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At least 235 records · Page 13Linked to original sources
PubMed2004

[25 years review of vascular microsurgery evaluation--perspectives].

Free-tissue transfer has become an accepted method for reconstructing complex surgical defects. We review 25 years' experience of this approach. In France, microsurgery was first performed in 1974. I myself constructed 839 consecutive free flaps in 821 patients during a 25-year period. Here we distinguish between two different indications, namely malignant and benign lesions. In oncology, the patient recovers good quality of life even if the prognosis is poor. In contrast, the transplant offers permanent cure for patients with benign lesions. Microvascular anastomoses were constructed with separated stitches (90% of anastomoses); end-to-end anastomoses were preferred (85%). Manual suture with thread is the best technique. Post-operative flap monitoring included clinical observation, Doppler sonography, thermic probing, and endoscopy. The overall success rate of free flap reconstruction was 95.5%. In cancer patients, surviving flaps resulted in wound healing and did not delay post-operative irradiation or chemotherapy. The incidence of major complications (death 0.36%, necrosis 4.5%) and minor post operative complications (27.1%) was acceptable. The mean hospital stay was 20 days. Careful selection of the transplants yielded good reliability. Six donor sites were sufficient to reconstruct the majority of defects. Teaching of microsurgery is one of our main preoccupations. This is an indispensable technique in all fields of reconstruction. Rigorous training is necessary and much time must be spent before reaching a high level of reliability.

Anastomosis, Surgical↗
PubMed2005

The thoracoacromial vessels as recipient vessels in microsurgery and supermicrosurgery: an anatomical and sonographic study.

The purpose of this study was to investigate the presence and the precise course of the pectoral branch of the thoracoacromial vessels on the underside of the pectoralis major muscle by anatomical dissection and by color Doppler ultrasound. A further goal was to determine whether these vessels were suitable as recipient vessels in microsurgery and supermicrosurgery for breast reconstruction. In 18 cadavers, the pectoral branch of the thoracoacromial vessels was followed caudally until the diameter of the artery diminished to 1 mm. The same examination was carried out in 40 young female volunteers by tracing the vessel course with color Doppler ultrasound. The 1-mm cutoff point of the artery was measured with reference to the manubrium, the midsternal line, the clavicle, and the upper border of the closest rib. In addition, in the cadavers, the 2-mm cutoff point was determined. At both cutoff points, the diameter of the accompanying vein was measured. The pectoral branch of the thoracoacromial vessels with the artery and concomitant veins could be detected on all 100 undersides of the pectoralis major muscle, anatomically and sonographically. In their course from the acromial region downward, the arteries reached a diameter of 1 mm at an average of 9.9 cm from the manubrium, horizontally 9.4 cm from the midsternal line, and vertically 4.0 cm from the lower border of the clavicle. The 1-mm reference point was situated on the upper border of the third rib in 85 percent of cases. The average distance between the 1-mm and the 2-mm cutoff points was 3.5 cm. At the 1-mm cutoff point, the diameter of the vein was 0.9 mm, and at the 2-mm cutoff point, it was 1.7 mm. Because of their central position at the anterior hemithorax, these vessels are easily accessible from mastectomy incisions, even in skin-sparing mastectomies; the donor-site morbidity is negligible; and as the diameters of the vessels gradually decrease along their caudal course, the recipient site can be chosen precisely according to the length and the diameter of the donor vessels and major mismatch can be avoided. Thus, the pectoral branches of the thoracoacromial vessels are well suited as recipient vessels for (super)microsurgery and are a very promising addendum to the thoracodorsal and internal mammary vessels.

Adult↗
PubMed2004

Robotic technology applied to meet the requirements of tools to support microsurgery and cellular surgery.

Microsurgery and processes involving cell manipulation or cell surgery are clinical practices where the operator works at or beyond the threshold of human dexterity. Current tools available are conventional in their design, and this limits consistency and the level of reliability and achievement. Surgical robotic devices have been explored to improve precision in minimal access surgical procedures to augment control of tool points in tissues, and have enabled feedback of sensory data from which the operator is able to deduce information on the tool at the working site. In this paper, relevant technologies are described that can be harnessed to improve perception of tool point interaction with tissues at the working site and to improve tool control at the small scale required in clinical practice for microsurgery and for cell surgery.

Humans↗
PubMed2005

[Teaching of microsurgery--in service of research and clinical practice].

We analyse the improving role of teaching microsurgery, the advantages of the microsurgical models in research and clinical practice. We summarize our experience in teaching basic microsurgery according to Furka's model in the last 15 years. The main characteristics of the principles are: activity, synchronism, video assistance, self-control, individualization, analysis. We show the curriculum of the courses for researchers and participants in graduate and postgraduate education, which consists dry-training on models followed by surgical interventions on rats. Summarizing of our practices: to learn the basic microsurgical techniques the participants need endurance, patience, and have to work hard. Effectiveness of the education is most successful if we organize small groups, if one teacher deals with a maximum of two or three candidates.

Biomedical Research↗
PubMed2005

[Carbon granuloma--an unwanted effect of laryngeal laser microsurgery].

Over recent twenty years, laser microsurgery has gained great recognition in the treatment of early carcinoma. From 1990 to 2004, more than 800 operations on the larynx were performed using laser microsurgery, including 167 chordectomies for squamous cell carcinoma. In 14 patients who were on the follow-up for 1 to 6 months, we observed a spherical, smooth structure (3-5 mm in diameter) in the middle part of the scar, which imitated local relapse of the neoplastic process. The lesion was removed with CO2 laser. Histopathologic examination revealed, in all cases, the presence of nonspecific, inflammatory process and development of granulation tissue. In only one patient in further follow-up, neoplastic growth recurred. Such lesions were not observed in other than chordectomy laser microsurgical procedures.

Carbon↗
PubMed2005

Microsurgery versus laparoscopy in distal tubal obstruction hysterosalpingographically or laparoscopically investigated.

OBJECTIVE: To compare pregnancy rates after laparotomic microsurgical or laparoscopic distal tuboplasty. DESIGN: Two hundred and twenty-four women with infertility due to distal tubal occlusion were randomized to be treated with either laparotomy or laparoscopy from 1987 to 2001 at the Institute of Gynaecology and Obstetrics, University of Rome, "La Sapienza". RESULTS: The results were evaluated taking into account the type of surgical approach, the severity of tubal damage and of adhesions. After a 24-month follow-up period, the overall pregnancy rate obtained with microsurgery was 43.7%, of which 33.3% were term pregnancies, 5.0% abortions, and 5.0% ectopic pregnancies. After laparoscopy, the overall pregnancy rate was 41.6%, of which 29.1% were term pregnancies, 8.3% abortions and 3.9% ectopic pregnancies. No significant differences was observed between the two groups in terms of fertility rate (chi-square 0.016, p = 0.9003). CONCLUSIONS: Laparotomy plus microsurgery and laparoscopy were equally effective in restoring fertility in women with comparable tubal damage. The severity of the damage is a critical factor for the results.

Adult↗
PubMed2006

[Early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm].

OBJECTIVE: To evaluate clinical strategy and effect of early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm. METHODS: Seventy-five patients presenting with anterior circulating aneurysmal subarachnoid hemorrhage (SAH) underwent early-mid-phase (within 3 days or 3-10 days) microsurgical clipping at Huashan Hospital between January 2001 and August 2004. Glasgow outcome scale (GOS) was conducted to evaluate patients' outcomes. RESULTS: Of 81 intracranial aneurysms, 77 lesions were clipped successfully, and 4 were wrapped. Good outcome was achieved in 53 cases, mild disability in 9 cases, severe disability in 7 cases, persistent vegetative state in 3 cases, and 3 patients (4%) died after surgery. The difference of GOS was statistically significant between patients in Hunt and Hess Grade I-III and Grade IV-V. However, there was no significant difference between early surgery and metaphase surgery. CONCLUSIONS: Early-mid-phase microsurgery for ruptured cerebral anterior circulating aneurysm is considered the feasible opinion.

Acute Disease↗
PubMed1991

[Training of microsurgery in the laboratory of the Hôpitaux de Paris].

The Microsurgical Laboratory of Paris Hospitals' Anatomy Amphitheater has been organizing an initiation into microsurgery since 1976 and the University Diploma of Microsurgical Techniques of Paris VI University since 1977. Since this time, 1,426 surgeons have been trained in the laboratory. The geographic origin of the students is worldwide, but predominantly European. The success rate at the final examinations is relatively constant and averages 60%. The results have been compared to the number of sessions in which the candidates had taken part, and a correlation between a number of sessions exceeding 30 and results above 90% at the examinations was established; A minimum number of sessions of vascular microsurgery was therefore laid down in order to ensure the serious training of the students.

General Surgery↗
PubMed1991

[A nicardipine-isoflurane combination in the microsurgery of the middle ear].

Middle ear microsurgery requires a bloodless operative field, achieved through deliberate hypotension techniques. The present work was designed to analyze the quality of the deliberate hypotension induced by the combination of isoflurane with nicardipine, an injectable calcium channel blocker. Eleven patients, ASA I, 10 minutes after induction of anaesthesia, received nicardipine as a bolus of 25 mg renewed every five minutes (maximum 4) and as a perfusion (5 mg/hour). The bloodless operative field was excellent in all cases with a 29.7% drop in arterial blood pressure after 15 minutes (heart rate: +22.3% after 25 min); values then remained stable until nicardipine was stopped; then hemodynamic data returned to the preanaesthetic values in 66 +/- 56 minutes. No side effect was registered. As a conclusion, deliberate hypotension induced by isoflurane--nicardipine combination provides good conditions for middle ear microsurgery.

Adult↗
PubMed1991

[Reconstructive microsurgery].

Progress in microsurgery has been accomplished by the technical improvements of the operative microscope and other delicate surgical instruments. Therefore, even small arteries as well as female tuba and male deferens, either presenting mechanical obstruction or a section, can be reconstructed. The same procedure may be applied in case of nerve injuries. Since Microsurgery was born, it has been employed in different medical fields offering lately good chances in sterility. Furthermore, microsurgical techniques offer a great support to Plastic Surgery. In fact, it is possible to repair wide tissue damages of the skin, muscles or bones using free flaps. The percentage of success of this Surgery increased the overall percentage obtained in General Surgery. Therefore a close multidisciplinary relation between the different Medical fields is absolutely required for a correct application of microsurgical techniques.

Adolescent↗
PubMedDate not supplied

[Our experience in microsurgery of rhino-sinus phlogosis].

Rhino-microscopy has made great progress in the diagnosis and surgical treatment of rhino-sinus phlogosis. In fact, a larger portion of the endonasal pathologies, which would not otherwise have been detected, can now be diagnosed through rhino-microscopic exploration. From the surgical point of view microscopy offers a clear, enlarged operating field. Moreover, with the aid of an autostatic speculum, it frees the surgeon to use both hands. These features make intricate, precise surgery possible thus enabling preservation of those structures which are not involved in the disease. At the same time it allows for re-establishment of the physiological functionality of the rhino-sinus cavity. Between 1980 and 1989 the microsurgery technique was employed in 950 cases of rhino-sinus cavity surgery. The results achieved using this technique were quite good and the number of complications was quite limited although the number of patients to be followed up over the years was not sufficient to draw any statistical conclusions. For several years now optic-fibre endoscopy has also been employed. This, too, is a functional technique although the method and instruments are totally different. It is not the intention of the authors here to assert that microsurgery is superior to endoscopy even though some technical details (i.e. the ability to operate with both hands) has made it easier to use, particularly for those accustomed to using a microscope. It is, however, felt that for rhino-surgery it is advisable to be familiar with both techniques so that they can be used alternately depending on the type of pathology and patient.

Chronic Disease↗
PubMed1991

[Oocyte removal in conjunction with pelvic microsurgery].

The paper evaluates results of gamete transfer into the oviduct or embryos into the uterus in connection with pelvic microsurgery. Between August 1981-December 1989 225 microsurgical operations have been performed in a stimulated cycle. Ovaries have been stimulated by clomiphene-citrate or in combination with human menopausal gonadotropin. The operation was timed 34 hours after application of human chorionic gonadotropin. In a group of 156 women we recovered at least one oocyte. From 77 gamete transfers into the oviduct we achieved 11 pregnancies, i.e. 14.3 per cent. 46 embryo transfers into the uterus resulted in 5 pregnancies, i.e. 10.9 per cent. From the total number of 16 pregnancies we achieved 5 deliveries, 8 clinic abortions and 3 ectopic pregnancies. The connection of sterility microsurgery with oocyte retrieval increases the success rate of operations without another stress of a patient and has also its economic significance.

Adult↗
PubMed1991

Microsurgery: directions for the 1990s.

Speculating on the possible advances of microsurgery in the 1990s has encompassed discussion of transplantation technique, biochemistry, monitoring, and nerve and motor reconstruction. This article, however, is by no means exhaustive, and many other discoveries and innovations may come from areas not discussed here. The only clearly incorrect possibility concerning microsurgery in the 1990s is that nothing exciting will happen.

Fingers↗
PubMedDate not supplied

[Microsurgery in revascularizations and replantations of the upper extremity in emergency cases. Department of Plastic and Reconstructive Surgery. University Hospital Center of Treichville-Abidjan].

The authors report their experience in vascular and nervous microsurgery. They remark that there is a long time between the emergency reception of the wounded person and the appeal to plastic surgery. They deplore also the bad collaboration between the different department of emergency surgery. Finally they emphasize that the scarcity of cases is due to insufficient information of different departments of emergency surgery in microsurgery era.

Adult↗
PubMed1990

Pediatric microsurgery. Replantation, revascularization, and obstetric brachial plexus palsy.

Revascularization and replantation of the amputated part is absolutely recommended for restoration of function, form, and future growth. From the beginning, microsurgery has been employed to treat children and infants, but as a group pediatric patients have not received much attention. This article discusses several areas in which reconstructive microsurgery plays a prominent role in the pediatric patient.

Birth Injuries↗
PubMed1990

Pediatric microsurgery. Reconstruction by free tissue transfer.

In the pediatric population, microsurgery has helped to overcome two of the problems particular to this group: the smaller size of their vessels and nerves and the need for future growth. Microsurgery will continue to play a major role in many difficult reconstructive problems in pediatrics in the future.

Adolescent↗
PubMed1989

Safety of labetalol-induced controlled hypotension during middle ear microsurgery.

In order to study the influence of labetalol on the peroperative oxygenation during deliberate hypotension, 50 patients undergoing middle ear microsurgery were randomly divided in two groups of 25 patients; one group receiving labetalol to induce hypotension, the other group receiving placebo in a double blind manner. In the group receiving labetalol the arterial oxygen tension (PaO2) decreased significantly 5 minutes after the intravenous bolus injection. Within 30 minutes the PaO2 returned to the starting level. The arterial carbon dioxide tension (PaCO2) increased within 5 minutes and also returned to the initial level after 30 minutes. These changes were absent in the control group. It is concluded that, although labetalol produces a statistically significant change in PaO2 and PaCO2, this finding has only minor clinical implications and so labetalol remains a safe drug to be used for the induction of deliberate hypotension during middle ear microsurgery.

Adult↗