ISSN:0738-1085    

DOI:10.1002/micr.1920150802

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

ISSN:0738-1085    

DOI:10.1002/micr.1920150803

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractThe surgical repair of cerebral aneurysms involving the apex of the basilar artery continues to undergo refinement and evolution. The inherent difficulty in accessing the basilar apex as well as the complexities of the microanatomy render this area a notoriously hazardous and technically challenging region in which to perform microsurgical clipping of cerebral aneurysms. Several operative approaches have been described and are constantly undergoing a state of evolution in the hopes of optimizing the exposure of the distal basilar artery and minimizing the inherent risks of surgery. The consistent decline in operative morbidity has paralleled improved understanding of the microvascular anatomy, both in this region and along the various corridors of approach. No single operative approach is universally superior, considering the wide variability of individual patient anatomy and vascular configurations. Each approach has strengths, weaknesses, and potential complications that must be considered in the thought process of planning an operative attack on a basilar apex aneurysm. Intimate familiarity with the microvasculature and the microsurgical anatomy of the region is an imperative prerequisite for the application of any surgical approach to this region. This paper outlines a detailed review of the microsurgical anatomy that is pertinent to microsurgery of aneurysms in this region, and describes an approach referred to as the combined transsylvian‐subtemporal approach. We have found this operative approach particularly useful in aneurysm surgery of the basilar apex but do not mean to imply that this single approach is suitable for all surgeons or all patients. This paper is designed to discuss an approach and microanatomic understanding that we find useful in the surgical treatment of aneurysms involving the basilar apex. © 1994 Wiley‐Liss,

ISSN:0738-1085    

DOI:10.1002/micr.1920150804

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractEndoscopic techniques have been utilized in neurosurgery for nearly a century. The history of application of these techniques is reviewed. Because of recent improvements in optics, microinstrumentation, and other associated technologies endoscopy has begun to have an impact on neurosurgery. Documented uses of these techniques are reviewed. Greater experience with the techniques, along with continued improvements in the technology, has the potential to result in broadened applications. These procedures can be performed quickly, safely, and effectively, and in selected applications may reduce tissue trauma, risks associated with surgery, hospital stays, and costs. Neuroendoscopy presents exciting possibilities for the future. © 1994 Wiley‐Liss, I

ISSN:0738-1085    

DOI:10.1002/micr.1920150805

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

ISSN:0738-1085    

DOI:10.1002/micr.1920150806

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractThe distal femoral epiphyseal plates of 21 8‐week‐old New Zealand white rabbits were totally or partially (nutrient artery only) devascularized, or devascularized and then microsurgically revascularized. Sacrifice was at 24, 48 or 72 hours postoperatively. The heights of the proliferative and hypertrophic zones of the epiphyseal plates operated upon were compared with the contralateral control epiphyseal plates for both the central and the peripheral regions of the epiphyseal plate. Neither extent of devascularization nor revascularization had a significant effect on the height of the proliferative zone of chondrocytes at any of the follow‐up intervals. Selective devascularization of the nutrient artery led to a significant increase in height of the central region of the hypertrophic zone of chondrocytes at 48 and 72 hours. Microsurgical revascularization did not lead to a significant change in the height of either the central or the peripheral regions of the hypertrophic zone of chondrocytes at any of the follow‐up intervals. This study is another ‘building block’ experiment toward vascularized epiphyseal plate transplantation in humans. © 1994 Wil

ISSN:0738-1085    

DOI:10.1002/micr.1920150807

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractA rabbit ear model resembling the human digit was studied to determine the vascular response of the rabbit ear to a cold stress. Following moderate cooling (10 minutes at 5°–8°C), auricular blood flow and cutaneous perfusion were reduced. This decrease was reversed by 30 minutes of warming. The response in the rabbit ear to cold stress is similar to that of normal human digits. The similarities between the control of the circulation in human digits and rabbit ears may result from the similarities in digital and auricular vascular receptors and receptor subtypes. Verification of the rabbit model provides an experimental method for obtaining important data regarding digital pathophysiology and the treatment of cold intolerance. Further study with this model will provide clinically relevant information regarding the pathophysiology of digital thermoregulatory abnormalities. © 1994 Wiley‐Lis

ISSN:0738-1085    

DOI:10.1002/micr.1920150808

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractSeveral researchers and clinicians have taken advantage of the omentum's rich vascular arcades to support skin grafts. We have previously described an experimental model using the omentum as a vascular carrier for prefabricated free flaps in the rat. In this study, we used this model to compare three different sizes of free flaps using the same size omental carrier. Twenty‐four male Sprague‐Dawley rats were used for this study. A 2.5 × 4 cm patch of omentum with gastroepiploic vessels and its rich vascular arcades was transferred under a bipedicled 2.5 × 6 cm (group I), a 2.5 × 8 cm (group II), and a 4 × 10 cm (group III) right abdominal panniculocutaneous flap. On the seventh postoperative day, the skin pedicles were divided and the skin flap raised as a composite island flap vascularized only by the underlying omental patch. The composite flap was then sutured back in place. Prefabricated flaps examined 7 days postoperatively demonstrated a dye florescence index percent (DFI) of 38.19 ± 7.52 and 98.13 ± 3.72% flap survival (FS) in the 6 ± 2.5 cm skin flap group; a DFI of 39.96 ± 6.81% and FS 94.88 ± 7.08% in the 8 ± 2.5 skin flap group (P>0.05) and a DFI 29.71 ± 2.85% and FS 57.06 ± 9.52% in the 10 × 4 cm skin flap group (P<0.05). India ink injection study and histologic examination confirmed revascularization of the overlying skin at 7 days. This study confirms that omentum can be used as a vascular carrier for prefabricated flaps. However, there is a limit to the size of the flap. A 10 cm2carrier can support 57% of a 40 cm2(10 × 4 cm) flap for a total area of 22.8 cm2, more than twice the area of the carrier. © 19

ISSN:0738-1085    

DOI:10.1002/micr.1920150809

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractWe previously reported pedicled venous flap survival using the rat model, as well as venovenous, arteriovenous, and arterialized flow‐through venous flap survival using the rabbit ear model. For this study, we utilized these flaps clinically. Five of seven pedicled venous flaps survived, displaying superficial necrosis. The others became partially necrotic; they were transferred after dissection of a long pedicle vein. Eight of nine venovenous flow‐through venous flaps survived; six displayed superficial necrosis. The nonsurviving flap became completely necrotic, possibly because only one donor vein and one recipient vein were used. Six of 10 arteriovenous flow‐through venous flaps survived. The remaining four became partially necrotic, possibly because only one vein was anastomosed for outflow. The arterialized flow‐through venous flap survived. The pedicled venous and venovenous groups studied seem likely to survive despite superficial necrosis. However, the draining vein should not be dissected more than 5 cm, and many draining veins should be anastomosed with recipient vessels. © 1994 Wiley

ISSN:0738-1085    

DOI:10.1002/micr.1920150810

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY

摘要:

AbstractTwenty‐eight femoral arteries in 14 rats were used to compare transverse closures and end‐to‐end anastomoses in blood vessels approximately 1 mm in diameter. The transverse closures were applied to arteriectomies created by excising one‐half the circumference of the vessel over a length of 1 mm. The end‐to‐end anastomoses were performed after resecting a 1‐mm segment. Recordings were made of pre‐and postrepair flow velocity and three‐point diameter measurements every 5 minutes using a 20‐MHz pulsed Doppler velocimeter and digimatic caliper. Maximum reductions in flow velocity were 18% and 31% for the transverse repair and end‐to‐end anastomosis, respectively. Otherwise, intergroup comparisons of the postrepair normalization of both flow velocity and vessel diameter showed few significant differences (P<0.05). We conclude that arterial defects involving no more than half the diameter of the vessel can be effectively repaired in significantly less time using the transverse closure.

ISSN:0738-1085    

DOI:10.1002/micr.1920150811

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1994

数据来源: WILEY