Microvascular free tissue transfers.
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Biomedical subjects
Publications and source records attributed to K Harii.
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The perfection of micro-suture of small vessels has enabled trnasplantation of various large composite tissues by anastomosing their nutrient vessels directly to suitable vessels in the recipient site. Among them, the so-called free skin flap has many advantages over the conventional flap methods for covering the complicated defects of the skin and subcutaneous tissues. In this paper, the author introduces the representative free skin flaps on the basis of his 300 clinical free flap experiences.
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In the field of reconstructive surgery, the greater omentum has been used as a transposed flap for the treatment of chronic lymphedema, radionecrosis, and so forth. Its transferable range was limited by the length of its pedicle. Microvascular anastomosis allows for free transplantation of this organ and has vastly expanded its usefulness.
Experience with a surgical technique of microvascular anastomosis for free tissue transfers and digital replantations has been applied in 184 cases, and demonstrates that complications such as total flap necrosis are avoidable by experience and technical skill.
A successful free groin flap transfer to the arm in a 3-month-old baby is described. The vessels were large enough for microvascular anastomosis and we believe that there is no minimum age restriction for free flap transfer.
We report the transfer of a free musculocutaneous compound flap, including the gracilis muscle, in one stage by microvascular surgery. The advantages of this free flap are discussed.
Since 1973 we have transferred various kinds of free flaps by microvascular surgery. In hand reconstruction, the free flap is less often required than in repairs of other sites, such as the leg. However, the importance of restoring sensibility in the hand is evident. Recently, we have transferred thin dorsalis pedis flaps as sensory free flaps in 5 cases of hand reconstruction, and we describe our experiences with them.
Free omental transplantation with vascular anastomosis was attempted in three clinical cases as a new method of treatment for chronic osteomyelitis. The bone cavity produced by debridement was completely eliminated by the transplanted omentum. Furthermore, the omentum, because of its biological characteristics, formed good vascular anastomoses with the adjacent bone tissue. Although sufficient time has not yet elapsed to prove the existence of healthy bone regeneration and therefore, further evaluation for a longer period is necessary, this therapeutic method would seem to have considerable potential in the treatment of chronic osteomyelitis.
In this article we have described general considerations relative to free flap transfers, introduced our operative technique of free flap transfers and outlined some of our representative cases. We also set forth the advantages and disadvantages of free flap transfers as we have experienced them.
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