• 제목/요약/키워드: Microvascular anastomosis

검색결과 97건 처리시간 0.028초

End-to-End Anastomosis of an Unanticipated Vertebral Artery Injury during C2 Pedicle Screwing

  • Nam, Kyung-Hun;Sung, Joo-Kyung;Park, Jae-Chan;Cho, Dae-Chul
    • Journal of Korean Neurosurgical Society
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    • 제48권4호
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    • pp.363-366
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    • 2010
  • Vertebral artery (VA) injury is a rare and serious complication of cervical spine surgery; this is due to difficulty in controlling hemorrhage, which can result in severe hypotension and cardiac arrest, and uncertain neurologic consequences. The authors report an extremely rare case of a 56-year-old woman who underwent direct surgical repair by end-to-end anatomosis of an unanticipated VA injury during C2 pedicle screwing. Postoperatively, the patient showed no neurological deterioration and computed tomography angiography of the VA demonstrated normal blood flow. Although direct occlusion of an injured VA by surgical ligation or endovascular embolization has been used for management of an unanticipated VA injury during surgery, these methods may be associated with significant morbidity and mortality. However, despite its technical demand, microvascular primary repair can restore normal blood flow and minimizes the risk of immediate or delayed ischemic complications. Here we report an iatrogenic VA injury during C2 pedicle screwing, which was successfully treated by end-to-end anastomosis.

Venous Free Flap with Interposition Bypass Graft for Arteriovenous Fistula Preservation: A Case Report

  • Cyril Awaida;Marion Aribert;Natalie Weger;Kendall Keck;Andrei Odobescu
    • Archives of Plastic Surgery
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    • 제50권6호
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    • pp.568-572
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    • 2023
  • Cutaneous squamous cell carcinoma (CSCC) overlying an arteriovenous fistula (AVF) is rare and presents unique challenges. This case report describes a method of fistula preservation after CSCC excision using a flow-through venous free flap. The saphenous vein of the venous flap was used as flow-through segment for AVF preservation. The flap was inserted along the dorsal aspect of the forearm wound and microvascular anastomosis of the arterial inflow was completed using a vein just proximal to the radiocephalic fistula anastomosis. Venous outflow was established by creating an end-to-end vascular anastomosis between the cephalic vein and the greater saphenous vein. A separate subcutaneous vein was used to provide a low-pressure outflow for the flap to avoid congestion. This case demonstrates an option for AVF preservation that has not been previously described. It also highlights the importance of a multidisciplinary approach for the safe treatment of CSCCs overlying AVFs.

포가티 카테터를 이용한 유리조직 전이술 시 수술 중 혈전 및 연축의 치료 (Treatment of Intraoperative Thrombosis and Spasm in Free Tissue Transfers Using the Fogarty Catheter)

  • 이승렬;윤영묵;오상하
    • Archives of Plastic Surgery
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    • 제35권2호
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    • pp.159-164
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    • 2008
  • Purpose: Microvascular free tissue transfer has become a reliable technique for the reconstruction of complex wounds. Occasionally, unexpected intraoperative thrombosis and/or spasm of recipient artery might be annoying problems even for the technically competent microvascular surgeons. If such problems are not treated properly, they will inevitably cause to flap failure. Methods: From January 2006 to February 2007, soft tissue reconstructions by free tissue transfers were performed on 21 patients having complex defects in the lower extremity. Although segmental revision and various pharmacologic agents were repeatedly applied, arterial occlusions were not managed in 6 cases. For removal of thrombi and release of spasm, Fogarty No. 2 or No. 3 catheters were inserted into the lumen to the proximal recipient artery. Its balloon was then inflated after passing through a resistant area. Next, the catheter was gently withdrawn backward. Results: After the Fogarty catheter was inserted two or three times, the pulsatile arterial flow was restored. When the catheter was inserted into the lumen, a feeling of resistance existed in a 5-10cm more proximal portion that could not be easily accessed from the vascular end. After the reestablishment of blood flow, successful anastomoses were achieved and immediate rethrombosis or spasm did not occur. No long-term sequelae associated with balloon trauma to the arterial wall were observed. Conclusion: The use of the Fogarty catheter can be an effective method in treating pedicle thrombosis and spasm. This is a very simple and rapid technique that offers microvascular surgeons another option to increase the success rate of microvascular anastomosis in free tissue transfers.

Horizontal Mattress Suture Technique을 이용한 미세혈관 문합 (Microvascular Anastomosis Using Horizontal Mattress Suture Technique)

  • 우상현;김정철;정영식;최시호;최원희
    • Journal of Yeungnam Medical Science
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    • 제6권2호
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    • pp.71-78
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    • 1989
  • 본 연구에서는 Spragus-Dawley준 흰쥐의 서혜하부의 대퇴동맥을 수술현미경하에서는 대조군은 단순봉합방법으로, 실험군은 수평연차봉합 방법으로 미세분합하여 그 문합시간을 측정하고, 일정시간이 경과한 후 개존율과 조직소견을 비교 관찰하여 얻은 결과를 요약하면 다음과 같다. 문합시간에 있어서 대조군과 실험군에서 각각 17분 25초와 15분 49초로 통계학적으로 유의한 차이가 있었으며, 미세혈관문합에서 수평연차봉합이 유리함을 알 수 있었다. 미세혈관문합 후 개존율은 대조군과 실험군에서 술 후 3일까지는 비슷하였으나, 술 후 3주째는 실험군에서 더 높았다. 조직학적으로는 대조군과 실험군에서 공히 내피가 손상을 입고, 중막이 얇아지면서 공히 혈관 강이 좁아지고 술 후 3주째는 내피가 재생되는 등의 비슷한 변화를 보였다.

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구강 및 안면재건을 위한 광배근 유리피판의 해부학적 고찰 (Anatomical Review of Latissimus Dorsi Free Flap for Oral Cavity and Facial Reconstruction)

  • 김성민;정영언;어미영;강지영;서미현;김현수;명훈;이종호
    • Maxillofacial Plastic and Reconstructive Surgery
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    • 제33권6호
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    • pp.549-558
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    • 2011
  • The latissimus dorsi myocutaneous flap (LDMF) was initially described at the turn of the century by Tansini et al, and latissimus dorsi myocutaneous free flap (LDMFF) was also first described for the coverage of a chronically infected scalp by Maxwell et al. As a pedicled flap, LDMF has been often used for breast reconstruction and for soft tissue replacement near the shoulder and the lower reaches of the head and neck. LDMFF is a flat and broad soft tissue flap with large-caliber thoracodorsal vessels for microvascular anastomosis. A skin paddle of the LDMFF can be more than $20{\times}40$ cm, so very large defects in the oral cavity and outer facial region can be covered by this LDMFF. Other advantages include consistent vascular anatomy, acceptable donor site morbidity and the ability to perform simultaneous flap harvest with tumor resection. For a better understanding of LDMFF as a routine reconstructive procedure in large defects of the oral cavity and facial legion, anatomical findings must be learned and memorized by young doctors during the special curriculum periods for the Korean national board of oral and maxillofacial surgery. This review article discusses the anatomical basis of LDMFF with Korean language.