RESUMEN
Objective:To sort out the history of microsurgery in China from 1960 to 1973 based on the literatures in chronological order.Methods:Chinese and English scientific journals and academic monographs published in public and in house were searched, and the words "microsurgery" and "microsurgery related" literatures in both Chinese and English were carefully read and analysed. The dates of operation, communication and report were recorded and confirmed.Results:Microsurgery in China started in early 1963, thanks to the report of the world's first successful severed limb replantation in Shanghai Sixth Hospital. In the following 3 years, many teams carried out experimental researches on microvascular technology and explored the replantation of severed fingers. In 1964, the world's first severed leg replantation. In 1966, the world's first toe transfer was operated to reconstruct the thumb, and the world's first batch of completely severed fingers were successfully replanted by microvascular suture. In 1972, it was reported, at the Guangzhou Conference on Replantation of Severed Limbs, that a 44.9% of survival rate had been achieved over 260 cases and the term "microsurgery" was used for the first time in the conference. In March, 1973, the second free inguinal flap transfer in the world was completed. In May, 1973, an American Replantation Mission visited China. It opened a precedent for academic exchange in microsurgery between China and foreign countries. With 10 years of clinical practices, the original and advanced Chinese limb (finger) replantation technology and principle had been recognised by the international peers.Conclusion:The research on the history of Chinese microsurgery has confirmed that the development of Chinese microsurgery was basically synchronised with the world, but with a difficult start in 1960-1973.
RESUMEN
Objective To explore the application of UW solution in the replantation of the rat limb,and to explore a simple method for the ideal preservation of the amputated limbs.Methods From September,2017 to Janurary,2018,one hundred and twenty healthy adult male SD rats,weight 320-350 g,were randomly divided into 8 groups:A,B,C,D,E,F,G,H group.The isolated limbs of the control group A,C,E,G were cryopreserved in refrigerator at 4 ℃,while those of the experiment group B,D,F,H were preserved under the same condition after being perfused with UW solution.All the severed limbs were replanted back to the rats after different time length of cry opreservation:A,B 12 hours,C,D 20 hours,E,F 28 hours and G,H 36 hours.During the operations the femoral artery and venous patency were detected immediately after anastomosis.And after the operations the survival rates of limb replantation were observed.On the third day after the limb replantation,the tibial posterior muscle tissue was examined for pathology.The cell areas in pathological photographs were compared with Image analysis software Image-pro Plus 6.0 and the ultra structural changes of skeletal muscle tissue were observed.Results The femoral artery and venous patency in experiment group A,C,E and control group B,D,F were all 100 percent.However,in the group G,H the severed limb vessels changed obviously,the patency dropped markedly and the survival rates of limb replantation turned out to be 0.The experiment groups perfused with UW solutions,had relatively higher survival rates compared with the control groups (12 h:93.33％ vs.53.33％,20 h:80.00％ vs.40.00％,28 h:53.33％ vs.13.33％) and the skeletal muscles edema was lighter than that of the control group,with a larger proportion of cell areas(12 h:69.49±8.57 vs.44.75±6.34,20 h:56.34±7.73 vs.36.69±5.74,28 h:45.76±8.23 vs.31.49±7.72).There was a significantly difference (P＜0.05).Electron microscope observation showed that the experiment group bore a lighter damage of myofibril,interstitial tissue and mitochondria compared with the control group.Conclusion The combination of UW solution and cryopreservation of organs is an ideal and proper way to preserve the amputation limb,to extend the time limit for replantation,and to achieve a better recovery effect of postoperative limb function.Besides,UW solution is easy to be promoted in the treatment of isolated limb in clinical work.
RESUMEN
Objective To investigate the replantation and postoperative rehabilitation methods for simultaneous amputation of 10 fingers and both forearms.Methods A case of replantation for simultaneous amputation of both forearms and 10 fingers was carried out with microsurgery method in September,2014.The replantation involved 3 teams over 11 hours and 55 minutes to consequently conduct alternate anterograde and retrograde replantation and accurate blood vessels,nerve anastomosis and further followed with physical therapy and occupational therapy treatment in 2 weeks of the surgery.Results All the amputated arms and fingers revived after the surgery.After 14 months follow-up,function of wrist flexion and expansion was normal,superficial and deep sensory functions on hands were good,function of thumb and finger grip,pinch and opposition had partially recovered,the two-point discrimination was 8-10 mm,and all of above rated good according to the temporary criteria of the upper limb functionality set forth by Hand Surgery Branch of China Medical Association.Conclusion For the case of simultaneous amputation of both forearms and 10 fingers,it is very likely to carry out successful replantation as well as achieve satisfactory function restoration with excellent teamwork and accurate vessel and nerve anastomosis under microsurgery as well as rehabilitation treatment afterwards.