Journal of microsurgery最新文献

Of 30,000 men examined for impaired fertility from 1964 to the present, 900 were diagnosed as having excretory azoospermia. Of this number, 465 underwent surgery. Epididymovasostomy was performed on 316 men. For 11 years, this surgery was done with surgical loupes, and a patency rate of 48% was achieved in those men undergoing bilateral epididymovasostomy. (Only 52% of our patients showed inflammatory obstruction.) In a small series of patients undergoing the procedure under the operating microscope, a patency rate of 75% was achieved. Vasovasostomy was performed in 20 patients with loupes and splints. Patency was obtained in 11 of the 17 that were followed. Ten of 12 patients receiving anastomosis by a technique placing nonabsorbable sutures through the entire wall of the vas became fertile. Nine of 10 patients who were operated on by a double-layer technique under the operating microscope were found to have patent ducts at follow-up. The advances in microsurgical techniques, equipment, and suture materials have considerably improved the changes for refertilization.

There are different opinions concerning the benefits of oblique anastomosis and stripping of the adventitia before microvascular anastomosis. For clarification of this question, microvascular anastomoses by different techniques were performed in the aortas and the femoral arteries of 80 female Wistar rats. The average diameter of the aortas in these rats was 1.4 mm, and the average diameter of the femoral arteries was 0.7 mm. The following procedures were carried out: transverse division of the vessel and end-to-end anastomosis; transverse division of the vessel with adventitial stripping of the ends before end-to-end anastomosis; oblique division of the vessel and end-to-end anastomosis; oblique division of the vessel with adventitial stripping before anastomosis. Forty of the animals were sacrificed after 5 hours, and the remaining 40 animals were sacrificed after 3 weeks, and histologic studies were performed. All anastomoses performed on the aorta were patent at the 5-hour follow-up. The 3-week follow-up showed no differences between the transverse anastomoses both with and without adventitial stripping, but there was an accumulation of false aneurysms in the groups with oblique anastomoses and adventitial stripping. In the animals that received femoral artery anastomoses, 80% of the transverse anastomoses without adventitial stripping were patent after 5 hours of 3 weeks. The animals that received oblique anastomoses without stripping had patent vessels after 3 weeks, but there was a significant accumulation of false aneurysms in the two groups that received adventitial stripping. As this study demonstrates, the patency rate of microvascular anastomoses in vessels less than 1 mm in diameter cannot be improved significantly by oblique division with or without adventitial stripping. In addition, adventitial stripping was followed by a high percentage of false aneurysms.

An operative method for lumbar microdiscectomy in rats is described in general terms so that it may be adapted to any microsurgical laboratory. The operation may be used as an advanced exercise in microsurgery, or to prepare surgeons for clinical lumbar microdiscectomy surgery.

Hemodynamic studies were carried out on a series of rats undergoing heart-lung transplantation according to the technique of Sun Lee. The results suggested a new hypothesis of blood circulation in the heart-lung block by demonstrating the lack of necessity for the venovenous anastomosis. A new technique, with just one aortoaortic anastomosis, was therefore evaluated. Its value and reliability in a series of 30 rats are discussed.

The optical principles of the Zeiss OPMI 1, 6-S, and 7 P/H operating microscopes are discussed, along with standard and fiberoptic illumination systems and the range of currently available support systems.

Microsurgical techniques were used to anastomose the femoral artery and vein of anesthetized rats to the ciliary artery and internal ophthalmic vein of isolated extracorporeal canine eyes. Microscopic inspection and fluorescein angiography appeared to show early patency of the anastomoses. The application of such an experimental model are discussed.

During the removal of subcutaneous fat 4 months after free groin flap transfer in a 25-year-old male, the anastomosed artery was also removed for histologic examination. The removal of the artery did not impair flap viability. The considerable narrowing of the arterial lumen caused by extensive hyperplasia of the intima suggested a restriction of arterial function. In addition, the internal elastic membrane had disappeared or was partially intact, doubled, and fragmented. Where sutures were tight, necrosis of the media was found, with heavy scar formation. If the sutures were loose, the media remained intact. The tissue of the flap artery was more heavily altered than the tissue of the recipient artery. This was evidently the result of trauma incurred during preparation of the flap vessels. Functional restriction of the anastomosed artery and secondary flap revascularization apparently occurred in a temporally favorable relationship in this case.

The technical details of a new procedure for the simultaneous transplantation of the spleen and the heart in rats are described. One hundred sixty-four such twin grafts from LEW to ACI rats and vice versa were performed. Seventeen animals were followed postoperatively without additional immunologic manipulations. There is a definite change in rejection pattern in terms of timing as well as intensity when heart and spleen twin grafts are compared with single cardiac grafts. A delay and mild form of rejection of twin grafts were observed especially in the strain combination of LEW to ACI. No graft-versus-host reaction occurred. There was no perfect correlation of the cardiac and splenic allografts in regard to their survival time. When the cardiac allograft arrested, however, the spleen was found to be rejected as well in all cases. In three cases a selective survival of the heart over the spleen was observed. Thus, the cardiac allograft can be used as a simple but not completely reliable indicator of the functional state of both grafts.

The operating microscope is now an essential tool for a large number of surgical procedures in a wide range of disciplines. At many medical centers, the optical equipment is often shared by surgeons from several disciplines. The expansion of microsurgical interest will continue to be interdisciplinary in the future, and this will call for microscope systems that are sufficiently versatile, both optically and mechanically, to meet the needs of surgery on a wide variety of anatomic structures. The development of the current range of microsurgical procedures in otolaryngology is presented to illustrate the concept of versatility by demonstrating the expansion of microsurgical technique to many regions of the head and neck. The key to this versatility has been the interchangeable objective lens system (200-400 mm), which allows a working distance appropriate to the depth of the various surgical approaches and which also allows the free transfer of microsurgical skills and instrumentation to new procedures.