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Introduction : During the past decades, free flaps have been given a central role in the reconstructive surgery. Especially in the extremities, where there is a scarcity of available tissues for local flaps, free flaps play a central part. The aim of this study was to evaluate the risk factors contributing to partial and total flap failure.Patients and methods : In a retrospective cohort study, all data concerning patients who underwent free flap reconstruction of the extremities during the first five years since the founding of the department of plastic surgery were gathered. Patient- and surgery-related risk factors were analyzed in correlation to the postoperative complications.Results : In total, 182 free flaps were included in this study. Partial and total flap failure were noted in 21.42% and 17.03%, respectively. A correlation was seen between the time lapsed from debridement until flap coverage, with flaps performed between day 4 and 14 having the least quote of flap failure (p=0.022). Gender, age, arterial hypertension, nicotine abuse, diabetes mellitus, peripheral arterial disease and the number of anastomosed veins were not significantly associated with free flap failure. Conclusion : Our study showed that free flaps can be safely performed in healthy patients as well as in patients with risk factors, with an acceptable flap loss rate. Randomized controlled studies are needed to clarify the exact role of each risk factor in free flap surgery., Einleitung : Während der letzten Dekaden erhielt die freie Lappenplastik eine Hauptrolle in der rekonstruktiven Chirurgie. Insbesondere an den Extremitäten, mit begrenzt verfügbarem Gewebe, haben freie Lappenplastiken eine besonders wichtige Funktion. Das Ziel unserer Studie war, die Risikofaktoren für einen partiellen oder kompletten Lappenverlust zu evaluieren.Patienten und Methoden : In einer retrospektiven Kohortenstudie wurden die Daten von allen Patienten gesammelt, welche eine freie Lappenplastik innerhalb der ersten fünf Jahre seit der Gründung unserer Abteilung erhielten. Patienten- und Chirurgie-bezogene Risikofaktoren wurden bezüglich der postoperativen Komplikationen untersucht.Ergebnisse : Insgesamt wurden 182 freie Lappenplastiken in diese Studie eingeschlossen. Ein partieller Lappenverlust trat bei 21,42%, ein kompletter bei 17,03% auf. Die Zeitspanne von Débridement bis zum Tag der Deckung mittels freier Lappenplastik stellte einen statistisch signifikanten Risikofaktor für den Lappenverlust dar (p=0.022). Die Lappenplastiken, die zwischen Tag 4 und 14 operiert wurden, zeigten die geringste Verlustquote. Geschlecht, Alter, arterielle Hypertonie, Nikotinabusus, Diabetes mellitus, periphere arterielle Verschlusskrankheit sowie die Anzahl der anastomosierten Venen waren nicht signifikant mit dem Lappenverlust assoziiert. Schlussfolgerung : Unsere Studie zeigt, dass freie Lappenplastiken sicher und mit einer akzeptablen Lappenverlustratte sowohl bei Gesunden als auch bei Risikopatienten durchgeführt werden können. Randomisiert kontrollierte Studien sind zukünftig notwendig, um die genaue Rolle jedes Risikofaktors festzustellen.

INTRODUCTION: Despite hundreds of training models for microsurgery being available in the literature, very few of them are scientifically validated. We chose to validate our low-fidelity training model on flower petals by comparing it head-to-head with a moderate fidelity training model, the anastomosis on chicken leg femoral artery. MATERIALS AND METHODS: A total of 16 participants of different levels of expertise were randomized into 2 groups, 1 training on flower petals and 1 on chicken leg femoral arteries. The groups were evaluated on performing a rat femoral artery anastomosis using the validated Stanford Microsurgical Assessment (SMaRT) Scale. The Mann-Whitney U test was used to check for statistically significant differences between the groups. The flower petal sutures were also evaluated and Pearson correlation was used to check for associations between better petal anastomosis scores and better final SMaRT results. RESULTS: After 6 weeks of flower petal training, microsurgical trainees had significantly better overall SMaRT scores than trainees using chicken leg training, better fine tissue feeling, and better scores in knot tying. The anastomosis times for the rat

We report a case of aorto esophageal fistula (AEF) with delayed esophageal reconstruction employing microvascular anastomosis. We demonstrate here that our method is useful for delayed esophageal reconstruction following AEF.

We report a case of aorto esophageal fistula (AEF) with delayed esophageal reconstruction employing microvascular anastomosis. We demonstrate here that our method is useful for delayed esophageal reconstruction following AEF.

生体内で分解・吸収するリングを開発し,このリングを用いて血管吻合を行い,開存率や血管の組織学的変化を調査した。リングの材料は乳酸とグリコール酸の共重合体(70:30)で,リングは外径3mm,厚さ1mmの円盤に直径1mmの穴を開けたもので,これに6本のステンレス製ピンが等距離に埋め込まれており,そのピンの問にピンが入り得る程度の穴が6個開いたものである。このリングを用いて,兎の大腿動脈27本を吻合し,電磁血流計で血流量を測定した。吻合した血管を術後1週,2週,6週,30週で再度露出し,開存状態を調べ血流量を測定したのち採取し,光顕と走査電癖で観察した。リングは6週から吸収され始め, 30週で完全に吸収されていた。血管は27例中24例開存していた(開存率89%)。血流量の時間的変化はなかった。術後2週で吻合部の血管壁は正常の約40%に菲薄化していたが,術後30週で正常の厚さに回復していた。術後30週で,内弾性板は一部再構築され,吻合部でのみ不連続となっていた。走査電顕所見では,術後30週で吻合部の内腔は平滑となり,内皮細胞で完全に被覆されていた。我々の開発した生体内で分解・吸収されるリングによる血管吻合は,従来の非吸収性リングによる血管吻合の欠点を補う極めて有用な方法と考えられた。, Purpose: The purpose of this study was to analyze patency and determine histology of vessels anastomosed using an absorbable ring device. Materials and Methods: We used an L-lactic acid/glycolic acid (70/30 mole %) copolymer as the material for our absorbable ring device. The internal diameter of the rmg was 1.0 mm, and the ring had six stainless steel pins and six holes alternately placed. The device was used to perform an anastomosis in the femoral artery of 27 rabbits. Anastomosed vessels were assessed for patency using an electromagnetic flowmeter. Anastomosed vessels were harvested for mstologic evaluation by light and scanning electron microscopy at 1, 2, 6 and 30 weeks. Results: The rmg was completely absorbed at 30 weeks, with a patency rate of 89% (24/27). No statistically significant difference was recorded between preoperative and postoperative arterial volumetric flow. At 2 weeks, the thickness of the vessel wall inside the device was only about 400f normal, but the thickness had returned to normal by 30 weeks; the internal elastic lamina was not reconstituted. Scanning electron microscopy demonstrated no depression at the anastomotic site at 30 weeks. Conclusion: We have developed a new absorbable ring device to perform vascular anastomoses which may solve some problems associated with rigid rings., 広島大学医学雑誌, 43(1), 65-75, 平7-2月(1995), 広島大学(Hiroshima University), 博士(医学), Medicine, doctoral