr Microsurg. 1990;6(1):77–83.

    Article  CAS  PubMed  Google Scholar 

  12. Adanali G, Ozer K, Siemionow M. Early and late effects of ischemic preconditioning on microcirculation of skeletal muscle flaps. Plast Reconstr Surg. 2002;109(4):1344–51.

    Article  PubMed  Google Scholar 

  13. Ross DA, Ariyan S, Restifo R, Sasaki CT. Use of the operating microscope and loupes for head and neck free microvascular tissue transfer: a retrospective comparison. Arch Otolaryngol Head Neck Surg. 2003;129(2):189–93.

    Article  PubMed  Google Scholar 

  14. Pieptu D, Luchian S. Loupes-only microsurgery. Microsurgery. 2003;23(3):181–8.

    Article  PubMed  Google Scholar 

  15. Spyriounis PK. Use of varioscope in free microvascular tissue transplants. Microsurgery. 2005;25(3):187–90.

    Article  PubMed  Google Scholar 

  16. Chen YX, Chen LE, Seaber AV, Urbaniak JR. Comparison of continuous and interrupted suture techniques in microvascular anastomosis. J Hand Surg [Am]. 2001;26(3):530–9.

    Article  CAS  Google Scholar 

  17. Alghoul MS, Gordon CR, Yetman R, Buncke GM, Siemionow M, Afifi AM, Moon WK. From simple interrupted to complex spiral: a systematic review of various suture techniques for microvascular anastomoses. Microsurgery. 2011;31(1):72–80.

    Article  PubMed  Google Scholar 

  18. Zhang L, Moskowitz M, Ostad D, Kessler K, Siebert JW. New four-stitch sleeve anastomosis: an experimental study in rats with reports of clinical use. Microsurgery. 1996;17(6):291–4.

    Article  CAS  PubMed  Google Scholar 

  19. De Boer B, Van Doormaal TP, Van Der Zwan A, Tulleken CA, Regli L. Towards sutureless non-occlusive cerebral revascularization. J Neurosurg Sci. 2011;55(2):117–25.

    PubMed  Google Scholar 

  20. Zeebregts CJ, Kirsch WM, van den Dungen JJ, van Schilfgaarde R, Zhu YH. Evolution of staples and clips for vascular anastomoses. Int Surg. 2004;89(3):152–60.

    PubMed  Google Scholar 

  21. Barker EV, Enepekides DJ. The utility of microvascular anastomotic devices in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg. 2008;16(4):331–4.

    Article  PubMed  Google Scholar 

  22. Wolf-de Jonge IC1, Beek JF, Balm R. 25 years of laser assisted vascular anastomosis (LAVA): what have we learned? Eur J Vasc Endovasc Surg. 2004;27(5):466–76.

    Article  CAS  PubMed  Google Scholar 

  23. Bas L, May Jr JW, Handren J, Fallon J. End-to-end versus end-to-side microvascular anastomosis patency in experimental venous repairs. Plast Reconstr Surg. 1986;77(3):442–50.

    Article  CAS  PubMed  Google Scholar 

  24. Lauritzen C. A new and easier way to anastomose microvessels. An experimental study in rats. Scand J Plast Reconstr Surg. 1978;12(3):291–4.

    Article  CAS  PubMed  Google Scholar 

  25. Chubb DP, Rozen WM, Whitaker IS, Ashton MW. Postoperative monitoring of microsurgical free tissue transfers for head and neck reconstruction: a systematic review of current techniques. Br J Oral Maxillofac Surg. 2009;47(7):574–5.

    Article  PubMed  Google Scholar 

  26. Chang LD, Buncke G, Slezak S, Buncke HJ. Cigarette smoking, plastic surgery, and microsurgery. J Reconstr Microsurg. 1996;12(7):467–74.

    Article  CAS  PubMed  Google Scholar 

  27. Howard MA, Cordeiro PG, Disa J, Samson W, Gonen M, Schoelle RN, Mehrara B. Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians. Plast Reconstr Surg. 2005;116(6):1659–68.

    Article  CAS  PubMed  Google Scholar 

  28. Mulholland S, Boyd JB, McCabe S, Gullane P, Rotstein L, Brown D, Yoo J. Recipient vessels in head and neck microsurgery: radiation effect and vessel access. Plast Reconstr Surg. 1993;92(4):628–32.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Maria Z. Siemionow MD .

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© 2015 Springer-Verlag London

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Siemionow, M.Z., Zor, F. (2015). Microsurgical Techniques in Reconstructive Surgery. In: Siemionow, M. (eds) Plastic and Reconstructive Surgery. Springer, London. https://doi.org/10.1007/978-1-4471-6335-0_1

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  • DOI: https://doi.org/10.1007/978-1-4471-6335-0_1

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  • Print ISBN: 978-1-4471-6334-3

  • Online ISBN: 978-1-4471-6335-0

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