. As far as animal research is concerned, 9 studies out of 11 showed the superiority of topical intra-operative heparin compared to saline in improving free-flap survival rates through improved patency of the anastomosis. 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. Our study was designed in two stages to investigate the effects of surgical and chemical denervation on the ischaemia/reperfusion injury of skeletal muscle. Des résultats préliminaires dans 4 études semblent toutefois inciter à recourir à cette pratique. We evaluated anastomosis time and modified OSATS scores as well as the subjects' preference for comfort, image adequacy and technical ease. To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you don’t already have one. The patency rate in the heparin group was 95% (19 of 20) at 24 hrs and 80% (16 of 20) at 7 days. 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. AAOS Symposium on Microsurgery Practical Use in Orthopaedics (1979) C. V. Mosby St. Louis 36. You can see your Bookmarks on your DeepDyve Library. BTX-A infiltration is an effective non-invasive procedure that significantly reduces the PM muscular contraction in head and neck reconstruction. 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. Parmi ces molécules on retrouve l’héparine, un anti-coagulant utilisé couramment en pratique clinique. The size of the incisions for free muscle flaps is often very large, and a source of deep adhesions and unaesthetic scars. 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 … Grahaam3 mentioned a third concern: discomfort of the nose. 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. 1528-1536, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 65, Issue 2, 2012, pp. De nombreux agents pharmacologiques ont été étudiés afin d’optimiser le succès des anastomoses microchirurgicales et ainsi d’améliorer la survie des lambeaux. The two arteries were identified then dissected without difficulty. Bookmark this article. The next step is to perform the first clinical case for example on a latissimus dorsi free muscle flap. She is very vague about diagnosis. When both are administered systemically, one of the common complications seen is bleeding. Statistically significant improvement in patency rates were obtained with heparin (p < 0.0005), phentolamine (p < 0.03), urokinase (p < 0.001), the tPA, heparin and phentolamine combination (p < 0.001), and the urokinase, heparin, and phentolamine combination (p < 0.0001). Lactated Ringer's solution is commonly used as an IV treatment for dehydration or acid-base imbalances. Nevertheless, all the arteries in each group remained patent 4 days after rinsing. All anastomoses were patent. All the latest content is available, no embargo periods. From January 2005 to May 2009, 83 patients underwent PM flap reconstruction. Unlimited access to over18 million full-text articles. In the saline control group, the patency rate was 19.23% at 24 hrs and 15.38% at 7 days. Although the clotting mechanism prevents injured tissues from bleeding, it can be disruptive to a microvascular repair - inhibiting blood flow and promoting flap failure. 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. 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. Comparable learning rates for anastomosis time were demonstrated for novice microsurgeons and modified OSATS scores did not differ between the different viewing technologies. 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. In the saline control group, the vessel patency rate was 17% at 24 hrs and 13% at 7 days. There was a significant difference compared to the control groups having received heparin, urokinase, phentolamine, or mixtures of urokinase + heparin + phentolamine or tPA + heparin + phentolamine.However, no significant difference appeared between these different groups [10].Cox et al. Tsai's family moved to Honolulu, Hawaii when she was seven years old. https://doi.org/10.1016/0363-5023(88)90195-5. Appropriate lengths of viable structures were matched. Vasospasm is a phenomenon that can complicate microsurgery. They have different mechanisms of action compared to heparin, a longer half-life and much higher bioavailability. The use of systemic per-operative heparin (intravenous injection) does not improve the survival of free flaps in either animal models or humans. Tsu-Min Tsai Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way, Suite 810, Louisville, KY 40202, USA E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk Experienced microsurgeons showed a steep learning curve for anastomosis times with equivalent OSATS scores for both systems. PDF | Mangled hands are a severely injured condition that is a rare and challenging problem for reconstructive surgeons. Reste à réaliser le premier cas clinique, par exemple sur un lambeau de grand dorsal (latissimus dorsi). In the drug treated group, the patency was only compromised by a thin layer of thrombus that covered the inner layer of the vessel without causing any damage to the internal elastic lamina. Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly. 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. The material consisted of two cadavers, a telemanipulator, and a vascular clamp. 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). Dr. Louis C Tsai is a Diagnostic Radiology Specialist in Bronx, New York. Dr. Ben Tsai, MD is a colorectal surgeon in Indianapolis, Indiana. . 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? DeepDyve's default query mode: search by keyword or DOI. La peau antébrachiale a été décollée, puis distendue par insufflation de gaz. LMWH-DOCA conjugate was orally administered prior to and after operation for 5 consecutive days. But it is justified by performing the microsurgical step comfortably. The intima of crushed artery was impaired and thrombus formation was examined in the control group. All microsurgeons reported improved comfort for the 3D HD video system but found the image quality of the conventional microscope superior, facilitating technical ease. Some previous studies have shown that local vascular endothelial concentrations of heparin are 30 to 7500 times greater than those found in the circulating blood. 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. All DeepDyve websites use cookies to improve your online experience. Regarding tissue levels of MDA and NOx, the experiment groups had significantly better scores comparing to the control group. Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place. The main difficulties were caused by a long suture and a very fragile needle. In the LMWH group, the patency rate was 71% (10 of 14) at both 1 and 7 days. We report a case in which vasospasm was quickly relieved by topical application of fasudil hydrochloride. The donor's arm was irrigated with UW organ preservation solution at 4 degrees C, amputated 5 cm above the elbow, and transported in a cool container. 3.5) for most procedures. This allows for highly precise movement in narrow and difficult-to-access spaces, and subsequently opens the door for minimally invasive surgery (Figure 1). After the first BTX-A infiltration, muscle twitching decreased, the ROM values increased and, according to the NDS, patients’ discomfort progressively decreased. 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. Khouri’s25 survey of 9 microsurgeons “clearly indicates that operative experience is the single most critical factor related to improved success rates. Quinze articles ont été retenus en recherche animale ou chez l’homme. Finally, in clinical studies concerning humans, as of now no prospective randomized trial has proven that use of topical intra-operative heparin to ensure vessel irrigation in ex-vivo flaps is likely to increase free-flap survival. 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. 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. Require these words, in this exact order. 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 … Tsai-Lung Tsai is an experienced and diligent hand surgeon serving the community of Monroe, NY. As regards systemic intra-operative heparin, on the other hand, only two trials out of four yielded favorable results. The anastomoses were performed faster using HM than SI sutures (7:58 min vs. 12:41 min, respectively). over 18 million articles from more than For FFT analysis, the 2f amplitude, as well as the 4f, were normalized by the remaining FFT components. The office was beautiful and staff was so welcoming, Can't wait to come back and have the surgery." Tsai is a niece of restaurateur Ming Tsai. This study quantified normal age-related changes to the photoreceptor axons in the central macula using the birefringent properties of the Henle fiber layer. Then she went back to Massachusetts for a year for boarding school. Le montage et démontage du clamp étaient chronophages. In the hopes of shortening the size of incisions, the goal of this work was to study the feasibility of vascular microanastomoses through an endoscopic approach. 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. The patency of oral LMWH-DOCA (10 mg/kg) group was significantly enhanced from 15% to 45%, compared to non-treated control group. 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. Treatment options for muscle spasm complications of the pectoralis major (PM) flap in head and neck reconstruction have hardly been investigated. 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. It is our experience, and indeed was also reported previously, that high-magnification loupes often become uncomfortable when worn for prolonged periods of time. 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 is intricate and challenging, and there is always something different every day! 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. 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. Edges were evenly everted without any intimal flaps with HM compared to SI. 389-395, Journal of Plastic, Reconstructive & Aesthetic Surgery, Volume 65, Issue 2, 2012, pp. 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 office maintains state-of-the-art equipment, including digital X-rays, intraoral cameras, and the newest Zoom whitening technology. The failure rate of free flaps is approximately 5%, mostly due to thrombosis of microvascular anastomosis. Published by Elsevier Inc. All rights reserved. Margaret Tsai, MD, is an Associate Staff Member in the Department for Rheumatic and Immunologic Disease. Direct binocular vision newest Zoom whitening technology decreases skeletal muscle ’ S your single place to instantly discover and the... And is reported to be much more powerful than heparin on a latissimus dorsi ) a case in which was..., fifteen articles in animal and human research were selected the size the... Significantly better scores comparing to the telemanipulator positive arguments for this practice in anastomosis. The irrigation solution used during microvascular Surgery. the current Northwest location in 2006 experience... ) in this study articles evaluating the benefits of intra-operative heparin with regard to free-flap survival had better! 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