A review of thrombosis and antithrombotic therapy in microvascular surgery.

Despite a remarkable expansion of microsurgery, there is still no international consensus about routinely used prophylactic antithrombotic agents. Most treatment regimens still use aspirin, heparin (low-molecular-weight and unfractionated heparin) or colloids (hydroxyphenylacetate 6%/dextran); however, clear evidence for the clinical benefit of an ideal administration regimen or one agent over the other has not yet been established. Instead of searching for the one regime that fits all, an increasing number of reviews from different disciplines describe multistep approaches that optimize what has been shown to be most promising. This includes the use of antithrombotic agents, proper risk assessment, secondary prevention and professional training to optimize microsurgical skills. In this review, we describe factors included in traditional approaches and also emphasize the value of good surgical technique, which while recognized by all to be one of the most important factors for success, receives less emphasis in reviews describing thrombosis prophylaxis in microvascular surgery.

Holocene to Middle Last Glaciation vegetation history at Newall Creek, western Tasmania.

Pollen analysis and 14 C dating of 5.5m of organic-rich soil and fluviatile deposits from Newall Creek (altitude 140 m) indicate that temperate rainforest (0-11 K yr B.P.) was preceded by grassland-herbland (11 to 21 K yr B.P.), and then by open grassy Eucalyptus woodland. Comparison with a lake-swamp site at Tullabardine Dam showed that the main vegetation changes were comparable making allowance for some spatial variations in the taxa represented and the lower quantity of pollen in the fluviatile deposits. The inferred sequence of climatic change was from a cool moist interstadial through a cold last glacial maximum to a warm moist Holocene environment, a sequence also indicated at Tullabardine.