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At least 937 records · Page 52Linked to original sources
PubMed1994

[A free transfer of the pulp of the toe with an exteriorized flap. A compromise between microsurgery and traditional surgery].

Free toe pulp transfer represents the most sophisticated technique which corresponds functionally as close as possible to total restoration of the digital pulp. However, this operation presents technical disadvantages related to the very small calibre of the vessels when the vascular anastomosis is performed in the digit. When the artery and vein are anastomosed in the metacarpal region to achieve vessels with a larger calibre, the passage of the pedicle in the finger is difficult and requires complete opening of the digital canal, resulting in a finger which is often enlarged with limited mobility. The authors propose a technique which overcomes these two disadvantages.

Anastomosis, Surgical↗
PubMed1990

[Socio-professional evaluation of 184 patients with hand injuries treated at an emergency microsurgery service].

184 consecutive patients were operated for severe industrial injuries of the hand. Microsurgical techniques were used in 86% of cases, with 41% of replantation (with about 1/3 of failures), and revascularization, and 17% of sutures of median and ulnar nerves. These patients were examined by medical experts from the French National Health Service, independently of their surgeons, in order to determine under which conditions they could resume their professional activities (changes of their working conditions or not, reduction in their wages or not, etc.). Moreover the duration of work interruption, as well as the percentage of professional disabilities, were known for more than 90% of the 115 patients who underwent an official assessment. The average percentage of professional disability was 19%, whereas without specialized surgery it used to be roughly 30 to 40% for the same lesions. The value of microsurgical techniques was obvious when considering the ability of the patients to resume their previous activities, especially as 96% of them were manual workers. Only 12% of the patients did not resume their work (5% were unemployed, and 7% retired or were too disabled to work). 18% were able to return to work, but with modifications of their working conditions or their wages. But, most important, 70% of the patients resumed their previous work with the same pay. On average, they had to stay for ten days in the surgical department and had to stop work for 3 months. This may be due to our great concern with early rehabilitation, aimed at manual work, with early transfer of patients to specialized rehabilitation centers.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMed1982

Pseudoaneurysms of the radial artery. Importance of microsurgery. Apropos of a case.

Following a case of pseudoaneurysm of the radial artery, curiously a rare pathological entity, the authors reviewed the literature, which consists of a maximum of 50 publicized cases. The arteriographic, plethysmographic and clinical studies as well as the anatomic and physiologic findings, all seem in favor of a treatment consisting of restoration of the vascular permeability of the principal arterial axes of the forearm (radial and ulnar arterial axes). Conservative treatment may expose the affected limb to a latent or immediate functional impotency, which may be more or less serious. The authors propose a microsurgical technique, with venous interposition grafting, for a better short or long term result, and also to replace the loss of substance secondary to the resected pseudoaneurysm.

Adult↗
PubMed1994

The role of microsurgery in salvage operations for cranio-cerebral gunshot wounds: a case report.

A case of gunshot wound of the brain associated with a scalp defect is presented. Repair of the scalp defect was primarily achieved by multiple rotation flaps. Successive complications occurred in the postoperative course related to wound breakdown and infection. The patient underwent a secondary reconstruction by a free forearm flap. Despite an infected recipient bed and poor general condition, the postoperative course was uneventful and the healing was complete within 1 month.

Adult↗
PubMedDate not supplied

[Radiosurgery or microsurgery of vestibular schwannomas?].

PURPOSE: Microsurgical excision is the reference treatment of vestibular schwannomas. Yet, morbidity and functional risk of this surgery is significant, as Pellet et al have demonstrated in their study. In order to define the role of gamma knife surgery we have designed a prospective study concerning effectiveness and tolerance of this treatment. PATIENTS AND METHODS: Between July 14, 1992 and August, 1997, 400 patients were included. All the treatments were carried out according to a homogeneous methodology, with multiisocentric planning. We use low marginal doses dependent mainly on the treatment volume: 14 Gy for small stade II tumors, 12 Gy or less for larger tumors and 16 Gy for intracanalicular tumors. The evaluation protocol included preoperative examination with clinical examination, House grading, Shirmer's test, tonal and vocal audiometry, brain stem electrical response audiometry (BERA), vestibular caloric and pendular tests, magnetic resonance imaging (MRI) or computerized tomography (CT) scan; control at 6 months, 1 year and 2 years with clinical examination, tonal audiometry and MRI and/or CT scan; at 3 years the preoperative examination was repeated and a questionnaire based on Pellet's concerning functional results was completed. RESULTS: Among the 400 treatments, 80% were first intended treatment of unilateral vestibular schwannoma. At the time of the analysis, 100 consecutive patients with unilateral schwannoma (treated in first intention) had a 3 year follow-up (results concerned these 100 patients). Average age was 61 years (17-82 years). According to Portmann's classification, five patients presented a stade 1 tumor, 60 a stade 2 tumor, 33 a stade 3, and two a stade 4 tumor. According to House's grading at preoperative examination, there was 86 (86%) grade 1 tumors, 12 grade 2, two grade 3, and at 3 year follow-up: 77 (94%) grade 1 and five grade 2 (17 patients had no House grading). At preoperative examination, three patients presented an hemispasm; at 3 years this had disappeared for all patients. Two others patients presented a transient hemispasm at 8 and 11 months, respectively. At preoperative examination, four patients presented with facial numbness and 14 with hypoesthesia. At 3 year follow-up, trigeminal function was normal for all patients but one, for whom this had only improved. Seven others patients presented a transient numbness or hypoesthesia. At preoperative examination, five patients presented hydrocephalus without cerebro spinal fluid (CSF) shunting. At 3 year follow-up, seven patients presented CSF shunting: three presented a preoperative hydrocephalus, three a hydrocephalus after treatment and one a hydrocephalus secondary to tumor growth. Average age for these six patients was 71 years. Audiological classification was based on Gardner-Robertson's. Seventy percent of patients with normal hearing maintained useful hearing, and 50% of patients with useful hearing maintained serviceable hearing. Three (3%) patients (two with stade 2 tumors and one with a stade 3) had microsurgical excision at 16, 35 and 36 months, respectively. During microsurgical excision no unusual difficulty was encountered. Seventeen questionnaires investigating functional outcome and quality of life were completed: 100% (63% in Pellet's study) of the patients answered they had no facial motion disturbance, 49% (17% in Pellet's study) had no ocular problems, 20% (in Pellet's study 55%) had subjective trigeminal problems, 8% (in Pellet's study 13%) had deglutition problems, none (16% in Pellet's study) had other eating problems, 91% (61% in Pellet's study) had no change in their life. Mean hospitalization stay was 3 days (for 23 days in Pellet's study). All the patients who worked, except one, had the same professional activity (66% in Pellet's study). Mean work cessation was 7 days (130 days in Pellet's study). (ABSTRACT TRUNCATED)

Adolescent↗
PubMedDate not supplied

Microsurgery for malignant gliomas.

Reflections directly involving the ongoing, intense research activities in biology, the neurosciences and in neurosurgery are discussed including the evolving diagnostic and treatment modalities of primary and secondary malignant gliomas of the central nervous system. The etiology of this enigmatic disease remains obscure, and a curative therapy is still not available. Nevertheless, as a result of changing paradigms in neuroanatomy, neuropathology, neurophysiology, neuroradiology and in neurosurgery, and taking into account the broader selection of adjuvant therapies available, well circumscribed malignant gliomas, which are in predilected compartments of the brain, can be efficiently resected. Good life quality and a respectable survival time are achieved in the majority of patients.

Brain Neoplasms↗
PubMed2001

Introduction to microsurgery: an emerging discipline in biomedical research.

Using microsurgical techniques, biomedical researchers are able to perform procedures that would otherwise be impossible on small laboratory animals. The authors provide a primer on learning microsurgical technique, from correct posture and hand position, to understanding lenses and proper handling of surgical needles and suture material.

Animals↗
PubMed1999

Clinical outcome of microsurgery for obstructive azoospermia.

BACKGROUND: Recent technical advances in microscopy have greatly improved the reconstruction of the seminal tract in cases of obstructive azoospermia. METHODS: We evaluated the clinical outcome of 28 patients with obstructive azoospermia who underwent microsurgical reconstruction (i.e. vasovasostomy or unilateral epididymovasostomy). Diagnoses included postvasectomy (n = 9), childhood inguinal herniorrhaphy (n = 10) and cases of unknown cause (n = 9). Six of the unknown cases proved to be inoperable. We analyzed the outcome of the surgical reconstructions of operable cases according to the causes of obstruction, duration of obstruction, quality of the fluid obtained from the distal seminal tract (concentration, morphology and motility of sperm) and the histologic findings of the testis. RESULTS: The surgical outcome was analyzed with regard to the incidence of patency and pregnancy. The incidence of patency achieved in nine vasectomy cases was 89%, while the incidence of pregnancy was 44%. In contrast, the incidence of patency in the nine operable cases with herniorrhaphy was 44%, while the pregnancy rate was 0%. Of four cases of unknown cause who underwent epididymovasostomy, the incidence of patency was 100% and the incidence of pregnancy was 75%. The outcomes were worse in post-vasectomy cases with long-term obstruction of more than 10 years; however, this was not statistically significant. The outcome was significantly worse in cases with low sperm concentrations. There was no significant relationship between histologic findings and surgical outcome. CONCLUSIONS: The surgical outcome of vasovasostomy of postherniorrhaphy cases was significantly worse than that of post-vasectomy cases. With regard to epididymovasostomy, a unilateral repair was clinically evaluated.

Adult↗
PubMed1999

Functional evaluation of the ileocolic sphincter transplanted to the neck using microsurgery technique: a manometric study in dogs.

The usefulness of ileocolic sphincter (ICS) transplantation to the neck after a total laryngopharyngectomy was investigated in 12 mongrel dogs. The authors aimed to evaluate the influence of the transplantation on ICS pressure amplitude and ICS length, and on ICS resistance to intracecal pressure increase. Electromanometric measurements showed that ICS pressure amplitude and length presented no changes after the procedure. Also, there was no significant change in ICS resistance. However, long-term follow-up studies are needed to determine whether the ileocolic transition maintains the properties observed in the immediate postoperative period.

Anastomosis, Surgical↗
PubMed2000

Immunohistochemical evaluation of failed vessel anastomoses in clinical microsurgery.

Failed vessel anastomoses collected from 12 patients during elective free flap surgery, and from one patient after failed mid-hand replantation were subjected to immunohistochemical analysis. The anastomotic failure was due to an obvious thrombosis, poor flow, an excessively sharp pulse or some other reason causing a non-functioning anastomosis. A total of 17 samples were obtained, 13 of them arterial, three between the artery and vein graft, and one venous. The majority of samples were resected during primary surgery and four of them at reoperation. Variables of coagulation and fibrinolysis were analysed repeatedly during the operation in 7/13 patients. Total occlusion was seen in 6/17 samples and a non-occlusive thrombus in 4/17; two of these were due to suture error. Immunohistochemistry showed that, overall, the endothelial cells (PECAM-l, CD 31) were absent and that the staining pattern for platelets (CD 42b and CD 31) and fibrin (fibrin II, T2G1) correlated. In the absence of a thrombus, however, adherent platelets were positive only for CD 42b, not for PECAM-1. Vessel inflammation was a prominent feature at reoperations. Analysis of coagulation and fibrinolytic markers (thrombin-antithrombin III complex, prothrombin fragment 1 + 2 and D-dimer) confirmed the occurrence of thrombosis in three patients undergoing breast reconstruction with clinically obvious thrombosis during primary surgery or at reoperation. Moreover, the patients with active cancer (2/7) were clearly hypercoagulable compared with the other patients. In short, the primary anastomotic failure was associated with loss of endothelial cells, and with co-localised platelet recruitment and fibrin formation at these sites. At reoperation, inflammation was a prominent feature at the vessel site of thrombi.

Adult↗
PubMed1978

[Microsurgery of sphenoidal ridge meningiomas (author's transl)].

On the basis of 22 sphenoidal ridge meningiomas operated on in the last two years, the topographical relationship of these tumours to the brain and the base of the skull is described. The microsurgical technique which is used is described and its advantages discussed.

Adult↗