1457 Years of Microsurgical Experience

Abstract

Microsurgery is a relatively new field of surgery involving various methods and practices that are currently evolving. Our goal was to register the current practices employed by the members of the American Society for Reconstructive Microsurgery. A survey was mailed to the 319 members of the society, resulting in a response rate of 33 percent (106 of 319). The data reflect the combined experience of 10,839 free-tissue transfers and 3487 digital and upper and lower extremity replants over a 4-year period between 1990 and 1994. Practices employed, such as pharmacologic adjuvant therapy, monitoring techniques, flap types, and success rates reported by the members of the American Society for Reconstructive Microsurgery, were analyzed.

Intraoperative Transfusion of Packed Red Blood Cells in Microvascular Free Tissue Transfer Patients: Assessment of 30-Day Morbidity Using the NSQIP Dataset

“…[10][11][12][13][14][15] Although the safety of intraoperative hemodilution and anticoagulation regimens have been well established, [16][17][18] recent data have emphasized the controversial nature of aggressive fluid resuscitation and preoperative anemia. 10,11,19,20 Historical data have focused on maintaining hemoglobin levels greater than 10 g/dL and is based on animal studies demonstrating optimal oxygen transport at these levels.…”

Mikrovaskulärer Gewebetransfer nach ablativer Chirurgie in der Gynäkologie

“…Durch ständige Verbesserung von Instrumenten, Nahtmaterial und Operationstechniken und Wissenszuwachs in der Lappenanatomie wurde es mehr und mehr möglich, regelmäßig freien Gewebetransfer im Rahmen großer Rekonstruktionen mit hervorragendem Erfolg durchzuführen. Auch ergaben die Überführung der lokal gestielten Myokutanlappen mittels Mikrochirurgie in freie Lappen eine verbesserte Blutversorgung des transferierten Gewebes, eine Abnahme der Spendermorbidität und einen einfacheren Gewebeeinbau am Rekonstruktionsort mit verlässlicheren ästhetischen und funktionellen Ergebnissen [8,9]. Insofern werden die freien Lappenrekonstruktionen nicht mehr als die letzte Sprosse auf der rekonstruktiven Leiter angesehen, sondern stellen die erste Wahl für die Rekonstruktion im Bereich von Weichgewebe dar.…”

Homocystinuria: An Unrecognized Cause of Microvascular Failure

“…Fewer than 5 percent of free tissue transfers suffer either subtotal or total flap loss, with experienced high-volume centers approaching a 100 percent success rate. [1][2][3] The most common cause of failure is a technical error leading to venous (50 percent) or arterial (24 percent) thrombosis. 1 Less frequent reasons for vascular complications are hematoma (19 percent) or vasospasm (5 percent).…”

“…[1][2][3] The most common cause of failure is a technical error leading to venous (50 percent) or arterial (24 percent) thrombosis. 1 Less frequent reasons for vascular complications are hematoma (19 percent) or vasospasm (5 percent). 1 In our own series of 432 flaps performed between 1977 and 2005, there have been two total failures, one of which is described in this report.…”

“…1 Less frequent reasons for vascular complications are hematoma (19 percent) or vasospasm (5 percent). 1 In our own series of 432 flaps performed between 1977 and 2005, there have been two total failures, one of which is described in this report.…”