Unilateral Incomplete Superficial Palwar Arch: A Case Report.

The functional importance of hand is revealed by its rich vascularity contributed by superficial and deep palmar arches (SPA and DPA).Superficial palmar arch is located superficial to flexor tendons, and deep palmar arch deep to lumbrical muscles. Variations are found more often in SPA than DPA, later being more or less constant. During routine undergraduate dissection, we observed, unilateral incomplete SPA being formed by superficial palmar branches of ulnar and radial artery in the right hand of a male cadaver. These two arteries remained independent without anastomosis forming incomplete arch (SPA).The superficial branch of ulnar artery entered hand superficial to flexor retinaculum and supplied middle, ring and little finger by three branches. The superficial branch of radial artery via its two branches supplied index finger and thumb. Classical SPA formation was seen on left side. The presence of an incomplete SPA as in this case is a potential danger in RA harvesting for CABG.Variations in SPA play a pivotal role in microvascular surgical procedures of hand, RAinterventions and arterial graft applications.

Improved Heat Lamp for Preventing Arterial Spasm after Microvascular Surgery

PURPOSE: Heat therapy by heat lamp after microvascular surgery is being used for preventing blood vessels's contraction and blood-flow's disturbance. As usually, incandescent lamp has been used. But there have been several problems and need for improvement in the existing heat lamp treatment. So we would like to introduce improved heat lamp to keep an appropriate temperature and intensity of illumination. METHODS: The existing heat lamps are the ones of general light stands covered with newspaper, having 60 watt light bulb of incandescence and lampshade made of aluminum. We have tried to improve shortcomings of the existing heat lamps by enlarging the size of aluminum lampshade and attaching a curtain that can block heat and light. We conducted a comparative study between the existing and improved heat lamps. Under the assumption that there are several affected parts, we have also measured the distance from heat lamp to patients' eye region and then intensity of illumination. RESULT: The target temperature of surface was realized in 11 minutes with the maximum temperature reaching at 36.6 degrees C in 28 minutes at the existing heat lamp while the target temperature reached in 7 minutes with the maximum temperature reaching at 39.0 degrees C in 17 minutes at the improved heat lamp. The existing and improved heat lamp showed 38 lx and 0.1 lx of intensity of lumination, respectively. CONCLUSION: Using improved heat lamps, we can keep an appropriate temperature and we think we can make contribution to patients' treatment by making them and their neighbors able to sleep with minimized disturbance thanks to low intensity of illumination secured by blocking light.

Surgical Treatment of Vascular Complications after Microvascular Surgery

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.

Early Development of Microvascular Surgery in Korea: To the Memory of the Late Dr. Poong Lim

Microvascular surgery in Korea started in 1970's. Doctor Poong Lim was one of several dedicated surgeons who made great efforts to develop this field in Korea. By performing inguinal free flap in 1978, he became the first man who applied microvascular surgical technique to the clinical field in Korea. In addition, he played an important role in the settlement of microvascular surgery in Korea, performing variety of free flaps such as omental free flap, dorsalis pedis free flap, and deltopectoral free flap in 1979. He also introduced microvascular surgery to the traumatic field by successfully performing multiple finger replantation and forearm replantation in 1979. Both his clinical and experimental works made it possible for microvascular surgery to become an important part of plastic surgery in Korea.

A Clinical Study on Treatment of Late-stage Malignant Tumors by Transplantation of Fetal Thymus / 中国医师杂志

Objective To explore the effect of fetal thymus transplantation on enhancing the immunity of patients with late-stage malignant tumors. Methods The whole thymus of 24～32 weeks fetus was transplanted into the forearm of the patients with late-stage milignant tumors by microvascular surgery. The levels of serum IgA,IgG and IgM were measured before and at the third, 6th and 12th months after operation. No immunosuppressive regimen was performed in all the patients after operation. The follow-up period was 1 to 2 years. Results The clinical symptoms of all the patients improved after treatment, and no rejection reaction occurred. The levels of serum IgA,IgG and IgM significantly increased 3,6 and 12 months after treatment(t≥4.23,P

Reconstruction of the Tissue Defects in Extremity by Microvascular Surgery: Analysis of 138 cases / 대한정형외과학회잡지

From 1981 to 1993, one hundred and thirty eight patients had been treated by free flap or island flap, for the tissue defects of the extremities. Among these 138 patients, vascularized bone graft was 29 cases, soft tissue free flap 40, replantation 22, local island flap 45, and lymphovenous shunt 2. Average age at the time of operation was 27 years(1-66 years), and men were 110, women 28. Average duration of follow-up was 2 years and 8 months(4 months-11 years and 8 months). Twenty nine cases of vascularized bone graft was consisted of fibular graft in 15 patients, ilium 8, joint transplantation 4, thumb reconstruction using big toe 1, and rib 1. Four of them were failed. Among 40 patients of soft tissue free flap, latissimus dorsi flap was 12 cases, dorsalis pedis flap 11, scapular flap 8, wraparound procedure 7 and gracilis flap 2. Seven of them were failed. The levels of replantations were both lower extremities in one patient, leg 1, arm 2, distal forearm 2, and finger(s) 16. In six patients, replantation was nor successful. Among 45 patients of local island flap, lateral supramalleolar island flap was performed in 8 patients, dorsalis pedis flap 2, Chinese flap 10, reverse ulnar artery flap 4, reverse posterior interosseous artery flap 3, neurovascular island flaps for fingers 14, and others 4. Two of them were failed. Two cases of lymphovenous shunt for the treatment of lymphedema were successful. As a whole, 119 cases were successful(86%) among 138 cases including local island flap 45 cases.

Microvascular Polytetrafluoroethylene Graft in the Rat

With the recent advancement in the field of microvascular surgery, the demand for a microvascular prosthesis of 1-2 mm diameter has been increasing. The authors attempted to insert a Gore-tex graft of 1 mm inner diameter to the rat aorta and renal artery with different techniques and different suture materials. The telescoped technique was utilized for the anastomosis of the proximal part of the artery. They showed 80% patency of grafts up to 116 days with 10-0 ethilon and 83% patency up to 96 days with 7-0 silk in the rat aorta. In the rat renal artery, they showed 53.3% patency with 10-0 ethilon. These results showed that Gore-tex grafts of a 1 mm inner diameter could be used for microvascular reconstructions but further laboratory experimentation is needed before clinical application.

Composite Tissue Transfer using Microsurgical Technique / 대한정형외과학회잡지

We have experienced 29 cases of microvascular surgery during a year since Apr. 1981. We performed 18 cases of composite tissue transfer in 17 patients. 3 cases of axillary flap, 5 cases of dorsalis pedis flap, 4 cases of living fibula transplantation, 2 cases of groin flap using deep circumflex iliac vessels, a case of osseocutaneous flap using the 11th rib, living M-P joint from the 2nd toe to finger, neurovascular island flap from the lateral side of the 3rd finger, and a case of musculocutaneous flap using the gracilis muscle were done. The causes of the soft tissues and/or bone loss were open fracture, which is the most common cause, osteomyelitis, congenital pseudarthrosis of the tibia, bone tumor, and scar contractures, etc. The success rate of the composite tissue transfer was 89%. The 2 cases of failure were observed. The one is due to the vascular damage after the leg lengthening in congenital pseudarthrosis of the tibia and the other due to the infection on the grafted area. The follow up period was from 4 to 18 months. The patients except failed 2 cases were pleased the result of the surgery. The composite tissue transfer using microvascular surgery has many advantages in that the tissue defect can be filled by one stage operation, the patient would be less dependent wish shorter hospital stay, the patient would be less morbid with better function than the patient with multi-staged complex operations. The composite bone and soft tissue transfer used for the infected bony defect made the infection heal more rapidly than the other conventional methods. The deep circumflex iliac artery played a good role in making the osseocutaneous flap, which has many advantages such that Taylor had described. But it is not the truth for the skin only problem. So we darely suggest the third category of the arterial supply to the skin as osseocutaneous artery to supply the overlying skin through the bone, which is exampled with the deep circumflex iliac artery. The vessels in the area of a limb lengthening would be stretched and severely damaged. And the overstretched vessels in limb lengthening should not be used in the microvascular surgery, if the time interval from the traction is not plentifully elapsed and the vessel status is not converted to normal.