Application of parachute suture technique in variant donor renal artery anastomosis of living-donor renal transplantation / 国际外科学杂志

Objective:To investigate the effects and advantages of parachute technique in arterial anastomosis of living-donor renal transplantation with anatomical variations of renal artery.Methods:A total of 79 pairs of donors and recipients who received living-donor renal transplantation at the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2020 to November 2022 were retrospectively collected. 11 pairs with completeness data and multiple donor renal arteries were selected. According to the different techniques, the cases using parachute technique were classified as experimental group and other cases as control group using traditional two-three-point fixation technique. There were 5 pairs in the experimental group and 6 pairs in the control group. The medical records of the two groups were collected, containing general data, the state of donated kidney, the arterial reonstruction method, the condition of perioperation and recovery of recipients. Measurement data were expressed as mean ± standard deviation ( ± s). Student- t test was used for inter-group comparison. The Chi-square test or Fisher exact probability method were used to compare the count data of groups. Results:The donations of experimental group and control group were left-sided kidney. There were no statistical difference in age, gender, body mass index and estimated glomerular filtration rate of donors and recipients. The average number of renal arteries in the experimental group was 2.2, and that in the control group was 2.0. There were no statistical difference between the two groups in the mean time of transplantation surgery[(152.0±23.9) min vs (148.3±24.0) min], estimated blood loss [(90.0±41.8) mL vs (91.7±58.5) mL] and mean arterial anastomosis time [(21.0±5.4) min vs (20.8 ± 4.7) min]. At the end of arterial anastomosis, no case in the experimental group need acupuncture or secondary anastomosis, while the control group had 3 cases, the difference was statistically significant ( P=0.002). There was no statistical difference in the recovery of renal function and complications related to renal arteries between the two groups ( P>0.05). Conclusions:Parachute suture technique can more accurately achieve the purpose of layer-to-layer eversion suture of vascular wall under the condition of narrow arterial lumen, and will not significantly prolong the operation time. It may have a good application value in living kidney transplantation with renal artery variation.

Neurodevelopmental outcomes in twin-to-twin transfusion syndrome survivors at 12 months old after fetoscopic laser occlusion of chorioangiopagous vessels / 中华围产医学杂志

Objective:To investigate the risk factors for cerebral injury in survivors of twin-to-twin transfusion syndrome (TTTS) after fetoscopic laser occlusion of chorioangiopagous vessels(FLOC) and to analyze the neurodevelopmental outcomes at 12 months of corrected age.Methods:A total of 136 cases of TTTS receiving FLOC in the Third Affiliated Hospital of Zhengzhou University from May 2018 to August 2021 were retrospectively selected as the FLOC group, and the survivors were followed up. Neurological development at 12 months of corrected age was assessed using the Griffiths mental development scales-Chinese (GDS-C) from five dimensions with locomotor, personal-social, hearing and language, hand-eye coordination and performance subscales. Eighty-eight fetuses of TTTS pregnancies receiving expectant treatment or amniotic fluid reduction were selected as the non-FLOC group. The perinatal mortality and the incidence of cerebral injury in the two groups were compared, as well as the incidence of cerebral injury between patients undergoing Solomon surgery and selective laser surgery in the FLOC group. Generalized estimating equations were used to analyze the risk factors for neonatal cerebral injury after FLOC and the factors influencing general developmental quotient score at the corrected age of 12 months. Chi-square test, t-test, and Mann-Whitney U test were used for statistical analysis. Results:(1) The perinatal mortality rate in the FLOC group was lower than that in the non-FLOC group [14.7% (20/136) vs 26.1% (23/88), χ 2=4.50, P=0.034]. There was no statistical significance in the incidence of neonatal cerebral injury between the two groups [18.7% (23/123) vs 21.8% (17/78), χ 2=0.29, P=0.592], but the incidence of severe cerebral injury in the FLOC group was lower than that in the non-FLOC group [6.5% (8/123) vs 15.4% (12/78), χ 2=4.20, P=0.040]. (2) In the FLOC group, there was no significant difference in the incidence of cerebral injury between donors and recipients, or between Solomon surgery and selective laser surgery [16.4% (10/61) vs 21.0% (13/62), χ 2=0.42; 20.0% (9/45) vs 17.9% (14/78), χ 2=0.08; both P>0.05]. (3) Multivariate analysis showed that neonatal asphyxia ( OR=7.04, 95% CI: 1.45-34.20, P=0.016) and higher preoperative TTTS stage ( OR=2.05, 95% CI: 1.10-3.82, P=0.023) were risk factors for neonatal cerebral injury. (4) Fifty-two cases were successfully followed up at the corrected age of 12 months, and the incidence of developmental delay in at least one dimension was 34.6% (18/52). Developmental delay was mainly manifested in locomotor skills and language, accounting for 26.9% (14/52) and 11.5% (6/52). No significant difference in Z value was found between recipients and donors in each dimension (all P>0.05). Solomon surgery, larger gestational age at operation and low birth weight were related to low general developmental quotient score (95% CI:－11.71 to－0.23，－1.99 to－0.47，0.00-0.01，respectively，all P<0.05). Conclusions:The occurrence of cerebral injury in TTTS survivors after FLOC is related to preoperative TTTS staging and intrapartum neonatal asphyxia. Neurodevelopment of survivors is related to birth weight and gestational age at surgery, and there is a higher incidence of mild developmental delay at corrected age of 12 months.

The design of the arteriovenous vascular loop does not affect its patency: experimental study / O formato da alça vascular não afeta a patência arteriovenosa: estudo experimental

ABSTRACT Objective: To evaluate the effect of the design of a femoral vascular loop with anastomosis in the femoral artery of rabbits on the presence of flow (patency) after seven days. Methods: A total of 39 rabbits underwent arteriovenous microanastomosis using the microsurgical technique. Two loop designs were used: one circular and the other angled. The parameters evaluated were presence or absence of flow, signs of hemolysis and hemodynamic changes. Results: After seven days, flow was present in 68% of the angled loops and 75% of the circular loops (p > 0.05). There was a significant intragroup decrease in pCO2 and a significant increase in pH. For the other parameters evaluated, no significant differences between the two loop models were found. Conclusions: A reproducible vascular loop model was shown. There was no significant difference between the two vascular loop models about the presence of flow after seven days. Level of Evidence V, Animal experimental study.

RESUMO Objetivo: Avaliar, em coelhos, qual é a influência do desenho da alça de veia femoral com anastomose na artéria femoral, na presença de fluxo (patência) após sete dias. Método: 39 coelhos foram submetidos à microanastomose arteriovenosa com técnica microcirúrgica. As alças foram acomodadas em dois desenhos, um circular e outro, o mais alongado possível sem dobras na alça. Os parâmetros avaliados foram: presença ou não de fluxo, sinais de hemólise, alterações hemodinâmicas. Resultados: após sete dias, o fluxo estava presente em 68% das alças anguladas e em 75% das alças circulares (p > 0,05). Houve, intragrupo, diminuição estatisticamente significante da pCO 2 e aumento estatisticamente significante do pH. Não houve diferença estatística no restante dos parâmetros avaliados entre os dois modelos de alça. Conclusões: apresentamos um modelo reprodutível de alça vascular. Não houve diferença estatística quanto à presença de fluxo após sete dias nos dois modelos de alça vascular. Nível de Evidência V, Estudo experimental em animais.

Curva de aprendizado de anastomose arteriovenosa com uso de simulador de baixo custo / Arteriovenous anastomosis learning curve using low cost simulator

Resumo Contexto A redução das dificuldades no aprendizado da técnica cirúrgica levou ao surgimento de ferramentas complementares. Este trabalho descreve a curva de aprendizado dos alunos sujeitos da pesquisa, utilizando um modelo alternativo para a prática de anastomose vascular. Objetivos Avaliar a curva de aprendizado da técnica de anastomose vascular e do desenvolvimento de habilidades manuais a partir da utilização de um modelo experimental de baixo custo. Métodos Este trabalho é um estudo experimental e prospectivo, com a realização de anastomoses vasculares do tipo terminolateral em balões de látex durante cinco fases sucessivas, iniciadas após orientação teórico-prática de uma cirurgiã vascular experiente. Os sujeitos foram seis graduandos do curso de Medicina, do terceiro ao quinto ano, da Universidade Federal da Paraíba (UFPB), João Pessoa, Paraíba, Brasil. A interpretação do material coletado acerca da qualidade das anastomoses e do tempo utilizado seguiu a análise de agrupamento. Resultados Houve redução do tempo de realização das anastomoses de todos os alunos, com diferença estatística da fase 1 quando comparada às fases 4 e 5, bem como tendência crescente no índice de qualidade ao longo das fases. Porém, não foi detectada diferença estatística a partir do teste de Friedman, apropriado para dados com nível de mensuração ordinal (escala de 1 a 5 na avaliação da qualidade). Conclusões O modelo de treinamento utilizado foi efetivo para incremento do aprendizado dessa técnica, acreditando-se que amostras de maior tamanho ou com maior número de fases em trabalhos futuros poderiam demonstrar redução do tempo associada a melhora da qualidade da anastomose realizada com significância estatística.

Abstract Background In order to reduce difficulties with learning surgical techniques, supplementary tools for training were developed. This paper describes the learning curve followed by student volunteer research subjects who used an alternative model for practicing vascular anastomosis. Objectives To evaluate the vascular anastomosis technique learning curve and development of manual skills using a low-cost experimental model. Methods Experimental and prospective study using end-to-side vascular anastomosis in latex balloons over five successive phases, initiated after theoretical and practical guidance given by experienced vascular surgeon. The study subjects were six undergraduate medical students from Universidade Federal da Paraíba (UFPB), João Pessoa, PB, Brazil, in their third to fifth years of the course. Cluster analysis was used to interpret the data collected on the quality of anastomoses and the time taken. Results The time taken to perform anastomosis reduced for all students, with statistical differences from phase 1 compared to phases 4 and 5. There was also a trend to increasing scores on the quality index as the phases progressed. However, no statistical differences were detected using the Friedman test, which is appropriate for data measured with ordinal levels (quality was assessed on a scale of 1 to 5). Conclusions It was found that the training model used was effective for increasing learning of this technique. It is believed that future studies with larger samples or a higher number of phases could demonstrate both reduced time and improved quality of the anastomoses performed with statistical significance.

Expanded flaps with vascular anastomosis for the treatment of scar contracture deformities of extensively burned patients / 中华烧伤杂志

Objective@#To explore the effect of expanded flaps with vascular anastomosis in the treatment of scar contracture deformities of extensively burned patients.@*Methods@#From April 2016 to February 2018, 9 patients with severe scar contracture deformities caused by extensive burns were hospitalized in our unit, including 7 males and 2 females, aged 23-54 years. There were 14 sites of scar contracture deformities and dysfunction, including 8 in face and neck, 2 in elbow, and 4 in wrist and hand. The expander was inserted into the chest or abdomen and was expanded by 2 to 3 times of its rated volume with injection of normal saline. After satisfied expansion, the expanded flap was harvested and transplanted with arteriovenous anastomosis onto the recipient site, where the scar was removed, the deformity was corrected, and the contracture was released. The number of expanders, the volume of normal saline injected, the period of expansion, the complications of skin and soft tissue expansion, the number, size, thickness, transplantation modes, and survival of flaps, and the repair method of donor site were observed and recorded. The reconstruction effect of scar contracture deformity was followed up. The patients′ satisfaction with the therapeutic effect of various surgical sites during follow-up was investigated with a 5-point Likert Scale. The Burn Specific Health Scale-Brief was used to evaluate the quality of life of the patients pretreatment and during follow-up. Data were processed with paired sample t test or Wilcoxon signed-rank sum test.@*Results@#A total of 16 expanders were inserted in this group of patients, including 6 in the chest and 10 in the abdomen. The volume of normal saline injected at the end of expansion was (1 421±348) mL. The expansion time was (8.1±2.6) months. One case of expander leakage and one case of injection port turnover resulted in failure of water injection occurred during expansion. Totally 17 flaps were resected from 16 expanded areas. The size of flaps ranged from 15 cm×13 cm to 30 cm×25 cm. The thickness was (0.49±0.06) cm in 6 chest flaps and (0.76±0.15) cm in 11 abdomen flaps. Free transplantation with vascular anastomosis was performed in 14 flaps, and pedicled transplantation supercharged with distal vascular anastomosis was performed in 3 flaps, one of which the vascular pedicle was divided and re-anastomosed to the other side of the recipient area 2 weeks later. Except for one donor site of abdomen flap which was transplanted with thin split-thickness scalp, the other donor sites were sutured directly. After operation, 2 flaps were slightly necrotic at the distal end and healed after dressing change and thin split-thickness scalp transplantation respectively, while the remaining 15 flaps all survived. During the follow-up of 6-24 months, the texture of the flaps was soft. The abdomen flap transplanted to the palm of hand in one patient was slightly hypertrophic, which was thinned 3 months after operation, while the other flaps were good in thickness. At the last follow-up, the appearance and function of the sites repaired by flaps of all patients were obviously improved compared with those before operation, the satisfaction score of the patients with the therapeutic effect of the surgical site was (4.4±0.6) points, the total score of quality of life and the scores of heat sensitivity, treatment antipathy, body image, and affect of patients were significantly higher than those before treatment (t=3.232, 2.683, 3.969, 2.884, 2.588, P<0.05), while the scores of hand function, sexuality, interpersonal relationship, simple function abilities, perception in returning to work of patients were close to those before treatment (t=0.778, 1.000, 1.664, Z=1.826, 1.633, P>0.05).@*Conclusions@#Expanded flaps with vascular anastomosis are suitable for the treatment of scar contracture deformities of extensively burned patients. The flaps are large in size and suitable in thickness. The donor sites are easy to be closed directly. The treatment can obviously improve the appearance, function, and the quality of life of the patients, with a high satisfaction of patients.

Clinical application of lobulated transplantation of free anterolateral thigh perforator flap in the treatment of electric burns of limbs / 中华烧伤杂志

Objective@#To explore the clinical efficacy of lobulated transplantation of free anterolateral thigh perforator flap in repairing electric burn wounds of limbs.@*Methods@#From August 2014 to April 2019, 19 patients with electric burns in the limbs were hospitalized in our unit, including 18 males and 1 female, aged 20-58 years. There were 37 wounds deep to bone. The area of wounds ranged from 3.0 cm×2.0 cm to 40.0 cm×8.0 cm. Multiple-perforator-based anterolateral thigh flap was designed and resected. Then the flap was lobulated taking the respective perforators of the lateral circumflex femoral artery as the axial vessels before being transplanted to the debrided wounds in the limbs. The blood vessel trunk or the perforator vessels of flap lobes were anastomosed with the respective vessels in the recipient sites. The wounds were repaired with respective lobes of the flap when repairing multiple wounds in one surgical procedure, whereas the lobes were spliced or staggered to cover the wound to fit the shape of wound when repairing a single irregular wound in one surgical procedure. For the limb with distal blood supply disorder, the blood supply branch of flap was used to reconstruct the blood supply. If necessary, an appropriate length of vein was taken for transplantation. The improvement of reconstructed blood supply was observed. The number of surgeries, the number of anterolateral thigh perforator flaps, the number and size of flap lobes, the number of anastomosed vessels in each surgery, the treatment of the donor sites, the length of each surgery, the postoperative complications and survival condition of flap lobes were recorded. The upper extremity function was evaluated with the Carroll′s Upper Extremity Function Test Scale, and the patients′ satisfaction degree with the therapeutic effect of each surgery was investigated with a 5-point Likert Scale during follow-up. Surgeries were divided into single wound group of repairing one wound at one time and multiple wounds group of repairing two or more wounds at one time. The number of anastomosed vessels in each surgery, the treatment of the donor sites, the length of each surgery, and the postoperative survival condition of the flap lobes were compared between the two groups. Surgeries were divided into early group of performing surgery within post burn day 7 and late group of performing surgery on post burn day 7 and beyond. The postoperative complications and survival condition of flap lobes, the evaluation score of upper limb function and the patients′ satisfaction degree with the therapeutic effect of each surgery at the last follow-up were compared between the two groups. Data were processed with independent sample t test, Mann-Whitney U test, or Fisher′s exact probability test.@*Results@#The blood supply of 5 patients with distal hand or finger blood supply disorder recovered or improved significantly after vascular transplantation. A total of 46 lobes [(2.2±0.4) lobes per flap] were obtained from 21 anterolateral thigh perforator flaps in 19 patients with 21 surgeries. The area of flap lobes ranged from 4.0 cm×3.0 cm to 24.0 cm×13.0 cm. In each surgery, 2.0 (1.5, 3.0) arteries and 3.0 (2.0, 3.0) veins were anastomosed. Six donor sites were repaired by thin split-thickness scalp, and 15 donor sites were closed directly. The duration of each surgery was (8.9±1.7) h. After surgery, bleeding and hematoma occurred in 2 flap lobes and local infection occurred in 5 flap lobes, which were improved after management. Vascular crisis occurred in 4 flap lobes, and exploratory surgeries were performed, after which 2 lobes survived, while the other 2 lobes necrotized and were repaired by other methods. The rest flap lobes survived well. After each postoperative follow-up of 3 to 60 months, the flap covering areas of the limbs were well-recovered. At the last follow-up, the function evaluation score of 20 affected upper limbs was 85 (63, 90) points, and the score of patients′ satisfaction degree with the therapeutic effect of each surgery was (4.4±0.7) points. A total of 30 flap lobes were obtained in 14 surgeries and repaired 30 wounds respectively in multiple wounds group, and 16 flap lobes were obtained in 7 surgeries and were spliced to repair 7 large irregular wounds in single wound group. There were no statistically significant differences in the number of anastomosed artery or vein in each surgery, and the duration of each surgery between multiple wounds group and single wound group (Z=0.240, 0.081, t=0.180, P>0.05), and the condition of skin grafting in the donor sites and the postoperative survival of the flap lobes in multiple wounds group were similar to those in single wound group (P>0.05). A total of 22 flap lobes were obtained in 10 surgeries and repaired 18 wounds in early group, and 24 flap lobes were obtained in 11 surgeries and repaired 19 wounds in late group. The incidence of postoperative hematoma, infection, vascular crisis, and survival of flap lobes in early group were similar to those in late group (P>0.05). There were no statistically significant differences in the patients′ satisfaction degree with the therapeutic effect of each surgery at the last follow-up between early group and late group (t=0.701, P>0.05). At the last follow-up, the function evaluation score of 9 upper limbs in early group was 90 (85, 97) points, significantly higher than 80 (40, 85) points of 11 upper limbs in late group (Z=2.431, P<0.05).@*Conclusions@#Free lobulated anterolateral thigh perforator flap is suitable for simultaneous repair of multiple electric burn wounds of limbs, as well as the repair of a single large irregular wound. It has the clinical advantages of less damage to the donor site and good repair quality. The early flap transplantation is beneficial to improve the function of limbs with electric burns.

Clinical repercussions of Martin-Gruber anastomosis: anatomical study / Repercussões clínicas da anastomose de Martin-Gruber: estudo anatômico

OBJECTIVE: The main objective of this study was to describe Martin-Gruber anastomosis anatomically and to recognize its clinical repercussions. METHOD: 100 forearms of 50 adult cadavers were dissected in an anatomy laboratory. The dissection was performed by means of a midline incision along the entire forearm and the lower third of the upper arm. Two flaps including skin and subcutaneous tissue were folded back on the radial and ulnar sides, respectively. RESULTS: Nerve communication between the median and ulnar nerves in the forearm (Martin-Gruber anastomosis) was found in 27 forearms. The anastomosis was classified into six types: type I: anastomosis between the anterior interosseous nerve and the ulnar nerve (n = 9); type II: anastomosis between the anterior interosseous nerve and the ulnar nerve at two points (double anastomosis) (n = 2); type III: anastomosis between the median nerve and the ulnar nerve (n = 4); type IV: anastomosis between branches of the median nerve and ulnar nerve heading toward the flexor digitorum profundus muscle of the fingers; these fascicles form a loop with distal convexity (n = 5); type V: intramuscular anastomosis (n = 5); and type VI: anastomosis between a branch of the median nerve to the flexor digitorum superficialis muscle and the ulnar nerve (n = 2). CONCLUSION: Knowledge of the anatomical variations relating to the innervation of the hand has great importance, especially with regard to physical examination, diagnosis, prognosis and surgical treatment. If these variations are not given due regard, errors and other consequences will be inevitable.

OBJETIVOS: Descrever anatomicamente a anastomose de Martin-Gruber e reconhecer suas repercussões clínicas. MÉTODO: Foram dissecados 100 antebraços de 50 cadáveres adultos no laboratório de anatomia. A dissecção foi feita através uma incisão mediana em todo o antebraço e terço inferior do braço, dois retalhos incluindo a pele e subcutâneo foram rebatidos, para o lado radial e ulnar respectivamente. RESULTADOS: A comunicação nervosa entre os nervos medianos e ulnar no antebraço (anastomose de Martin-Gruber) foi registrada em 27 antebraços. Classificamos a anastomose em seis tipos. Tipo I: anastomose entre o nervo interósseo anterior e o nervo ulnar (nove membros); Tipo II: anastomose entre o nervo interósseo anterior e o nervo ulnar em dois pontos (dupla anastomose - dois membros); Tipo III: anastomose entre o mediano e o nervo ulnar (quatro membros); Tipo IV: anastomose entre ramos dos nervos mediano e ulnar destinada ao músculo flexor profundo os dedos, esses fascículos formam uma alça de convexidade distal (cinco membros); Tipo V: anastomose intramuscular (cinco membros); Tipo VI: anastomose entre ramo do nervo mediano para o músculo flexor superficial e nervo ulnar (dois membros). CONCLUSÃO: O conhecimento das variações anatômicas em relação à inervação da mão tem importância relevante, principalmente quando se considera o exame físico, diagnóstico, prognóstico e tratamento cirúrgico. Se essas variações não forem valorizadas, erros e consequências serão inevitáveis.

Anastomose intramuscular de Martin-Gruber / Intramuscular Martin-Gruber anastomosis

Objetivo: A finalidade deste trabalho foi apresentar a incidência,origem, curso e ralações anatômicas da anastomose intramuscular de Martin-Gruber. Método: Foram dissecados 100 antebraços de 50cadáveres adultos. A comunicação nervosa intramuscular entre os nervos mediano e ulnar no antebraço (anastomose de Martin-Gruber)foi registrada em cinco antebraços, três no antímero direito e duasno esquerdo, sendo uma bilateral. Todas as comunicações nervosas localizavam-se entre os nervos interósseo anterior e o nervo ulnar.Conclusão: As comunicações nervosas intramusculares, que registramos em 5% dos 100 membros dissecados, tem apenas a finalidade de suprir o músculo flexor profundo dos dedos, sendo pouco provável que tenham alguma influência na inervação dos músculos intrínsecos da mão. Nível de Evidência IV, Série de Casos.

Objective: This paper reports the incidence, origin, courseand anatomical relationships of intramuscular Martin-Gruberanastomosis. Methods: Anatomical dissection of 100 limbsfrom 50 adults cadavers was performed. The intramuscularMartin-Gruber anastomosis was found in five forearms, threein the right and two in the left side, one was bilateral. All communicationwere located between the anterior interosseousnerve and the ulnar nerve. Conclusion: The purpose of intramuscularMartin-Gruber anastomosis, which we found in 5%of dissected limbs, is to supply the flexor digitorum profundusmuscle and it is unlikely to have any influence on the innervationof the intrinsic muscles of the hand. Level of Evidence IV,Cases Series.

Angioarquitectura placentaria y los orígenes de la patología monocorial

Los gemelos coriangiopagos (fetos que comparten una placenta) pueden tener de manera exclusiva asimetría en la distribución de territorios placentarios, con alta incidencia de inserción marginal y algunas veces en velamento del cordón umbilical; además, transfusiones interfetales (agudas o crónicas) que se producen por la presencia de comunicaciones sanguíneas (anastomosis placentarias). Resulta así una serie de fenotipos fetales que solo se presentan en este tipo de embarazos, en orden de frecuencia, el síndrome de transfusión feto-fetal, restricción del crecimiento intrauterino selectivo, síndrome de anemia-policitemia y la secuencia arterial reversa (twin reversed arterial perfusion- TRAP), pudiendo coexistir más de uno en un mismo embarazo. Es importante entonces el estudio de la angioarquitectura placentaria en los gemelos monocoriónicos, para comprender el comportamiento y el fenotipo que resultara en cada embarazo.

Chorio-angiopagus twins (fetuses sharing one placenta) may exclusively show asymmetry in the distribution of placental territories with high incidence of marginal insertion and sometimes velamentous placenta as well as twin-twin transfusion (acute or chronic) produced by vessel communications (placental anastomosis). A series of fetal phenotypes may result including twin-to-twin transfusion syndrome, selective intrauterine growth restriction, anemia-polycythemia syndrome, and twin reversed arterial perfusion - TRAP- sequence; they may coexist. It is therefore important to study placental angioarchitecture in monochorionic twins in order to understand resulting both outcome and phenotype.

The effect of diltiazern on patency rate of arteriovenous anastomosis in rat and how it works / 中华胸心血管外科杂志

Objective This study was designed to study the effect of Diltiazem on patency rate of arteriovenous anastomosis in rat and how it works.Methods 24 SD rats were divided into control group and experimental group,12 rats in each group.Experimental group rats were gavaged with Diltiazem after vascular anastomosis.Control group rats were gavaged with water.By comparing the patency rate and the thickness of artery to make sure whether Diltiazem will affect the patency rate.;By comparing the clotting time,prothrombin time,artial thromboplastin time,and serum thromboxane B2 levels to explore the pathway of diltiazem.Results The patency rate was 75％ in the experimental group and 25％ in control group.Compared with the control group,experimental group venous blood vessels in the film segment was significantly thicker,clotting time was prolonged,TXB2 levels in blood was decreased,the differences were statistically significant(P ＜ 0.05).There were no significant difference in prothrombin time and partial thromboplastin between two groups (P ＞ 0.05).Conclusion Diltiazem can inhibit the secretion of TXB2,antagonize the effct of antiplatelet,and increase the patency rate of vascular anastomosis in rats.

Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for repair of complex tissue defect of lower legs / 中华创伤杂志

Objective To introduce surgical repair methods of cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula for complex lower leg defect and discuss its clinical feasibility.Methods The study included 12 patients with tibial defect larger than 8 cm (range,9-12 cm) combined with soft tissue defect of 17 cm × 12 cm to 20 cm × 18 cm treated from May 2008 to May 2012.Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula was performed at the first phase.The flap pedicled with subscapular vessel was anastomosed to posterior tibial artery and vein of normal lower leg.The flap pedicled with anterior serratus muscle of distal thoracodorsal artery was anastomosed to peroneal vessel of fibular flap.External fixators were used to immobilize the bilateral lower legs postoperatively.Results All patients were followed up for 13-32 months (mean 21 months).According to Enneking system,mean leg function was scored 23 points after tandem transplantation of free latissimus dorsi muscle and free fibula,with recovery rate of 77％.Conclusions Cross-bridge transplantation of free latissimus dorsi muscular flap and free fibula tackles the problem of recipient vessel limitation.Further,the technique is effective in repair of large area of complex defect in lower legs.

Inner fistula by abdomino-back arteriovenous anastomosis in patients with hemodialysis / 中华全科医师杂志

Inner fistula by abdomino-back anastomosis of cephalic vein to radial artery was erformed in 86 patients with hemodialysis (test group) and end-to side arteriovenous anastomosis was performed in 85 cases (control group).There were no significant differences in postoperative anastomotic blood flow and vascular complications between two groups (P ＞ 0.05);however the average time consuming for operation in test group was shorter than that in control group (36 min vs.75 min,P ＜ 0.01).The minimally invasive abdomino-back anastomosis is a desired arteriovenous fistula method for hemodialysis patients.

Renal transplantation in rate :revascularization of renal artery by the modified sleeve anastomosis / 中华器官移植杂志

Objective To improve arterial anastomosis method for renal transplantation model in rats.Methods Male Fisher and Lewis rats were used as kidney donors and recipients respectively,and left kidneys were harvested in situ.Revascularizations of renal artery were fashioned end-to-end by the modified sleeve anastomosis.The renal artery was placed in the orthotopic position and sutures were inserted in order to place the feeding vessel into the receiving vessel.One invaginating suture was placed starting outside the donor's renal artery wall,approximately 2 mm from the free edge,then passing through the free edge of the recipient renal artery,and lastly passing again through the donor's renal artery wall out alongside the point of entry.The sutures Were tied so that the recipient renal artery was drawn inside the donor's renal artery.Thereafter,one external stitch was placed opposite to the invaginating suture passing through the overlapped free distal edge and the adventitia of the recipient renal artery,and the suture the opposite side using the same technique.The renal veins and ureters were anastomosed using end-to-end interrupted suture technique.Results Twenty cases of rat renal transplantation were performed.The transplantation procedures took totally between 70-90 min.The time for arterial anastomosis was approximately(4.6 ± 0.6)mint the mean time for anastomosis of the renal vein in 20 grafts was(11.8 ± 1,2)min.and ureter was(12.2 ± 1.4)mia The successful rate of the model was 95 % at the 5th day.Conclusion New end-to-end technique which incorporatesa modification of the sleeve anastomosis is the safest way to perform a revascularization of renal artery.This suggests that the technique is feasible and reliable.

Afferent Arteriovenous Anastomosis For Finger Tip Replantation

PURPOSE: The vessels of the finger tip are very small and fragile, have many branches, so the anastomosis of this vessel is very difficult. Guillotine type amputation of digits are rare, on the other hand, crush/avulsion injuries which require complex surgical solutions are more frequent. We often found that the arteries of distal amputee on crush/avulsion injuries are lost. In these cases, replantation is much more difficult even impossible. But when replantation is successes, the replantated finger tip provides adequate soft tissue, restoration of length, sensory and nail. MATERIALS AND METHODS: We report here our experience of finger tip replantation using afferent a-v anastomosis technique accumulated from March 2006 to March 2009. RESULT: The success rate was 96.4%. Complications occurred in eight patients. (5 digit atrophy, 1 osteomyelitis, 1 severe digit pain and 1 cold intolerance) CONCLUSIONS: We believe that the afferent a-v anastomosis replantation provides us wider range of indication of finger tip replantation on crush/avulsion injuries.

Tri-cuff vascular anastomosis for the heterotopic small bowel transplantation in rat / 中华器官移植杂志

Objective To improve the vascular anastomosis of the rat small intestinal transplantation, reduce the ischemia of transplanted intestine and make it apt to survive, simplify the operation procedure, elevate the operation success rate. Methods Artery anastomosis was done by employing the cuff anastomosis between a segment of donor abdominal aorta with superior mesenteric artery and recipient abdominal aorta, and venous anastomosis by employing the cuff anastomosis between donor's portal vein and recipient's left renal vein, namely Tri cuff anastomosis. Results Sixty six out of 70 transplant operation cases survived with the operation success rate being 92.9 % . Total operation time was about 2 3 h . The average time for the arterial anatomosis and venous anastomosis was (5?2) min and (2?1) min, respectively. Conclusion The method simplifies the rat small intestine transplantation, shortens the operation time and improves the operation survival rate.

A Case of Retinal Racemose Hemangioma

PURPOSE: Racemose hemangiomas of the retina are rare developmental vascular anomalies with abnormal arteriovenous anastomoses. We report our observations of a retinal racemose hemangioma with marked dilation and tortuosity of the retinal vessels in the entire left retina. METHODS: In a 9-year-old boy with loss of vision and mild esotropia who presented with hugely dilated and tortuous retinal vessels in left retina, we examined fundus, fluorescein angiography, cerebral angiography, brain CT and MRI. RESULTS: Fundus and fluorescein angiography of the left eye showed marked dilation and tortuosity of the retinal vessels. Angiographic finding showed rapid filling of all vessels and no dye leakage. MRI finding revealed small tortuous vessels around left optic nerve, optic chiasm and tract. Brain CT and cerebral angiography showed nothing abnormal.

Treatment of severe lower extremity ischemia with distal bypass and arteriovenous anastomosis / 中国普通外科杂志

ObjectiveTo explore the effectiveness o f distal arterial bypass for the treatment of severe lower limb ischemia with p oor outflow artery. Method From July 2000 to Dec 2004, we treated 21 cases (21 limbs) of severe lower limb ischemia with poor outflow artery by distal bypass with additional arteriov enous anastomosis at or distal to the distal graft anastomosis. Results Among the 21 cases, one case recei ved reoperation for “void arterial perfusion” distal to the arteriovenous anas tomosis. The operative success rate was 95.2%.The patency rate of graft was 100 % and the healing rate of foot ulcer was 33.3% on discharge. Conclusion Additional areriovenous anastomos is at or distal to the distal graft anastomosis can dramatically increase the pa tency rate of the graft when outflow artery is too poor to guarantee a patent gr afting in the case of severe lower limb ischemia, although long-term effectiven ess needs to be varified.

Retinal Arteriolar Changes in a Patient with Branch Retinal Vein Occlusion

The isolated abnormal arterial tortuosity in a 65 year old male patient with the branch retinal vein occlusion was found in non-perfusion area near the macular region. The arterial tortuosity anastomosed with the vein across the median raphe. It was what is called the the arteriovenous anastomosis. The author deduced the pathogenesis of the arterial tortuosity in arteriovenous anastomosis as following. The sclerosis of the arterial branch occurs in the severe ischemic state in the non-perfusion area following the branch retinal vein occlusion. The arterial blood easily have to flow to the unoccluded vein through only one or a few collateral channel(s). Such a arterial flow need the reduction of arterial pressure and the pathologic changes of the artery. As a result, the artery have to reduce the radius and to increase the length.

The observation of the effects of arteriovenous bypass with in situ great saphenous vein without extripation of venous valves / 中国现代普通外科进展

To summarize the experience of chronic ischemic disease in the lower limb using arteriovenous bypass in situ great saphenous vein without extirpation of venous valves.Methods: The operations of in situ great saphenous vein arterial bypass without venous valves extirpation had been done and the perioprative clinical manifestation had been observed in 11 patients with serious chronic ischemia of lower limbs.Results: The clinical manifestations of ll patients had been improved gradually.Conclusion: It may be a better operation of in situ great saphenous vein arterial bypass without venous valves extirpation,which is effective,simple,practicable,and deserved to be popularized in some cases.

Optimal laser energy for laser induced chorioretinal venous anastomosis in the treatment of experimental branch retinal vein occlusion / 中华眼底病杂志

Objective To inspect the rate of success of anastomosis and tissue damage with different power levels of photocoagulation in the treatment of experimental branch retinal vein occlusion (BRVO) by laser induced chorioretinal venous anastomosis. Methods Forty pigmented rabbits (80 eyes) were divided into four groups in random, and 10 (20 eyes) in each. Chroioretinal venous anastomosis was attempted to create using the krypton red laser with 4 different power levels (group A: 400 mW,group B: 600 mW,group C: 800 mW,group D: 1000 mW) in these animals in which BRVO had previously been created photodynamically. Fundus photography and fundus fluorescein angiography were performed at various times after the treatment and histological examination was taken at the end of the study. Results The model of BRVO was successfully set up. At the lowest power of 400 mW there was an absence of anastomosis formation and the damage to the retina and choroid was mild, Bruch′s membrane showed no evidence of rupture. At the power levels of 600 mW and 800 mW an anastomosis formed in 15% and 55% respectively and the damage was medium in degree. At the highest power level of 1 000 mW a 80% rate of success was obtained, however, the damage to the retina and choroid tended to be severe. The difference of the rate of success of anastomosis between different groups was highly significant ( P =0 001), the difference between group B and group C was also highly significant ( P BC =0.008), and the difference between group A and group B, group C and group D was not significant ( P AB =0 072、 P CD =0 091). Conclusion The optimal power level of krypton red laser induced chorioretinal venous anastomosis is 800 mW, 0.1 s, 50 ?m in our study.