• Archives of Plastic Surgery
• /
• v.32 no.4
• /
• pp.461-466
• /
• 2005

Despite the major advances in the microvascular surgery with success rates of up to 98%, failure and vascular complications still remain even in the experienced hands. Failure of blood to flow across an anastomosis is usually caused by three factors: (1) Technical errors; (2) Undetected damage more proximally or via vasospasm; or (3) A clot or a thrombus. The success of a microvascular surgery depends on the severity of the vascular injury and, proper debridement of an injured vessel, and the failure rate of microvascular anastomosis in cases of trauma is higher as the thrombogenic possibility is increased by the endothelial damage. From January to November in 2003, 460 patients were underwent microvascular surgery(270 replantations and 190 free flap transfers) and re-operations were performed in 15 cases. Cases were reviewed by clinical and operative records. In these cases, causes of post-operative circulation insufficiency were identified as 9 vascular spasms and 6 thromboses at the previous anastomotic site. The average of re-operative success rate was 73%(60% in replantations and 100% in free flaps). In conclusion, through precise postoperative monitoring and assessment, immediate surgical re-exploration could be performed when a vascular complication is suspicious, the success rate of microvascular surgery would be increased more.

• Archives of Plastic Surgery
• /
• v.47 no.3
• /
• pp.242-249
• /
• 2020

Background The Exoscope is a novel high-definition digital camera system. There is limited evidence signifying the use of exoscopic devices in microsurgery. This trial objectively assesses the effects of the use of the Exoscope as an alternative to the standard operating microscope (OM) on the performance of experts in a simulated microvascular anastomosis. Methods Modus V Exoscope and OM were used by expert microsurgeons to perform standardized tasks. Hand-motion analyzer measured the total pathlength (TP), total movements (TM), total time (TT), and quality of end-product anastomosis. A clinical margin of TT was performed to prove non-inferiority. An expert performed consecutive microvascular anastomoses to provide the exoscopic learning curve until reached plateau in TT. Results Ten micro sutures and 10 anastomoses were performed. Analysis demonstrated statistically significant differences in performing micro sutures for TP, TM, and TT. There was statistical significance in TM and TT, however, marginal non-significant difference in TP regarding microvascular anastomoses performance. The intimal suture line analysis demonstrated no statistically significant differences. Non-inferiority results based on clinical inferiority margin (Δ) of TT=10 minutes demonstrated an absolute difference of 0.07 minutes between OM and Exoscope cohorts. A 51%, 58%, and 46% improvement or reduction was achieved in TT, TM, TP, respectively, during the exoscopic microvascular anastomosis learning curve. Conclusions This study demonstrated that experts' Exoscope anastomoses appear non-inferior to the OM anastomoses. Exoscopic microvascular anastomosis was more time consuming but end-product (patency) in not clinically inferior. Experts' "warm-up" learning curve is steep but swift and may prove to reach clinical equality.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.42
• /
• pp.29.1-29.7
• /
• 2020

Background: Microvascular reconstruction is the treatment of choice after oral cancer ablation surgery. There are few published studies of free flap survival among Korean populations. This study aimed to determine the survival rate after 121 consecutive cases of maxillofacial microvascular reconstruction and to analyze the complications associated with microsurgery. Methods: This study included consecutive patients who underwent microsurgical reconstruction with free flaps, from January 2006 through September 2019, performed by a single surgeon at the oral and maxillofacial surgery department of a tertiary medical center. A total of 121 cases were reviewed retrospectively. The flap survival rate, flap type, radiotherapy history, complications, and treatment results were analyzed. Results: Four different flap types were used for microvascular reconstruction: radial forearm (n = 65), fibula (n = 34), latissimus dorsi (n = 21), and serratus anterior muscle with rib bone free flap (n = 1). Total necrosis of the flap was found in four cases (two latissimus dorsi flaps and two fibular flaps). The free flap survival rate was 97.5%. Nineteen patients received radiotherapy before surgery, and none of them experienced flap failure. The mean operation time was 334 ± 83.1 min, and the mean ischemic time was 48.9 ± 12.7 min. Conclusions: The success rate was reliable and comparable with previous studies. The success rate was not affected by radiation therapy. Free flaps can be safely used even after radiation treatment.

• Archives of Reconstructive Microsurgery
• /
• v.16 no.2
• /
• pp.53-56
• /
• 2007

Purpose: Microsurgical exercise has been performed with rat femoral vessels. But, it needs animal laboratory, anesthesia and its keeping facilities. Materials and Methods: Ten human placentas were studied for suitability in a microvascular exercise. The size and useful length of vessels were measured, and various microvascular anastomoses were performed. Result: The human placenta has many vessels traversing its fetal surface. A variety of sizes are available down to vessels of diameter 1 mm and up to vessels of diameter 6.5 mm (1.0

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.37 no.4
• /
• pp.312-320
• /
• 2011

A reconstruction following a resection of malignant oral cavity tumors is one of the most difficult problems in recent oral oncology. For a better understanding of oral and maxillofacial reconstructive procedures, basic and advanced microvascular anastomosis techniques must be learned and memorized. The aim of this article was to clarify and define the microvascular anastomosis methods, such as primary closure after an arteriotomy, end to side anastomosis, end to end anastomosis, and side to side anastomosis with an artery and vein. This review article discusses the basic skills regarding microvascular anastomoses with brief schematic diagrams in the Korean language. This article is expected to be helpful, particularly to young doctors in the course of the Korean national board curriculum periods for oral and maxillofacial surgery.

• Archives of Plastic Surgery
• /
• v.42 no.6
• /
• pp.741-745
• /
• 2015

Background Microvascular complications after free-flap breast reconstructions are potentially devastating problems that can increase patient morbidity and lead to flap loss. To date, no comprehensive study has examined the rates of salvage and the methods of microvascular revision in breast reconstruction. We reviewed the treatment of microvascular complications of free-flap breast reconstruction procedures over a seven-year period. Methods A retrospective review of all patients who underwent microvascular breast reconstruction at our institution between April 2006 and December 2013 was conducted. Based on their surgical records, all patients who required emergency re-exploration were identified, the rate of flap salvage was determined, the factors associated with flap salvage were evaluated, and the causes and methods of revision were reviewed. Results During the review period, 605 breast reconstruction procedures with a free lower abdominal flap were performed. Seventeen of these flaps were compromised by microvascular complications, and three flaps were lost. The overall salvage rate was 82.35%. No significant differences between the salvaged group and the failed group were observed with regard to age, BMI, axillary dissection, number of anastomotic arteries and veins, recipient vessel types, or use of the superficial inferior epigastric vein in the revision operation. Successful salvage of the flap was associated with a shorter time period between recognizing the signs of flap compromise and the take-back operation. Conclusions The salvage rate of compromised lower abdominal flaps was high enough to warrant attempting re-exploration. Immediate intervention after the onset of flap compromise signs is as important as vigilant postoperative monitoring.

• Archives of Plastic Surgery
• /
• v.46 no.3
• /
• pp.214-220
• /
• 2019

Background Microvascular anastomosis patency is adversely affected by local and systemic factors. Impaired intimal recovery and endothelial mechanisms promoting thrombus formation at the anastomotic site are common etiological factors of reduced anastomosis patency. Epigallocatechin gallate (EGCG) is a catechin derivative belonging to the flavonoid subgroup and is present in green tea (Camellia sinensis). This study investigated the effects of EGCG on the structure of vessel tips used in microvascular anastomoses and evaluated its effects on thrombus formation at an anastomotic site. Methods Thirty-six adult male Wistar albino rats were used in the study. The right femoral artery was cut and reanastomosed. The rats were divided into two groups (18 per group) and were systemically administered either EGCG or saline. Each group were then subdivided into three groups, each with six rats. Axial histological sections were taken from segments 1 cm proximal and 1 cm distal to the microvascular anastomosis site on days 5, 10, and 14. Results Thrombus formation was significantly different between the EGCG and control groups on day 5 (P=0.015) but not on days 10 or 14. The mean luminal diameter was significantly greater in the EGCG group on days 5 (P=0.002), 10 (P=0.026), and 14 (P=0.002). Intimal thickening was significantly higher on days 5 (P=0.041) and 10 (P=0.02). Conclusions EGCG showed vasodilatory effects and led to reduced early thrombus formation after microvascular repair. Similar studies on venous anastomoses and random or axial pedunculated skin flaps would also contribute valuable findings relevant to this topic.

• Archives of Reconstructive Microsurgery
• /
• v.15 no.2
• /
• pp.51-57
• /
• 2006

Free flap having been used for reconstruction of skin and soft tissue defect in various areas in a body is spreading up its application for not only functional reconstruction but also aesthetic reconstruction. Authors met with good results minimizing the demerits of anastomosis using suture through microvascular anastomotic device, hereupon, we intend to report this. We worked with 27 cases that used microvascular anastomotic device for venous anastomoses among patients who were processed free flap in our hospital. Age ranged from 12 to 63 (average 43.2), and there were 12 females and 15 males. As a result of a follow-up by 3 months - 5years (average 11.3 months), there was no particular complication in the anastomosed vein except 1 cases among 27 cases that sutured their veins through microvascular anastomotic device. Use of microvascular anastomotic device at free flap shortened the time required for vascular anastomoses to reduce ischemic time of tissue, and minimized the damage of intima during anastomoses and made easy anastomoses possible even in case the difference of diameters of blood vessels being sutured is wide. As well, even for survival rate of flap, satisfactory results were obtained compared with using suture. Consequently, it is concluded that use of microvascular anastomotic device in free flap is a useful way that can substitute existing anastomosis using suture.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.22 no.2
• /
• pp.133-141
• /
• 2000

Purpose : The purpose of this study is to estabilish clinical guidance of microvascular anastomosis in diabetic patients. This study was performed with experimental microvascular anastomosis in streptozotocin induced diabetic rats and observed histopathologic change and endohelial healing process. Materials and Methods : 70 Sprague-Dawley rats, weighting 200 to 250grams, were used for the experiment. 35 induced diabetic rats with streptozotocin and 35 control group were selected. After end-to-end carotid artery microvascular anastomosis was done, the experimental rats were sacrificed at different time interval (1st day, 3rd day, 1st week, 2nd, 4th, 6th and 8th week) for histologic examination. Light microscope observation was used in this study. Results : 1. Histopathologic changes are nearly the same healing process in two groups. But period of tissue reaction was faster in the control than diabetic group. 2. In endotheliall healing, control group started at 1 week after and completed at 4 weeks after, but diabetic group was observed partially at 4 weeks after and complete healing was not observed still at 8 weeks after. 3. In subintimal hyperplasia, control group was observed at 6 weeks after but diabetic group was observed at 6 weeks after and partially at 8 weeks after. 4. All groups showed severe inflammatory response in the early period. This respond is decreased at 2 weeks after in control group but still remained at 8 weeks after in the diabetic group. 5. In media, inflammatory response and degeneration were observed in early period. Regeneration of smooth muscle cell was observed at 1 week after in control group but 4 weeks after in the diabetic group. Conclusions : As the results of study, it could be thought that vascular regeneration process was not failured but delayed in the diabetes. It was considered that diabetes mellitus was not absolute contraindication of microvascular anastomosis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• v.47 no.6
• /
• pp.432-437
• /
• 2021

Objectives: The mandible and other parts of the maxillofacial region suffer significant morbid injuries following road traffic accidents. Our study gives epidemiological description of mandibular fractures in Ghana and also evaluates the relevance of closed reduction and indirect fixation for managing mandibular fractures in low-resource health facilities in low-income countries like Ghana. Patients and Methods: This is a retrospective study involving 268 patients who reported to the Department of Oral and Maxillofacial Surgery of the Sunyani Regional Hospital with mandibular fractures from January 2010 to December 2019. Patient medical records were assessed for information on age, sex, fracture etiology, anatomic location of fracture, time of day of road traffic accident, and other associated injuries. Results: A total of 268 patients were included in this study (males, 216 [80.6%]; females, 52 [19.4%]). Motor vehicular accident (MVA) was the leading cause of mandibular fractures (202 injuries, 75.4%). Other etiologies included assault (39, 14.6%), gunshot (13, 4.9%), falls (12, 4.5%), and industrial accidents (2, 0.7%). Of the 161 male cases caused by MVA, 121 (75.2%) occurred at night and in the evening while the remaining 40 (24.8%) occurred in the morning and afternoon. Among all managed 222 patients, 212 (79.1%) were treated with closed reduction and indirect fixation technique while 10 (3.7%) were treated with open reduction and direct fixation. Conclusion: Closed reduction with indirect fixation could successfully be used to manage mandibular fractures in low resourced health facilities, especially in low-income countries. The poor lightening system on roads in Ghana is a major contributory factor to motor vehicular accidents.