Using 70 SD white rats, diveded in two groups at random, after the common carotid artery wa(?) exposed, anastomosis of the artery was done by whole-layer suture and suture without including the endothelial layer, respectively. The rate of patency of both groups immediately after operation was 100 percent, where as in late stage, 94 percent and 97 percent, respectively. From the histologic exam ination, it was found that in the group of whole-layer suture, the time required to cover the sutureline with endothelium was delayed and there was rupture of the clastic fibers.
rom Aug.1965 to Dec. 1992,29 patients suffered from the peudoaneurysms were treatedwlth 4 different methods. They were:1.ligating the vessels;2. repairing the defected area in thearterial watl: 3, anastomosing the vessels after the peudoaneurysms being removed; 4, repoiring thearteries with vessel grafts after the resection of the poudoaneurysm or by-passing operation. Of the 4different methed, the method 3 and 4 gave the best results. It was thought that the operation should bep...
OBJECTIVE To investigate the clinical result in repair of soft tissue defect with combined skin flap vascularized by pedicle on the one end and vascular anastomosis on the other end. METHODS From October 1990 to August 1995, 5 cases with soft tissue defect at the extremities and 1 cases with sacral bed sore were repaired by the combined skin flaps transfer, ranged from 15 cm x 30 cm to 16 cm x 70 cm in defect, among them, 5 cases with myocutaneous flap and 1 case with skin flap, and the size of the combined skin flaps was 15 cm x 40 cm to 12 cm x 80 cm. RESULTS All the flaps were survived with satisfactory effect. Followed up 3 to 6 years, there was no obvious complication. CONCLUSION Transfer of combined skin flaps vascularized by pedicle and vascular anastomosis is suitable to repair the soft tissue defect, especially in large area defect.
Abstract In order to study the possibility of repairing bone defect by cryopreserved vascularized bone allograft, 8 dogs were divided into 2 groups. In the experimental group, 15% dimethylsulfoxide (DMSO) was used as a cryoprotective agent, the posterior segments of dog s rib, pedicled with intercostal vesseles, were cryopreserved by a two-step freezing procedure,stored in liquid nitrogen for 96 hours, and then transplanted as allografts to theiliac bone defects of recipients by vascular anastomosis. In the control group, the autografts were transplanted in the same procedure. Immunosuppersive agents were administrated postoperatively for 3 weeks. The specimens were analyzed by immune response monitoring (IL-2, T cell subsets), SPECT scanning, angiography and pathologic examination. The results showed that the allografts had good blood supply and active osteocyte metabolism, bone healing of the allografts was perfect at 3 months and no evidence of immunologic rejection. The process of bone healing of allografts should be further investigated.
ObjectiveTo investigate the advantages of magnetic compressive anastomosis (MCA) for non-suture femoral artery anastomosis. MethodsTwelve adult health mongrel dogs,weighing (16.5±3.6) kg,were selected for in situ end-to-end anastomosis of the femoral artery.One side of the femoral artery was anastomosised with MCA (group A) and the other side of the femoral artery was anastomosised by hand-suturing (group B).The anastomosis time,complications,and vascular bursting pressure were recorded.Gross observation,histological staining (HE and Masson),and scanning electron microscopy observation were performed at 2,4,12,and 24 weeks postoperatively. ResultsThe anastomosis time in group A [(3.89±1.16) minutes] was significantly shorter than that in group B [(14.16±3.72) minutes] (t=14.226,P=0.000).The complication rate of group A (0) was significantly lower than that of group B (75%)(P=0.000).At immediate,4 and 12 weeks after operation,the vascular bursting pressure of anastomosis site in group A was more than 280 mm Hg (1 mm Hg=0.133 kPa),and was (140.11±15.23),(180.31±24.55),and more than 280 mm Hg in group B,showing significant differences at immediate and 4 weeks (P<0.05),but no significant difference at 12 weeks (P>0.05).In group A at 4 weeks,good intima contact,smooth endothelium,and regular arrangement of endothelial cells were observed;at 12 weeks,chronic inflammation was present,with a few lymphocytes infiltration;and at 24 weeks,inflammation significantly decreased.But in group B,obvious suture foreign body and scar formation were observed,which led to uneven surface with lumen incomplete intima,and irregular endothelial cells in arrangement disorder. ConclusionCompared with traditional hand-suturing,the MCA has the advantages of shorter operation time,higher patency rate,less complication,and better healing at the anastomotic site.Non-suture anastomosis of the femoral artery by MCA can achieve reliable results.
The formation of an arteriovenous fistual for dialysis by routine interrupted sutures anastomosing the vein and artery is difficult to perform and time-consuming. A new method, telescopic adhesive anastomosis was studied and applied in 10 hemodialysis patients, who were in need of an arteriovenous fistula. The external diameter of the vessels anastomosed was 2.40 +/- 0.20 mm (radial artery) or 2.40 +/- 0.35 mm (cephalic vein). After thorough debridement of the vascular ends, the arterial end was put in the venous lumen. In order to fix the telescopic vessels, two stitches were applied 180 degrees apart from each other and tied. Each stitch was inserted from vein (penetrating the whole wall) to artery (just through the adventitia and partial thickness of the media vasorum). The distance from the stitch to the edge of the vein was 0.5 mm, and that of the artery was approximated to the external diameter of the vessle. The medical adhesive was then applied for sealing the anastomotic adventitia. Ten seconds were given for the solidification of the adhesive. The patients were followed up for 8 months. The patency rate was 100%, and the rate of blood flow was more than 300 ml/min (measured by ultrasonography). It was shown that this method could be managed easily and quickly, and the so-formed fistula would fulfill the need of hemodialysis.
OBJECTIVE: To study the anatomical basis for reconstruction of vertebral artery with neighboring non-trunk arteries. METHODS: Twenty preserved adult cadavers were used in this study to observe the morphology of superior thyroid artery, inferior thyroid artery, transverse cervical artery, thyrocervical trunk and extracerebral portion of vertebral artery, and reconstruction of vertebral artery with these arteries was simulated in two preserved cadavers. RESULTS: The calibers of superior or inferior thyroid artery, or transverse cervical artery were more than 2 mm in diameter, and the arteries had suitable free length for end-to-side anastomosis with vertebral artery. Thyrocervical artery had similar caliber to vertebral artery so that end-to-end anastomosis could be carried out between them, but only 38.5% of this artery had adequate artery trunk (more than 10 mm). It was proved from the simulated procedures that the reconstruction of vertebral artery with these neighboring non-trunk arteries was possible. CONCLUSION: Reconstruction of vertebral artery with neighboring non-trunk arteries has anatomical basis and can be used clinically for treatment of the lesion affecting the first or second portion of vertebral artery.
The method of diversion of the arteryvein flow was used for vascular anastomosis in 12 cases undergoing replantation of the severed limbs(fingers)and free tissue transplantations. The results from this method were successful. The efficacy of this method of re-establishment of the blood circulation broadened the indications for replantation and also provided a method of choice in cases when there was impediment of the venous return during tissue transplantation.
Objective To summarize the anatomical types of the concomitant veins of deep inferior epigastric artery and the corresponding choice of anastomosis methods, and to evaluate the indications and safety of various methods. MethodsBetween October 2015 and June 2021, 296 female patients received breast reconstruction with autologous free lower abdominal flap, including 154 cases of immediate breast reconstruction and 142 cases of delayed breast reconstruction. The average age of the patients was 36.5 years, ranged from 26 to 62 years. Unilateral free deep inferior epigastric artery perforator flap transplantation was performed in 172 cases, and unilateral free muscle-sparing rectus abdominis myocutaneous flap transplantation was performed in 124 cases. The internal thoracic vessels were selected as the recipient vessels in all cases. The length of vascular pedicle ranged from 9.5 to 13.0 cm, with an average of 11.2 cm. The concomitant veins of deep inferior epigastric artery included three anatomical types: one-branch type in 26 cases (8.8%), two-branch type in 180 cases (60.8%), and Y-shaped structure in 90 cases (30.4%). Anastomosis of inferior epigastric artery was performed with the proximal end of internal thoracic artery, while that of vein should be adjusted according to the diameter, length, wall thickness, and branches of the vein. The specific classification of venous anastomosis included: ① The sole concomitant vein of deep inferior epigastric artery was anastomosed with the internal mammary vein (26 cases); ② The two concomitant veins of deep inferior epigastric artery were anastomosed with the internal mammary vein respectively (151 cases); ③ The larger one of two concomitant veins of deep inferior epigastric artery was anastomosed with the internal mammary vein, and the other one was ligated and discarded (29 cases); ④ The two concomitant veins of deep inferior epigastric artery were Y-shaped, and the common trunk segment was directly anastomosed with the internal mammary vein (31 cases); ⑤ The smaller branch of the concomitant veins of Y-shaped structure was ligated, and the thicker branch was anastomosed with the internal mammary vein (17 cases); ⑥ The concomitant veins of Y-shaped structure were anastomosed with the internal mammary veins respectively (42 cases). Results Among the patients who underwent venous anastomosis according to scheme ④, 3 cases had venous crisis of flap after operation, of which 1 case was successfully rescued by emergency exploration; the other 2 cases had flap necrosis, of which 1 case survived after being repaired by pedicled latissimus dorsi flap, and 1 case closed the wound directly. Flaps with other venous anastomosis protocols survived completely. All 296 patients were followed up 12-70 months, with an average of 37.5 months. The reconstructed breast has good shape, good elasticity, and no skin flap contracture. The donor site of the flap only left linear scar, and the abdominal wall function was not affected. ConclusionThe method of direct anastomosis of concomitant veins of deep inferior epigastric artery with Y-shaped structure is relatively risky, and the vessels are prone to be twisted and compressed, leading to the occurrence of venous crisis. It can improve the safety of surgery if only one large vein is anastomosed or two veins are separated to anastomose respectively.