OBJECTIVE: To observe the architecture of elastic fiber of anastomosed artery. METHODS: The right femoral arteries of 60 Wistar rats were cut off transversely and end-to-end anastomosis were performed. On the 3rd, 7th, 14th, 21st, 30th and 90th days after operation, the anastomosed artery segments were harvested and fixed by 10% formalin. After routine processed, the architecture of elastic fiber of anastomosed artery was observed under scanning electronic microscope and was compared with that of normal artery. RESULTS: On the 3rd and 7th days after anastomosis, there was no the elastic fiber in the middle of the anastomosed area. From 14 to 90 days after anastomosis, the newborn elastic fiber connected the anastomosed area. The reconstruction of elastic fiber could be divided into quiescent stage, proliferation stage, and rebuilding stage. CONCLUSION: The reconstruction of elastic fiber occurs after arterious anastomosis and newborn elastic fiber originates from endoarterious layer. The structure of elastic fiber can return to normal 30 days after anastomosis.
Abstract During 1960 to 1995, 19 of the 269 casesof arterial injuries in limbs treated developed ischemic contracture (7.06%), in which 14 in the lower limbs and 5 in the upper limbs. In the 19 cases, 3 injured arteries were not treated; 1 had his injured arteries repaired infailure; 5 cases had the concomitant veins injured, and 3 of them had their injured veins ligated in the primary treatment. Only 1 case received fasciotomy in his former treatment in other hospital. Four cases were admitted in our Institute in 14 hours, 8 cases were 34 to 57 hours and 7 were 19 days to 19 months after injury. Seventeen out of the 19 injured ateries and 5 out of the 8 injured vein were repaired. Eight cases received fasciotomy. The follow up ranged from 3months to 28 years (averaged 5 years). Sixteen out of the 17 injured arteries remained patent after repair, and the patency were proved by Bultrasound. The causes of ischemic contracture in these cases were analyzed. It was concluded that in order to prevent the limb from ischemic contracture, it should be emphasized that the accurate diagnosis of the injury of the artery and its concomitant ein be made early, the proper treatment be given to the injured artery and vein,and fasciotomy be done immediately as indicated.
Objective To improve arterial anastomosis method for rat renal transplantation. Methods Renal transplantations were performed on 72 wistar rats. The donor superior mesenteric artery was end-to-end anastomosed to the recipient left renal artery by using of sleeve anastomosis technique. The external diameters of the vessels anastomosed were 0.60±0.05 mm (left renal artery) or 0.80±0.07 mm (superior mesenteric artery). The procedure consisted of a guidingsuture and two fixing sutures. The guiding suture was used to “telescope” therecipient left renal artery into the donor superior mesenteric artery about 2 millimetre. Two fixing sutures were applied 180°apart from each other and tied. Three sutures passed through all layers of the donor superior mesenteric artery andconstricted the vessel lumen, but only penetrated the adventitia of the recipient left renal artery. Results The time for arterial anastomoses was approximately 6 to 8 minutes. The renal grafts perfused very well after the recipient left renal artery clamp was removed. Complications included anastomotic hemorrhage(1 case) and thrombosis (1 case). Histologic examination of 34 grafts at different postoperative time ranging from 6 to 30 days revealed that renal artery was fully patent, with no evidence of ischemic injury. Conclusion The modified arterial sleeve anastomosis technique is simple and feasible regardless of experimentalcondition and can be easily performed.
In order to develope a new method to overcome the difficulties in anastomosis of blood vessels with different diameter, phleboplasty was utilized at the join-point to expand the diameter of branched vein graft, with a funnel-shaped stoma formed consequently. After successfully experimented in fresh blood vessels in vitro, the method was practised clinically to repair injured arteries in extremities, with the outcome that phleboplasty of branched vein graft could enlarge the diameter by 1-1.25 times, and with satisfied effects in 3 clinic cases. So, the conclusion was that: phleboplasty of branched vein graft was a new effective and convinient method to repair injured arteries with different diameters
To explore the effectiveness and methods of intervention assistant operation in the treatment of phalanx closed fracture combined with artery crisis. Methods Between August 2002 and December 2008, 24 cases (31 toes) of phalanx closed fracture combined with artery crisis were treated. There were 17 males (22 toes) and 7 females (9 toes), aged from 16 to 62 years (mean, 38 years). The causes of injury included crush and bruise (20 cases), traffic accident (3 cases),and machine twist (1 case). The locations were the first toe (19 toes), the second toe (10 toes), and the third toe (2 toes). The period between injury and hospital ization was 1-10 hours (mean, 6.8 hours). Phalanx angiography was performed by using venous indwell ing needle for dorsal is pedis artery and posterior tibial artery puncture; according to angiography results, proper treatment could be done, then the constrast medium was injected to the artery to observe the blood supply. According to different types and locations of fracture, Kirschner wire and plate were choosen to fix fracture after the blood supply were recovered. Results Two cases (2 toes) received amputation due to necrosis at 4 days and 6 days after interventional therapy, respectively. Twenty-two cases (29 toes) survived. Incision healed primarily in 21 cases. Exudation occurred at wound of 1 case and was cured at 3 weeks after dressing change. Twenty-two cases (29 toes) were followed up 1-6 years (mean, 3.5 years) postoperatively. Two cases (3 toes) felt cool or anaesthesia and could not tolerate even in cold environment. The other toes had no senses of cold pain and paresthesia. Two cases (2 toes) had nonunion and achieved fracture heal ing after grafting bone. The mean union time was 4.5 months (range, 3-6 months) in other cases. Conclusion Intervention assistant operation is an effective measure in the treatment of phalanx closed fracture combined with artery crisis.
Objective To investigate the blood supply of the ulnar nerve in the elbow region and to design the procedure of anterior transposition of ulnar nerve accompanied with arteries for cubital tunnel syndrome.Methods The vascularity of the ulnar nerve was observed and measured in20adult cadaver upper limb specimens. And the clinical surgical procedure was imitated in 3 adult cadaver upper limb specimens. Results There were three major arteries to supply the ulnar nerve at the elbow region: the superior ulnar collateral artery, the inferior ulnar collateral artery and the posterior ulnar recurrent artery. The distances from arterial origin to the medial epicondyle were 14.2±0.9, 4.2±0.6 and 4.8±1.1 cm respectively. And the total length of the vessels travelling alone with the ulnar nerve were 15.0±1.3,5.1±0.3 and 5.6±0.9 cm. The external diameter of the arteries at the beginning spot were 1.5±0.5, 1.2±0.3 and 1.4±0.5 mm respectively. The perpendicular distance of the three arteries were 1.2±0.5,2.7±0.9 and 1.3±0.5 cm respectively.Conclusion It is feasible to perform anterior transposition of the ulnar nerve accompanied with arteries for cubital tunnel syndrome. And the procedure preserves the blood supply of the ulnar nerve following transposition.
OBJECTIVE: To investigate the relationship between the different defect length of vessels and the options of vascular repair, and to compare the different options of repair because of the longitudinal biomechanical effect. METHODS: A clinical analysis was undertaken to evaluate the major arterial and venous injuries in human extremities repaired by end-to-end anastomoses or venous autograft(177 cases, 185 vessels). Compared the defect length of the same kind of vessels repaired by different options (Student-t test). Evaluated the defect length to repair arterial injuries between by end-to-end anastomoses and by vein graft by means of 95% confidence interval. RESULTS: There was significant difference between the defect length of brachial artery repaired by end-to-end anastomosis and femoral artery and popliteal artery repaired by autogenous vein graft (P lt; 0.01). The upper limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 3.17 cm, 2.81 cm and 2.44 cm respectively by end-to-end anastomosis by means of 95% confidence interval. The lower limit of confidence interval in the defect length of brachial artery, femoral artery and popliteal artery was 2.82 cm, 2.41 cm and 2.17 cm respectively by vein graft by means of 95% confidence interval. The defect length of brachial artery, femoral artery and popliteal artery repaired by vein graft was linear correlation with the length of graft. CONCLUSION: Because of the longitudinal biomechanical difference of arteries and veins in human extremities, different options of repair are necessary to different arterial injuries.
ObjectiveTo investigate the safety and effectiveness of vascular reconstruction in patients with symptomatic tortuosity common carotid artery (SCAT). MethodsA retrospective analysis was made on the clinical data of 12 cases of SCAT treated with vascular reconstruction between June 2010 and October 2013. There were 11 females and 1 male with the mean age of 54.8 years (range, 48-62 years). The unilateral common carotid artery was involved in all cases. Imaging examination showed C-shaped tortuosity of 4-8 cm in length (mean, 5.4 cm). The CT, brain CT, ultrasound examinations, or angiography was performed at 1, 3, 6, 9, and 12 months, and annually. ResultsThe surgery success rate was 100% with no perioperative death and serious complications. The mean operation time was 1.98 hours; the mean blood loss was 50 mL; and the mean clamping time was 14.9 minutes. The systolic pressure gradient across the lesion was significantly decreased from (39.58±9.54) mm Hg (1 mm Hg=0.133 kPa) at pre-operation to (5.50±2.39) mm Hg at immediate after operation (t=15.492, P=0.000). No recurrence or stenosis was found at 9 months to 3 years of follow-up. The systolic and diastolic pressures at last follow-up were significantly improved to (132.17±6.24) mm Hg and (82.67±6.51) mm Hg from (152.83±14.80) mm Hg and (94.17±11.30) mm Hg at pre-operation (t=5.751, P=0.000; t=4.976, P=0.000). ConclusionVascular reconstruction in SCAT is recommended for good short- and mid-term effectiveness and relatively low complication and mortality after operation. Moreover, the long-term results still need to be investigated.
ObjectiveTo investigate the effectiveness of the island flaps based on the superficial palmar branch of the radial artery (SPBRA) to repair the thumb wound. MethodsBetween February 2012 and November 2013, 8 cases of thumb defects and bilateral artery defect were treated. There were 5 males and 3 females with an average age of 30.5 years (range, 19-51 years). The injury was caused by crush (4 cases), avulsion (3 cases), and twist (1 case). The injury located at the metacarpophalangeal joints in 3 cases, at the proximal palmar side in 2 cases, and at the interphalangeal joints in 3 cases. The defect size ranged from 3.5 cm×1.5 cm to 6.5 cm×2.0 cm. The digital artery defect was 2.5-8.5 cm (mean, 5.3 cm). The disease duration was 2.0-4.5 hours (mean, 3.2 hours). The reversed island flaps based on the SPBRA were designed, which size was 4.0 cm×2.0 cm to 7.5 cm×3.0 cm. The donor sites were closed directly. ResultsThe operation was successfully completed in 7 patients except 1 patient having vascular variation. All flaps survived completely. Wound and incision at the donor site healed by first intention. All patients were followed up 6-18 months (mean, 13 months). The flaps had similar color and texture to adjacent skin. Linear scar was seen at the donor site in 1 patient, with no functional limitation. According to the functional assessment criteria of upper limb by the Hand Surgery Branch of Chinese Medical Association, the results were excellent in 6 cases, good in 1 case, and fair in 1 case, with an excellent and good rate of 87.5%. ConclusionThe reversed island flap based on the SPBRA is an ideal flap for the thumb reconstruction because the advantages of reliable blood supply, easy dissection, less injury at donor site, and good repair results.
ObjectiveTo evaluate the application of artery first approach in pancreaticodudenectomy, aiming to explore superior mesenteric artery(SMA) and celiac axis in early stage of operation, confirming the resectability and achieving radical resection of the nervous and lymphatic tissues around axis of celiac artery and SMA. MethodsThe data of 27 patients with suspected carcinoma in pancreatic head who received the artery first approach in pancreaticodudenectomy from Sep, 2009 to Dec, 2013 in our hospital were retrospectively analyized. ResultsEight cases received palliative drainage operation, while other 19 cases received radical pancreatectomy, including 2 cases total pancreatectomy and 17 cases pancreaticodudenectomy, with 5 cases portal vein or superior mesenteric vein resection and reconstruction, 1 case common hepatic artery resection, and 2 cases extended right pancreatectomy. The operative time was(281.28±78.53) min(133-354 min), and amount of bleeding was(352±537) mL(189-1 352 mL). There were no operative death, and no reoperation due to complications. ConclusionArtery first approach is preferred for patients with borderline resectable tumors, pancreatic surgeon should be familiar to the various approach.