Classification of microvascular anastomosis in oral and maxillofacial reconstruction

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.

Management of a Complicated Cerebral Aneurysm with Distal Migration of a Detachable Coil: A Case Report / 대한뇌혈관외과학회지

We describe our experience in which the migration of a coil into the parent artery occurred during the coil embolization. A feared complication during coil embolization of cerebral aneurysm is parent artery occlusion by migration of a detachable coil. Obstruction with migration of the coil into the parent artery may be especially hard to solve with an endovascular procedure. The patient had an unruptured internal carotid artery trunk aneurysm where endovascular treatment was performed with detachable coils. One of the packed coils escaped from the sac and migrated into the distal middle cerebral artery (MCA). Cerebral angiography demonstrated non-filling of a number of MCA branches. Repeated attempts at endovascular retrieval of the migrated coil were unsuccessful. Only after an emergent arteriotomy the migrated coil could be successfully removed. Subsequently, endovascular intra-arterial thrombolysis was required to dissolve the thrombus formed postoperatively in the distal MCA. The patient fully recovered with no neurological deficit. In our case a combined surgical and endovascular treatment of coil migration were performed.

Detection of Chlamydophila pneumoniae (Chlamydia pneumoniae) in endarteroctomy specimens of coronary heart diseases patients.

Background & objectives: Association of Chlamydia pneumoniae with atherosclerosis and coronary artery disease is debated. Increased antibody levels against C. pneumoniae in patients with coronary artery disease is widely reported. Direct evidence would be demonstration of C. pneumoniae, its antigen or genome in the diseased arterial tissue. This study was thus conducted to look for antigen or genome of C. pneumoniae in coronary artery specimens from patients with coronary artery disease along with serology. Methods: Sixty two end arteriotomy specimens of discarded coronary arteries from patients of coronary heart disease were tested for presence of C.pnuemoniae genome using 2 nested PCR assays and antigen detection by immuno-fluorescence assay. Presence of species specific antibodies were also tested in the patients. Results: C. pneumoniae could not be detected by PCR or immunofluorescence assay in any specimen. C. pnuemoniae Ig G antibody was detected in 42 of the 62 (67.7%) patients studied, compared to 10 of the 23 (43.47%) of controls. Moreover 18 of 62 (29%) patients compared to 4 of 23 (17.39%) controls possessed IgA antibodies. Interpretation & conclusions: Association of C.pneumoniae and coronary artery disease would not be established by genome or antigen detection. However, C. pneumoniae antibodies were detected in more number of patients than controls. More studies are required to reach to a conclusion.

The Effects of Elliptical Versus Slit Arteriotomy on Patency in End-to-Side Microvascular Anastomosis

The fashion of vascular anastomosis, end-to-end or end-to-side (E-to-S), are depended upon surgeon's preference or surgical situations. In E-to-S anastomosis two different methods of arteriotomy are applicable but it has been suggested the type, either elliptical or slit arteriotomy, play a different role in the flow hemodynamics. We thought that the difference is more considerable in microvascular surgery. This study examines the effects of elliptical versus slit arteriotomy on morphologic vessel patency. Twenty male Sprague-Dawley rats were divided into two groups of ten rats each. Both carotid arteries were selected as a experimental model. During the procedures the rat brain was tolerable to ischemia and all animals were survived after operations. The morphologic analysis of anastomosis site was through resin-casting method with scanning electromicroscopic examination. The results showed notable difference between two groups in three-dimensional morphology at two-month of operation. This difference may affect the flow hemodynamics and long-term vessel patency. In microvascular anastomosis, the mortpologic difference of the elliptical arteriotomy is worse than slit arteriotomy which compromises the vessel circumference.