[Increasing the survival rate of endangered free microvascular tissue transplants using a prostacyclin derivative]. / Steigerung der Uberlebensrate gefährdeter freier mikrovaskulärer Gewebetransplantate mittels Prostacyclinderivat.

Free flap transplantations and replantations of extremities are threatened by venous occlusion due to haematomas, contusions, and secondary healing of the surrounding tissues. In an experimental investigation in 18 Sprague-Dawley-rats, the influence of the Prostacyclin analogue Iloprost on temporary ischemia by venous occlusion was tested. Free groin flaps were transplanted to the neck of these animals with microanastomoses of the nutrient superficial epigastric vessels to the carotid artery and the jugular vein. On the first postoperative day the vein was temporarily clamped. In the control group there was always a total loss of the flap by haemorrhagic necrosis. The intraarterial flap perfusion by Iloprost was able to diminish the effects of the secondary ischemia. In some cases shortly after the perfusion and always on the next day, positive oxygen pressures were measurable. 80% of the flaps survived.

[Experimental studies of the no-reflow phenomenon with prostacyclin]. / Experimentelle Untersuchungen zum No-Reflow-Phänomen unter Prostacyclin.

The no-reflow phenomenon is a dreaded complication in free tissue transplantations. After a critical period of warm ischemia, insufficient reflow is observed after vessel anastomosis and opening of the artery. In an experimental study in 72 rats, groin flaps were harvested with the nutrient superficial epigastric vessels and transplanted to the neck using a microvascular technique with anastomoses to the carotid artery and jugular vein. Before transplantation, the isolated flaps were perfused either with saline solution, with Iloprost, with and without heparin, or the nutrient vessels were simply flushed with heparin solution. After saline perfusion, there was no venous reflow, after pure Iloprost perfusion, there was venous return in 26% of the flaps, after Heparin-Iloprost perfusion in 88% and after flushing with heparin alone in 93%. The addition of heparin to Iloprost seems to improve the reflow rate. The most effective protection against a no-reflow phenomenon, however, is flushing the nutrient vessels with a heparin solution.

[Initial clinical and cysto-urethral tonometric results with a new modification of the Marshall-Marchetti-Krantz-Operation]. / Erste klinische und zystourethrotonometrische Ergebnisse nach einer neuen Modifikation der Marshall-Marchetti-Krantz-Operation.

From January 1976 to July 1978 a modified Marshall-Marchetti-Krantz-procedure for correction of urinary stress-incontinence was performed in 260 patients. A follow-up examination was done in 132 patients 6 weeks after surgery and in 96 pateints after 1 year. Urodynamic measurements were carred out in 66 patients, before and 1 year after after surgery. The incidence of perioperative complications was low, severe complications were found in less than 0.5%. Six weeks after surgery the subjective cure rate was 92%, after 1 year it was 80%. Cystoceles were corrected by the procedure and remained so in 87% one year after the operation. The urodynamic evaluations showed an increase of the maximal urethra-closure-pressure and, above all, a marked and significant improvement of the urethra-stress-profile. In 6 patients a motoric urge-incontinence was found at the follow-up examination after 1 year. The results of the new modification of the Marshall-Marchetti-Krantz-procedure are similar to those described in the literature after other operations for urinary stress-incontinence.