Reconstructive Microvascular Surgery

ISBN-13: 9783642684562 / Angielski / Miękka / 2011 / 151 str.

E. Biemer; W. Duspiva; M. Soutar

Opis

For many years, the operative manipulation of the most minute struc tures was frustrated by the limitations of the human eye. With the introduction of the operating microscope by Nylen (1921), fine detailed anatomy was made visible, so that structures could be prepared, pre sented and manipulated. Nylen used the microscope for treating dis eases of the middle ear. In 1946 Perrit in the U. S. A. introduced the operating microscope into the field of ophthalmic surgery. In 1964, Smith, Kunze and Mitchen published reports on their clinical experi ence using the operating microscope in nerve surgery. Using this tech nique, it was possible to divide a peripheral nerve into individual fascicle bundles and reapir each bundle precisely. Following on from these developments, the term" microsurgery" was introduced to cover that branch of surgery which was carried out using the" equiped" eye - either by using 10upe spectacle magnifica tion or, more commonly, the operating microscope. The term "micro vascular surgery" developed for the operative treatment of small ves sels below 2 mm in diameter. Experimental studies for the use of microsurgery in the clinical situation developed alongside its use on small research animals for transplantation models in immunological study. Microsurgical techniques were used in the transplantation of rat liver, kidneys, pancreas, heart and other organs. The clinical appli cation of these microsurgical techniques is nowadays called "recon structive microvascular surgery.""

Spis treści

1 Technique of Microvascular Surgery and Preliminary Experimental Studies.- I. Development of Microvascular Surgery.- II. Technical Equipment.- 1. Operating Microscope.- 2. Accessories and Documentation.- 3. Operating Seats.- 4. Instruments.- 5. Suture Material.- III. Experimental Microvascular Surgery.- IV. Suture Technique in Microvascular Surgery.- 1. Preliminary Remarks.- 2. End-to-End Anastomosis.- 3. End-to-Side Anastomosis.- V. Complications of Microvascular Suture.- 1. Assessment of Microvascular Anastomosis.- 2. Patency Test.- 3. Microthrombectomies.- 4. Micro-vein Grafts.- a) Indications for Micro-vein Grafts.- b) Donor Sites for Micro-vein Grafts.- c) Rules for Micro-vein Grafts.- VI. Micromorphological Evidence at the Site of Anastomosis in Small Vessels.- VII. Medical Prophylaxis and Treatment of Vessel Thrombosis and Spasm.- 1. Local Measures.- 2. Systemic Measures.- References.- 2 Clinical Microvascular Surgery.- A Replantation with Microvascular Anastomosis (micro-replantation).- I. Definitions and Nomenclature.- 1. Replantation.- 2. Amputation.- 3. Total Amputation.- 4. Subtotal Amputation.- 5. Revascularisation.- 6. Replantation: Macro- and Micro-replantation.- II. Classification of Amputations in the Hand.- III. Indications for Replantation.- IV. Guide-lines for the Primary Treatment of Amputation Injuries.- V. Replantation Technique.- 1. Wound Debridement.- 2. Bone Shortening.- 3. Osteosynthesis.- 4. Suturing of the Flexor Tendon and Tendon Sheath.- 5. Arterial Anastomosis.- 6. Nerve Suturing.- 7. Management of the Extensor Tendon Apparatus.- 8. Vein Anastomosis.- 9. Skin Closure.- 10. Dressings.- 11. Medicinal Treatment.- VI. Considerations of Differing Levels and Mechanisms of Amputation.- 1. Levels of Amputation in the Hand.- 2. Guillotine Amputations.- 3. Crushing Injuries.- 4. Severe Crushing and Combination Injuries with Damage to the Amputated Part.- 5. Avulsion Injuries.- 6. Degloving Injuries.- VII. Primary Replacement of Destroyed Phalangeal Joints.- VIII. Primary Finger Transplantation.- IX. Post-operative Management.- X. Physical Management.- XI. Secondary Operations.- XII. Results.- XIII. Microreplantation of Other Parts of the Body — (e.g., toes, ears, scalping injuries, and penile amputations).- XIV. Replantation Service.- B Tissue Transplantation with Microvascular Anastomosis.- I. Development of Tissue Transplantation Using Microvascular Anastomosis.- II. Definitions and Nomenclature.- III. Indications for Free Tissue Transplantation.- IV. Preparations for Tissue Transplantation.- V. Operating Technique.- 1. General Operative Plan.- 2. Medicinal Treatment.- 3. Post-operative Treatment and Supervision.- 4. Complications.- VI. Free Flap Transplantation.- 1. Development.- 2. Advantages and Disadvantages of Free Flap Transplantation.- 3. Special Requirements for Free Flap Transplantation.- 4. Donor Sites.- a) Groin Flaps (fat flap, iliac flaps).- b) Dorsalis Pedis Flaps (interdigital fold flap, toe pulp flap).- c) Delto-Pectoral Flap.- d) Temporal Flaps.- e) Axillary Flaps.- f) Retro-Auricular Flaps.- VII. Combined Skin and Muscle Flap Transplantation (musculo-cutaneous flaps).- VIII. Combined Skin Flap with Bone Transplantation (osteocutaneous flaps).- IX. Bone Transplantation.- X. Muscle Transplantation.- XI. Transplantation of the Omentum.- XII. Toe Transplantation.- References.