The advent of microsurgical tissue transfer including replantation greatly has expanded the scope of reconstructive surgery. This chapter describes the surgical techni- que of microvascular anastomosis, and the management of patients undergoing vascu- larrised free tissue transfer reconstruction of the head and neck. microsurgery became more prevalent and experi-ence with free tissue transfer mounted, the success rates of microvascular procedures also climbed, to >90% today (Table 1). His clinical research studies the anatomy of microsurgical approaches and clinical outcomes of microsurgery for aneurysms, AVMs, and bypass surgery. Le montage et démontage du clamp étaient chronophages. Raw image data of the macular cross were used to compute phase retardation maps associated with Henle fiber layer. 15,000 peer-reviewed journals. Atroshi I, Gummesson C, Johnsson R, McCabe SJ, Ornstein E. Severe carpal tunnel syndrome potentially needing surgical treatment in a general population. This large sample size demonstrates systematic changes to the central cone photoreceptor morphology using scanning laser polarimetry. Antithrombotic drugs, such as heparin, have been used in the clinics for a long time. It is our experience, and indeed was also reported previously, that high … The anastomosis was performed in good conditions. The patency rate in the heparin group was 95% (19 of 20) at 24 hrs and 80% (16 of 20) at 7 days. This article reviews major pharmacologic modalities of anticoagulation, delineates the mechanism of action and study of efficacy of each agent, and compares the risks and benefits of popular anticoagulation therapies. Then she went back to Massachusetts for a year for boarding school. La taille des incisions des lambeaux musculaires libres est souvent très grande, source d’adhérences profondes et de cicatrices inesthétiques. Une revue de la littérature effectuée sur la base de recherche PUBMED a permis d’identifier les articles étudiant les bénéfices de l’héparine peropératoire sur la survie des lambeaux libres. Degenerative histology and apoptosis scores were significantly better in groups to which BoNT-A and SD were applied 1 or 7 days before the ischaemia/reperfusion cycle. Although the clotting mechanism prevents injured tissues from bleeding, it can be disruptive to a microvascular repair - inhibiting blood flow and promoting flap failure. There are few recent innovations in anticoagulation therapies for microsurgery, however, and anastomotic thrombosis remains an occasional cause of surgical failure. A routine microanastomosis was done with one of seven irrigation solutions employed in the study. 2002;22(8):397-398. Dr. Tsai has more than 130 publications to his credit and is actively engaged in research at the Christine M. Kleinert Institute for … But it is justified by performing the microsurgical step comfortably. Copy and paste the desired citation format or use the link below to download a file formatted for EndNote. Chez l’animal, 9 articles sur 11 ont montré une amélioration du taux de survie des lambeaux grâce au flush des vaisseaux par du sérum hépariné avant la fin de la réalisation de l’anastomose micro-chirurgicale. Three-dimensional (3D) high definition (HD) video systems are changing microsurgical practice by providing stereoscopic imaging not only for the surgeon and first assistant using the binocular microscope, but also for others involved in the surgery. 240-248, A comparison of irrigation solutions for microanastomoses, A new microsurgical research model using Thiel-embalmed arteries and comparison of two suture techniques, Treatment of pectoralis major flap myospasms with botulinum toxin type A in head and neck reconstruction, Foveal phase retardation changes associated with normal aging, Vascular microanastomosis through an endoscopic approach: Feasibility study on two cadaver forearms, The learning rate in three dimensional high definition video assisted microvascular anastomosis in a rat model, The effect of surgical and chemical denervation on ischaemia/reperfusion injury of skeletal muscle. Finally, it examines available human outcomes–based data and attempts to provide a glimpse of the future direction of microsurgical anticoagulation research. Comparable learning rates for anastomosis time were demonstrated for novice microsurgeons and modified OSATS scores did not differ between the different viewing technologies. 61A: (1979) 98-104 37. LMWH-DOCA conjugate was orally administered prior to and after operation for 5 consecutive days. The intima of crushed artery was impaired and thrombus formation was examined in the control group. Grahaam3 mentioned a third concern: discomfort of the nose. Copyright © 2021 Elsevier B.V. or its licensors or contributors. AAOS Symposium on Microsurgery Practical Use in Orthopaedics (1979) C. V. Mosby St. Louis 36. Require these words, in this exact order. Quinze articles ont été retenus en recherche animale ou chez l’homme. The anastomosis lasted 2 hours under insufflation without any leak. Presented at the Sixteenth Annual Meeting of the American Association of Hand Surgery, Los Angeles, California, October 24, 1986. We dissected the donor limb and the recipient's arm simultaneously to identify anatomical structures. In the LMWH group, the patency rate was 71% (10 of 14) at both 1 and 7 days. Advancements in microsurgery have made lower extremity reconstruction possible even after major soft tissue loss or tibial nerve disruption. The antebrachial skin was detached then distended by gas insufflation. I have a very difficult case and I have full confidence he can make them perfect ! However, the preliminary results of four trials seem to provide positive arguments for this practice. Tsai-Lung Tsai DO . 389-395, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 65, Issue 2, 2012, pp. No statistically significant difference was found between the effects of Ringer's lactate and normal saline. Only two of the 11 patients required two additional BTX-A sessions. Tsai is a niece of restaurateur Ming Tsai. The stricture rate was higher with HM than with SI (60% vs. 35% surface area reduction). In the experimental groups, BoNT-A was applied 1 day, 7 days and 30 days before the ischaemia/reperfusion cycle. https://doi.org/10.1016/0363-5023(88)90195-5. He is the principal investigator for the Brain Vascular Malformation Consortium, a NIH-funded multi-centre group studying the genetics and clinical course of rare vascular diseases of the brain. The use of systemic per-operative heparin (intravenous injection) does not improve the survival of free flaps in either animal models or humans. The size of the incisions for free muscle flaps is often very large, and a source of deep adhesions and unaesthetic scars. The office was beautiful and staff was so welcoming, Can't wait to come back and have the surgery." Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals. L’artère était disséquée (radiale ou ulnaire) et le clamp démontable était introduit par un trocart sous la peau, puis installé sur l’artère qui était sectionnée. It’s your single place to instantly L’anastomose était réalisée dans de bonnes conditions. The material consisted of two cadavers, a telemanipulator, and a vascular clamp. No consensus exists on the ideal anticoagulation protocol for microsurgery. Whether you need a routine eye exam for eyeglasses or contact lenses, a medical eye exam for diabetes or other health-related issues and medications, cataract or oculoplastic surgery, eyelash enhancement with Latisse, or Botox injections, you will find excellence here. PDF | Mangled hands are a severely injured condition that is a rare and challenging problem for reconstructive surgeons. 136-140, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 69, Issue 11, 2016, pp. Annular regions of interest ranging from 0.25° to 3° eccentricity and centered on the fovea were used to generate intensity profiles from the phase retardation data, which were then analyzed using sine curve fitting and Fast Fourier Transform (FFT). Readers are referred to the open access atlas chapters on vascularised free fibula As regards systemic intra-operative heparin, on the other hand, only two trials out of four yielded favorable results. The control group had the worst scores in all experiment parameters. Heparinized saline produced significantly less damage to the medial layer and less platelet cell deposition. Parmi ces molécules on retrouve l’héparine, un anti-coagulant utilisé couramment en pratique clinique. The rationale for hand transplantation. 2263-2272, Chirurgie de la Main, Volume 32, Issue 3, 2013, pp. A routine microanastomosis was done with one of seven irrigation solutions employed in the study. Reste à réaliser le premier cas clinique, par exemple sur un lambeau de grand dorsal (latissimus dorsi). Four incisions, 1 cm each, allowed the insertion of four trocarts connected to the telemanipulator. Ischaemia was created by a tourniquet strictly wrapping the right lower extremity for 4 h. After ischaemia, the tourniquet was cut, and the extremity was reperfused for another 4 h. In the experimental groups, surgical denervation was applied 1 day, 7 days and 30 days before the ischaemia/reperfusion cycle. These agents have been used clinically for several years. The vascular anastomosis was performed with the use of a 10/0 nylon suture. It is intricate and challenging, and there is always something different every day! The purpose of this study was to evaluate the potential to replace the binocular microscope for microarterial anastomoses and assess the rate of learning based on surgeons' experience. 3.5) for most procedures. London-based jewellery brand inspired by Taiwanese heritage: classic unique minimalist designs with natural semi-precious gemstones set on sterling silver or rosegold. Recently topical antithrombotic administration has been suggested as an alternate approach to local anticoagulation. The authors report their experience using botulinum toxin (BTX-A) injections as a treatment of PM flap myospasm complications in head and neck reconstruction. Author information: (1)Department of Hand and Reconstructive Microsurgery, National University Hospital, Lower Kent Ridge Road, Singapore, Singapore, stevenjlo@gmail.com There are very few reports in the literature … All microsurgeons reported improved comfort for the 3D HD video system but found the image quality of the conventional microscope superior, facilitating technical ease. Il n’existe pourtant pas de consensus sur son utilisation en microchirurgie, que ce soit sur le moment de son introduction (pré-, per- ou postopératoire), la durée ou encore la dose d’utilisation. The animals were divided into five groups: one control group and four treatment groups which received varying concentrations of heparin and hirudin. Studies should be conducted to decide whether or not to validate a rather ritualistic practice that consists in irrigating the relevant vessels before anastomosis; does it or does it not improve the patency rate? over 18 million articles from more than Quatre incisions d’1 cm permettaient d’installer quatre trocarts reliés à un télémanipulateur. We have successfully evaluated all outcomes. Lauren Tsai was born on February 11, 1998 in Wellesley, Massachusetts, to a Taiwanese-American father and a European-American mother, and has two older sisters. e23-e28, Vision Research, Volume 51, Issues 21–22, 2011, pp. Elle est justifiée pour réaliser le temps microchirurgical confortablement. On the other hand, when the dosage of LMWH-DOCA was reduced to 1 mg/kg, its efficacy on anastomosis was not as efficacious in terms of patency. The effect of an orally active low molecular weight heparin (LMWH) derivative conjugated with deoxycholic acid (DOCA) on the patency of anastomosis of the crushed rat artery was investigated, expecting its antithrombogenic effect. Clotting times such as ACT, PT and APTT performed on samples drawn one hour after drug administration were within the normal ranges for both the control and the treatment groups. that matters to you. In order to avoid such complications, topical administration of antithrombotic drugs may be an ideal route of administration. The present study demonstrates the potential of 3D HD video systems to replace current binocular microscopes, offering qualitatively-equivalent microvascular anastomosis with improved comfort for experienced microsurgeons. She earned her medical degree from Northeast Ohio Medical University in Rootstown, Ohio. In this study, low molecular weight heparin (Certoparin, Sandoz) was topically administered in a rabbit ear arterial crush-avulsion thrombosis model and compared with heparin. With similar experimental outcomes, denervation with BoNT-A can be preferred to surgical denervation because of its abundant clinical availability and it can be applied without any secondary surgery. Scanning electron microscopy revealed the different extent of the clots on the injured intimal surfaces of the vessels in different groups. The HM microvascular suture is a promising technique that requires further in vivo validation. Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place. In addition t… The assembling and disassembling of the clamp were time consuming. He is affiliated with Franciscan Health Mooresville, Community Hospital South, and Franciscan Health Indianapolis. Tsai's family moved to Honolulu, Hawaii when she was seven years old. DeepDyve's default query mode: search by keyword or DOI. Top special gift idea: … Pour la diminuer, le but de ce travail était d’étudier la faisabilité de microanastomoses vasculaires par voie endoscopique. discover and read the research However, prolonged anastomosis times were required when using the novel 3D-HD system rather than direct binocular vision. To assess the utility of the Thiel arterial model in microsurgical research, we compared interrupted horizontal mattress (HM) sutures to simple interrupted (SI) sutures in human vessels. Que ce soit chez l’homme ou l’animal, l’utilisation d’héparine systémique (injection intra-veineuse) en peropératoire n’améliore pas la survie des lambeaux. The results suggest that topical administration of LMWH prevents the occurrence of thrombosis at the traumatic anastomosis site to a similar degree as heparin. In the saline control group, the vessel patency rate was 17% at 24 hrs and 13% at 7 days. A higher patency rate at 7 days was obtained in groups treated with high concentration of heparin and hirudin. causing an extremely sweaty head and allergic reactions.3 A type of suspension system with a safety pin attached, Microsurgery To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you don’t already have one. However, image quality was rated inferior with the 3D HD system resulting in prolonged anastomosis times. L’anastomose durait deux heures sous insufflation, sans fuite. Published by Elsevier Inc. All rights reserved. As all 11 patients refused a second surgery, they were offered BTX-A injections. The International Microsurgery Club (IMC) is a comprehensive social media-based platform that facilitates sharing of technical experience and advice among international microsurgeons, discussion of interesting cases, online paper-writing collaborations, and promotion of microsurgery … Microsurgery practice manual. In the control group, only the ischaemia/reperfusion cycle was applied. This study quantified normal age-related changes to the photoreceptor axons in the central macula using the birefringent properties of the Henle fiber layer. . Lo S(1), Sebastin S, Tsai L, Pin PY. By continuing you agree to the use of cookies. Select data courtesy of the U.S. National Library of Medicine. A microsurgical set-up using an operating microscope and Thiel-embalmed arteries was used to practice ten SI and HM anastomoses. Eleven of them reported muscle twitching as a post-operative complication and are therefore included in this study. Zuker2 also talked about two significant problems associated with the use of loupes: slippage of the glasses towards the tip of the nose, and postauricular pain. The rabbit ear arterial crush-avulsion thrombosis model was used in this study. Dr. Ben Tsai, MD is a colorectal surgeon in Indianapolis, Indiana. Vessel patency, leak and stricture were evaluated using angiography, and vessel wall architecture was evaluated using light microscopy and scanning electron microscopy (SEM). In the first stage, the effect of surgical denervation was investigated in four groups each containing six rats. LMWH-DOCA was potentially useful for improving the patency in compromised vessels after microsurgery. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. 2018, Annales de Chirurgie Plastique Esthetique, 1997, Journal of Hand Surgery: European Volume, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 67, Issue 3, 2014, pp. On the sixth day of operation, the patency of the anastomosed artery was evaluated. Chez l’homme, il n’existe pas d’essai prospectif contrôlé randomisé étudiant l’action topique peropératoire du sérum hépariné pour le rinçage des vaisseaux des lambeaux libre ex-vivo en ischémie froide avant reperméabilisation vasculaire. The technique speed was also assessed. However, there exists no consensus on its use in microsurgery as concerns time of introduction (pre-, intra- or post-operative), recommended dosage, or duration of utilization. Nevertheless, all the arteries in each group remained patent 4 days after rinsing. Dr. Louis C Tsai is a Diagnostic Radiology Specialist in Bronx, New York. Another tool in microsurgery: Tsai loupes. Anticoagulation in microsurgery . The patency rate of lactated Ringer's solution (10%) (the control solution) was compared with solutions of heparin (35%) urokinase (50%), phentolamine (35%) tissue plasminogen activator (tPA) (15%), a combination of urokinase, heparin, and phentolamine (55%), and a combination of tPA, heparin, and phentolamine (42.5%). A surge in interest lately for the use of local flaps as the solution when a vascularized flap is indicated for lower extremity reconstruction, presumably to avoid the risks of microanastomotic failure or technical challenges, should not obscure the fact that free flaps will still always sometimes be needed. This group of patients was followed up at regular intervals with clinical examinations, digital photography, range of motion (ROM) of the neck in different vectors, and neck disability system (NDS) questionnaires. Bookmark this article. Nos résultats démontrent la faisabilité de microanastomoses vasculaires par voie endoscopique. In clinical research in humans, there has been no prospective randomized trial studying the action of topical intra-operative heparin in vessel irrigation of ex-vivo free flaps before vascular repermeabilisation. Do not surround your terms in double-quotes ("") in this field. The phase retardation changes in the central macula indicate structural alterations in the cone photoreceptor axons near the fovea as a function of age. Katsarma E, Tsai TM. You can see your Bookmarks on your DeepDyve Library. Vasospasm is a phenomenon that can complicate microsurgery. Lignocaine 2% was found to be extremely damaging to the whole vessel wall, and highly thrombogenic. Various innovations have been described by surgeons in order to resolve the pressure in these areas. A number of pharmacological agents have been tested in order to enhance the patency of microvascular anastomosis and so to as extend the survival of free flaps. For FFT analysis, the 2f amplitude, as well as the 4f, were normalized by the remaining FFT components. Tsai-Lung Tsai is an experienced and diligent hand surgeon serving the community of Monroe, NY. J Hand Surg Am. A 36-year-old man underwent preoperative chemotherapy and wide excision for a malignant soft tissue tumor around the knee joint. En recherche fondamentale, sur les modèles animaux, l’utilisation peropératoire d’héparine topique (irrigation des vaisseaux) améliore le taux de survie des lambeaux libres en diminuant le taux de thrombose au site de l’anastomose. Abstract Heparin is commonly included in the irrigation solution used during microvascular surgery. Specialties: Hand Surgery, Orthopedic Surgery. The failure rate of free flaps is approximately 5%, mostly due to thrombosis of microvascular anastomosis. He is affiliated with Franciscan Health Mooresville, Community Hospital South, and Franciscan Health Indianapolis. The office maintains state-of-the-art equipment, including digital X-rays, intraoral cameras, and the newest Zoom whitening technology. A systematic review on the PUBMED database enabled us to identify articles evaluating the benefits of intra-operative heparin with regard to free-flap survival. To save an article, log in first, or sign up for a DeepDyve account if you don’t already have one. The main difficulties were caused by a long suture and a very fragile needle. Karen Stewart. The next step is to perform the first clinical case for example on a latissimus dorsi free muscle flap. Enjoy affordable access to In the saline control group, the patency rate was 19.23% at 24 hrs and 15.38% at 7 days. Les difficultés principales ont été causées par un fil trop long et une aiguille trop fragile. . These changes result in either fewer cone photoreceptors in the central macula, or a change in the orientation of their axons. This allows for highly precise movement in narrow and difficult-to-access spaces, and subsequently opens the door for minimally invasive surgery (Figure 1). They were placed on your computer when you launched this website. Dr. Ben Tsai, MD is a colorectal surgeon in Indianapolis, Indiana. Hirudin is a new antithrombotic agent and is reported to be much more powerful than heparin on a gravimetric basis. The medication of oral LMWH-DOCA conjugate has been vetted in microvascular anastomosis of the crushed artery. From January 2005 to May 2009, 83 patients underwent PM flap reconstruction. Les deux artères ont été repérées, puis disséquées sans difficulté. He is a Fellow in the American Academy of Orthopaedic Surgeons, holds memberships in the American Society for Reconstructive Microsurgery and the International Society of Reconstructive Microsurgery, and is an active member of the American Society for Surgery of the Hand. Doesn't seem to want to take time & interest in patient. She is very vague about diagnosis. On the second stage, the effect of chemical denervation with botulinum toxin type-A (BoNT-A) was investigated in three groups, each containing six rats. La peau antébrachiale a été décollée, puis distendue par insufflation de gaz. Thrombogenic occlusion, at the anastomotic microvessels, contributed impaired blood flow to flap failure. Tsai Ing-wen (born 31 August 1956) is a Taiwanese politician and academic serving as the seventh president of the Republic of China (Taiwan), since 2016.A member of the Democratic Progressive Party, Tsai is the first female president of Taiwan.She has served as Chair of the Democratic Progressive Party (DPP) since 2020, and previously from 2008 to 2012 and 2014 to 2018. Low molecular weight heparins (LMWHs) are antithrombotic drugs composed of lower molecular weight components of heparin with an apparent molecular weight in the range of 4.0–8.0 KDA. A scanning laser polarimeter was used to acquire 15° × 15° macular images in 120 clinically normal subjects, ranging in age from the third decade to the eighth. A comparative study of irrigating solutions that contained various clot-active substances and/or vasodilating substances was done using a crush injury model of the rat's femoral artery. Femoral artery of rats has been one of the most widely used tools for practice and experiment of anastomosis of small vessel under the microscope.It also provides a perfect model for the study of the prevention of thrombus formation after microanastomosis [17,18].Result of the microvascular surgery is highly sensitive to various factors. Two of the anastomosed artery was impaired and thrombus formation was examined in central... Btx-A injections exists on the sixth day of operation, the preliminary results of four seem! 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Cross were tsai solution microsurgery to compute phase retardation maps associated with Henle fiber layer un clamp démontable. To resolve the pressure in these areas PubMed, and completed his internship at Rowan University in,... And normal saline layer and less platelet cell deposition read the research that matters to you not improve the of. Relieved by topical application of fasudil hydrochloride for improving the patency rate was 17 % at days... That significantly reduces the PM muscular contraction in head and neck reconstruction have hardly been investigated ideal anticoagulation for. Result in either fewer cone photoreceptors in the clinics for a malignant soft tissue loss or tibial nerve disruption cette!, it examines available human outcomes–based data and attempts to provide a full range of services to all! 24, 1986 our previous studies to avoid bleeding complications observed with administration. 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