Application of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery perforator flap transfer / 中华显微外科杂志

Objective:To explore a comparative study of arterial end-to-end and end-to-side anastomosis in superficial branch of the superficial circumflex iliac artery(SCIA) perforator flap transfer.Methods:Between November, 2019 and December, 2020, 21 patients with the soft tissue defects in the limbs were repaired with superficial branch of the SCIA perforator flaps. The size of flaps ranged from 3.5 cm×7.0 cm to 9.0 cm×18.0 cm. According to the upper or anterior wall of the main artery in the recipient area having branches that matched the flap artery, 2 groups were established. End-to-end group: 10 cases were anastomosed end-to-end between the flap artery and branch of the main artery in the recipient area; End-to-side group: 11 cases were anastomosed end-to-side between the flap artery and side mouth of the main artery in the recipient area. The vein of flap was anastomosed end-to-end with the accompanying vein to the main artery in the recipient area. All of the donor sites were sutured directly. All patients were followed-up for 6-12 months and the survival of the perforator flap, the appearance and function of the perforator flap and the donor site were observed. All data of the 2 groups were conducted statistical analyzed. P<0.05 was statistically significant. Results:All 10 flaps in end-to-end group survived successfully. In end-to-side group, 2 cases had venous crisis in 11 cases of flaps,the exploration revealed venous thrombosis, and the arterial end-to-side anastomosis had smooth blood flow had embolism. One flap survived after re-anastomosis of the vein, and 1 flap was changed to a pedicled abdominal flap during the re-venous crisis. The postoperative follow-up was 6 months to 1 year. The appearance and function of the flap and donor site were satisfactory, without difference between the 2 groups. The SCIA superficial branch artery caliber, recipient artery branch or lateral caliber was not statistically different between the 2 groups( P>0.05). The time of anastomosis for end-to-end group was[(16.70±1.34) min]. It was lower than that of anastomosed end-to-side group[(23.73±1.68) min]. The difference was statistically significant( P<0.01). Conclusion:In superficial branch of the SCIA perforator flap transfer, if the upper or anterior wall of the main artery in the recipient area has a branch that matches the flap artery, the flap artery should first be anastomosed with its end. Because it dose not required to make a side port, and makes the operation more convenient with a short anastomosis time; Otherwise, perform end-to-side anastomosis with the main artery of the recipient site.

Application of end-to-side anastomosis in personalised free ilioinguinal flap transfer / 中华显微外科杂志

Objective:To investigate the clinical application and effect of end-to-side anastomosis in personalised free ilioinguinal flap transfer.Methods:From March, 2015 to July, 2020, 88 patients with soft tissue (bone) defect of limbs were treated. Different ilioinguinal flaps were designed according to the wound condition of patients, which were 48 cases of free superficial circumflex iliacartery perforator flap, 7 cases of free superficial epigastric artery perforator flap, 19 cases of composite tissue flap with iliac bone, 8 cases of combined flap of superficial circumflex iliac artery and superficial abdominal wall artery, and 6 cases of superficial circumflex iliac artery and superficial abdominal wall artery lobulated flap. The area of the flap was 4.0 cm×6.0 cm-10.0 cm×30.0 cm. The artery and recipient artery were anastomosed end-to-side: 36 cases to radial artery; 12 cases to ulnar artery; 18 cases to dorsalis pedis artery; 15 cases to anterior tibial artery; 7 cases to posterior tibial artery. Venous anastomosis of skin flap: 42 cases were anastomosed with 2 veins, which were superficial vein of the same name and accompanying vein; 46 cases were anastomosed with 1 superficial vein of the same name. The accompanying vein of the flap was anastomosed end-to-side with the accompanying vein of the main artery of the recipient area, and the superficial vein of the same name was anastomosed end-to-end with the accompanying vein or subcutaneous superficial vein of the recipient artery. Follow-up includes flap blood supply, blood supply to the distal limbs, appearance of both the donor site and the recipient area, and patient satisfaction.Results:There were 83 cases of flaps survived successfully, and 5 cases of crisis. Among them, 2 cases had artery crisis at 48 h after surgery. After exploration, it was found that 1 case caused by arterial thrombosis, and 1 case compressed by the stapler that anastomoses the vein. The other 3 cases had venous crisis at 72 h after surgery: after exploration, it was found that caused by thrombosis at the venous anastomotic site. The average follow-up period was 10 (range, 3-24) months. All flaps survived after re anastomosis or vascular transposition. The donor site and recipient site of the flap healed well. The blood supply of the flap was good and the texture was soft. There was no blood supply disorder in the distal limb.Conclusion:The end-to-side anastomosis technique is suitable for all kinds of free flap transplantation in ilioinguinal region, with high vascular patency rate. It can not only solve the problem of thin vascular pedicle of donor site flap, but also retain the main artery of recipient limb without affecting the distal blood supply.

An interesting case of spindle cell sarcoma of elbow

Spindle cell sarcomas are a group of aggressive malignant soft tissue tumors with a diverse clinical presentation. A 32 years old woman presented with a recurrent nerve sheath tumour, involving flexor carpi ulnaris and a portion of ulnar nerve. Wide local excision of the tumour was done creating a 4 cm gap defect in the ulnar nerve. Distal nerve transfer and Guyon’s canal release was done and anterior transposition of ulnar nerve to distal motor branch of ulnar nerve end to side (ETS) supercharge was done preserving motor function to the little and ring finger. Achieving negative surgical margins in primary soft tissue sarcoma is a critical for local disease control. The anatomical and functional compromise that can occur while giving adequate clearance margin for the tumor can be overcome by microsurgical techniques and neuroanastomosis with positive outcomes like preservation of function and better prognosis.

The application of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation / 中华显微外科杂志

Objective To explore the clinical application effect of multiple end-to-side anastomosis in free anterolateral thigh perforator flap transplantation.Methods From January,2013 to October,2017,29 cases were applied the technology of multiple end-to-side anastomosis to the same recipient vessel in anterolateral thigh perforator flap transplantation for wound repair.Fifteen cases treated with multiple end-to-side anastomosis on flap arteries,and 2-3 arteries were anastomosed,with the average of 2.13.Nine cases were treated with venous multiple end-to-side anastomosis,and 2-4 veins were anastomosed,with the average of 3.11.Five cases treated with arterial and venous multiple end-to-side anastomosis,and 4-6 vessels were anastomosed,with the average of 5.20.Distribution of wounds:10 cases with hands and wrists wounded,15 cases with forearms and elbow joints wounded,and 4 cases with lower legs and feet wounded.The soft tissue defect size was 5 cm×13 cm-11 cm×27 cm,and the flap area was 6 cm× 15 cm-12 cm×29 cm.Postoperative followed-up was performed every 3-6 months to review flap survival.Results All flaps of 29 cases survived.Venous congestion occurred in 2 flaps within 48 h after the operation,among which,1 was overcomed after released the dressing and sutures,and the other underwent surgical exploration.The venous end-to-side anastomotic stomas were unobstructed,and hematoma was formed.After the hematoma compression was removed,circulation was recovered and the flap survived.With followed-up for 6 months to 2.5 years,both donor site and recipient site of the flaps healed well and the injured distal limbs had no hemodynamic disorder.Conclusion The application of multiple end-to-side anastomosis to the same recipient vessel for free transplantation of anterolateral thigh perforator flaps is safe and reliable.

Comprehensive training of rat abdominal aorta and common iliac artery for neurosurgical microvascular anastomosis / 中国脑血管病杂志

Objective To establish an animal model suitable for neurosurgeons for the comprehensive training of microvascular anastomosis using rat abdominal aorta and common iliac artery. Methods Twelve adult SD rats were selected,they were generally anesthetized and laparotomized.The abdominal aortas and bilateral common iliac arteries were exposed and fully separated.The lengths and diameters of abdominal aortas and common iliac arteries of each segment were measured.The end-to-end anastomosis were performed choosing the main trunk of the abdominal aorta without a branching artery and longer segment.The unilateral common iliac artery and the sacral median artery were used for end-to-side anastomosis.The bilateral common iliac arteries were used for end-to-side and side-to-side anastomosis.The micro Doppler ultrasound probe was used to detect the blood flow patency of each anastomotic stoma. Results Anatomical separation of the abdominal aortas and the common iliac arteries was successfully performed in 12 SD rats.Each rat could provide 4 vascular anastomosis exercises.The length of abdomen aorta trunk was 15.6 ± 2.5 mm and the diameter was 1.6 ±0.2 mm between the lower left renal artery and right iliolumbar artery.The side-to-side anastomosis was performed.The mean diameter of the median sacral arteries was 0.80 ±0.08 mm.After the fish mouth-like cutting,the end-to-side anastomosis of the right common iliac arteries were conducted.The lenth of left common iliac artery was 9.0 ± 1.5 mm,the diameter was 1.0 ± 0.1 mm,and was cut off at its origin and then the end-to-side anastomosis of the right common iliac arteries were conducted.After end-to-side anastomosis of bilateral common iliac arteries,its distal segment was arranged in parallel with a length of 5.1 ± 0.3 mm,and then the side-to-side anastomosis could be conducted. Conclusions The rat abdominal aorta and iliac artery model can be comprehensively used to simulate the commonly used neurosurgery bypass graft.It is suitable for neurosurgeons with a certain microsurgical basis to conduct a preliminary vascular anastomosis training.

Analysis of 35 cases with end-to-end layered anastomosis in esophagogastrostomy after esophagectomy / 局解手术学杂志

Objective To evaluate the surgical efficacy of end-to-end layered anastomosis for patients with esophagogastrostomy after esophagectomy.Methods Selected 35 patients who received end-to-end layered anastomosis in esophagogastrostomy after esophagectomy in people' s hospital of Meishan from January 2016 to February 2017 as end-to-end group,while 21 patients with end-to-side layered anastomosis in esophagogastrostomy after esophagectomy as end-to-side group.The anastomosis time,anastomosis tension,oppression degree,fistula incidence,acid reflux incidence,belching incidence and obstruction incidence between two groups were compared.Results The average anastomosis time was (25.17 ± 5.15)minutes in end-to-end group,and (26.10 ± 5.30)minutes in end-to-side group,the difference was not significant (P ＞ 0.05).The anastomosis tension of end-to-end group,without oppression,was mostly smaller than that of end-to-side group.There were no case of anastomotic fistula in end-to-end group and 2 cases(14.29％) of anastomotic fistula in end-to-side group,the difference was not significant (P ＞ 0.05).There were no case of obstruction in end-to-end group and 4 cases (19.05％) of obstruction in end-to-side group,the difference was significant (P =0.016).There was no significant difference in acid reflux and belching between the two groups (P ＞ 0.05) in perioperative period and 6 months after surgery.There was no delayed anastomotic fistula and anastomotic stenosis needing expansion in 6 months after surgery.Conclusion Without causing more adverse reactions,end-to-end layered anastomosis in esophagogastrostomy after esophagectomy can avoid the incision that may affect the blood supply of esophagus and stomach,and avoid the pressure from esophagus and stomach.

Sensory nerve baby-sitting in reverse end-to-side fashion improves the recovery of denervated muscle in rats / 中华显微外科杂志

Objective To delay the atrophy of denervated skeletal muscle by baby-sitting in reverse end-to-side fashion and explore the feasibility of this operation to improve the recovery of denervated muscle in rats.Methods From July,2015 to March,2016,32 female SD rats were divided into 4 groups randomly and the tibial nerve of each rats was transected.In immediate repair group,the transected tibial nerve was sutured in situ.In unprotected group,the tibial nerve stump was putting-aside.The sural nerve was transected in other 2 groups.The proximal sural nerve was connected to the distal tibial nerve stump directly in end-to-end (ETE) protected group and to the side of the distal tibial nerve stump in end-to-side (ETS) protected group.After 3 months,connected the two ends of tibial nerve except immediate repair group.After another 3 months,the tibial nerve functional index,electrophysiological testing,histology and morphology were examined.Results The gastrocnemius muscle was atrophy obviously in unprotected group,while in other groups the muscle structure was well protected.The tibial nerve functional index (-39.54±24.32),motor nerve conduction velocity[(30.25±12.65)m/s],and muscle contraction [(0.98 ± 0.38)N)] indicated that the gastrocnemius muscle function in ETS protected group was statistically better recovery than in unprotected group [-75.65±32.13,(24.93±8.69)m/s and (0.64±0.20)N,respectively] and ETE protected group [-62.34± 21.65,(16.90±7.92)m/s and (0.75-±0.15)N,respectively](P＜0.05).The contractility of muscle were poor recovery in ETE protected group,which was similar to unprotected group(P＞0.05).Conclusion Sensory nerve baby-sitting in reverse end-to-side fashion is a effective method to improve the recovery of denervated muscle in rats.

Anterolateral thigh flaps for reconstruction of soft tissue defect in lower extremities caused by the Gustilo Ⅲopen fracture / 中华显微外科杂志

Objective To evaluate the effectiveness of free anterolateral thigh flaps for the reconstruction of lower extremities vast soft tissue defect caused by Gustilo Ⅲ open fracture. Methods From June,2013 to December, 2016,pedicled vascular anterolateral thigh flaps with end-to-side vascular anastomosis were adopted to repair 10 cas-es of lower legs caused by Gustilo Ⅲ open fracture and soft tissue defects. Among those cases,6 cases combined with anterior tibial arteries injury and 4 cases with posterior tibial arteries injury. The receiving arteries were anastomosed with flaps arteries in end-to-side method and the receiving veins were anastomosed in end-to-end method. All pa-tients were regular follow-up, and follow-up contents included flap appearance, color, limb ischemia. Results All the flaps survived in10 cases. Venous crisis was happened in one case,and flap survived after the exploration. Two cases delayed healing because of wound infection.All the 10 cases were followed up for 3-24 months,with an average of 10 months.The skin flaps of 10 cases were thin and well fitted,with good appearance and soft texture. The color of the flaps were similar to that of the recipient areas.The appearance and function of the affected limbs were satisfacto-ry. Conclusion Free anterolateral thigh flap with end-to-side vascular anastomosis is an ideal method to repair the vast soft tissue defects caused by Gustilo Ⅲ open fracture.

Promoting effect of percutaneous electrical stimulation on nerve regeneration after end-to-side neurorrhaphy in rats / 中国比较医学杂志

Objective To observe and explore the effect and clinical value of percutaneous electrical stimulation on nerve regeneration after end-to-side neurorrhaphy in rats. Methods Thirty-two SPF male S-D rats were randomly divided into four groups ( n = 8 ): group A, the normal control group; group B, with end to end neurorrhaphy of musculocutaneous nerve injury matched to the ulnar nerve; group C, with end to side neurorrhaphy of musculocutaneous nerve injury matched to the ulnar group; and group D, with end to side neurorrhaphy of musculocutaneous nerve injury matched to the ulnar nerve plus postoperative transcutaneous electrical stimulation ( 30 min per day for 6 weeks ) . Electromyography, postoperational nerve conduction velocity, the histological and ultrastructural changes of the nerve fibers were examined, and NF-200 expression in frozen sections was observed using imunohistological staining, to assess the recovery of muscle strength of the diseased side limb and the neuroregeneration in the rats after treatment. Results The amplitude and conduction velocity of the groups C and D were lower than that of the group A, the latency was higher than that of the group A, while the amplitude and conduction velocity of the group D were lower than that of the group C,and the latency was higher than that of the group C. The wet weight ratio of the biceps brachii muscle and the cross-sectional area of muscle fibers in the groups B, C and D were lower than those in the group A, and the recovery of muscle in the group C was the worst. The expression of NF-200 in the rats of groups B, C and D was significantly lower than that in the group A, and the expression of NF-200 in the group D was significantly higher than that in the group C, but still significantly less than that in the group B ( P < 0. 05 ) . Electron microscopy showed mature myelinated fibers in the group B, whereas unmyelinated fibers were the main component and the myelin sheath was poorly developed in the group C. The myelin regeneration in the group D was better than that in the group C, but still some unmyelinated nerve fibers were seen. Conclusions The percutaneous electrical stimulation can effectively promote nerve axonal regeneration and can delay the atrophy of the target muscle after end-to-side neurorrhaphy. Though there is difference compared with the end-to-end neurorrhaphy, the end-to-side neurorrhaphy is still an effective method in clinical repair of peripheral nerve injury.

Usefulness of End-to-Side Bridging Anastomosis of Sural Nerve to Tibial Nerve: An Experimental Research

OBJECTIVE: Repair of sensorial nerve defect is an important issue on peripheric nerve surgery. The aim of the present study was to determine the effects of sensory-motor nerve bridging on the denervated dermatomal area, in rats with sensory nerve defects, using a neural cell adhesion molecule (NCAM). METHODS: We compared the efficacy of end-to-side (ETS) coaptation of the tibial nerve for sural nerve defect repair, in 32 Sprague-Dawley rats. Rats were assigned to 1 of 4 groups: group A was the sham operated group, group B rats had sural nerves sectioned and buried in neighboring muscles, group C experienced nerve sectioning and end-to-end (ETE) anastomosis, and group D had sural nerves sectioned and ETS anastomosis was performed using atibial nerve bridge. Neurological evaluation included the skin pinch test and histological evaluation was performed by assessing NCAM expression in nerve terminals. RESULTS: Rats in the denervated group yielded negative results for the skin pinch tests, while animals in the surgical intervention groups (group C and D) demonstrated positive results. As predicted, there were no positively stained skin specimens in the denervated group (group B); however, the surgery groups demonstrated significant staining. NCAM expression was also significantly higher in the surgery groups. However, the mean NCAM values were not significantly different between group C and group D. CONCLUSION: Previous research indicates that ETE nerve repair is the gold standard for peripheral nerve defect repair. However, ETS repair is an effective alternative method in cases of sensorial nerve defect when ETE repair is not possible.

Outcome of different facial nerve reconstruction techniques / Resultados de diferentes técnicas de reconstrução do nervo facial

Abstract Introduction: There is no technique of facial nerve reconstruction that guarantees facial function recovery up to grade III. Objective: To evaluate the efficacy and safety of different facial nerve reconstruction techniques. Methods: Facial nerve reconstruction was performed in 22 patients (facial nerve interpositional graft in 11 patients and hypoglossal-facial nerve transfer in another 11 patients). All patients had facial function House-Brackmann (HB) grade VI, either caused by trauma or after resection of a tumor. All patients were submitted to a primary nerve reconstruction except 7 patients, where late reconstruction was performed two weeks to four months after the initial surgery. The follow-up period was at least two years. Results: For facial nerve interpositional graft technique, we achieved facial function HB grade III in eight patients and grade IV in three patients. Synkinesis was found in eight patients, and facial contracture with synkinesis was found in two patients. In regards to hypoglossal-facial nerve transfer using different modifications, we achieved facial function HB grade III in nine patients and grade IV in two patients. Facial contracture, synkinesis and tongue atrophy were found in three patients, and synkinesis was found in five patients. However, those who had primary direct facial-hypoglossal end-to-side anastomosis showed the best result without any neurological deficit. Conclusion: Among various reanimation techniques, when indicated, direct end-to-side facial-hypoglossal anastomosis through epineural suturing is the most effective technique with excellent outcomes for facial reanimation and preservation of tongue movement, particularly when performed as a primary technique.

Resumo Introdução: Não existe uma técnica de reconstrução do nervo facial que garanta a recuperação da função facial até o grau III. Objetivo: Avaliar a eficácia e segurança de diferentes técnicas de reconstrução do nervo facial. Método: Ao todo, 22 pacientes foram submetidos a reconstrução do nervo facial (enxerto com interposição do nervo facial em 11 pacientes e com transferência do nervo hipoglosso facial em 11 pacientes). Todos os pacientes apresentavam função facial de grau VI (de acordo com a classificação de House-Brackmann - HB) causada por trauma ou pela ressecção de um tumor. A reconstrução do nervo principal foi efetuada, exceto em sete pacientes, nos quais a reconstrução foi realizada entre duas semanas a quatro meses após a cirurgia inicial. O período de acompanhamento foi de, no mínimo, dois anos. Resultados: Para a técnica de enxerto com interposição de nervo facial, o grau de função facial obtido foi HB III em oito pacientes e HB IV em três pacientes. Sincinesia foi observada em oito pacientes e contratura facial com sincinesia em dois pacientes. Em relação à transferência do nervo hipoglosso facial com o uso de diferentes modificações, obtivemos função facial HB grau III em nove pacientes e HB grau IV em dois pacientes. Contratura facial, sincinesia e atrofia lingual foram observadas em três pacientes e sincinesia observada em cinco pacientes. No entanto, aqueles submetidos a anastomose primária direta hipoglosso-facial término-lateral apresentaram o melhor resultado, sem qualquer déficit neurológico. Conclusão: Entre as várias técnicas de reanimação, sempre que possível, a anastomose direta término-lateral hopoglosso-facial por meio de sutura epineural é a técnica mais eficaz, com excelentes resultados para reanimação facial e preservação do movimento da língua, especialmente quando realizada como técnica primária.

Arched nerves of double end-to-side neuroanastomosis for repairing bilateral acute proper digital nerve injuries / 第二军医大学学报

Objective To explore a new method for repairing bilateral acute proper digital nerve injuries. Methods From Feb. 2009 to Aug. 2012, 56 patients with bilateral acute proper digital nerve injuries were admitted to our center, with20 undergoing double end-to-side neuroanastomosis. During operation, the injured digital nerve was excised, and then the bilateral distal ends and proximal endswere stured, consequently forming the distal and proximal nerve bows. A cutaneous antebrachii lateralis nerve was freed and obtained from the homolateral forearm, and then was equally divided into 2 parts to bridge the 2 nerve bows. Twenty patients underwent nerve graft with end-to-end neuroanastomosis, and the rest 16 patients underwent direct end-to-end neuroanastomosis. Results All the patients achieved primary healing of wound after operation, with no circulation disorders. A total of 50 patientswere followed up for 3-12 months. In double end-to-side neuroanastomosis group, 18 patientswere successfully followed up, with the average sensation measurement being S3+, which was significantly higher than those of the other 2 groups(P = 0. 024). The average result of two point discrimination was (5. 2±0. 7) mm, which was significantly lower than those of the other 2 groups(P = 0. 037). According to TAM scales, the results of finger joint motion were excellent in 14 cases, good in 3 cases and fair in 1; and there were no significant differences in the motion of joints between the 3 groups (P = 0. 914). In nerve graft with end-to-end neuroanastomosis group, 19 patients were successfully followed up; the average result of sensation measurement was S2 and the average result of two point discrimination was (7. 2±1. 4) mm. In direct end-to-end neuroanastomosis group, 13 patients were successfully followed up; the average result of sensation measurement was S3 and the average result of two point discrimination was (6. 3±0. 8) mm. Conclusion The arched nerves of double end-to-side neuroanastomosis can be used for repairing bilateral acute proper digital nerve injuries, which can quickly restore the sensation of fingers, but the related conclusion needs further verification with large sample studies.

The embracing end-to-side neurorrhaphy in rats / A neurorrafia término-lateral abraçante em ratos

PURPOSE: Compare two new methods with the traditional end-to-side neurorrhaphy. METHODS: Rats were divided into four groups. In A-L group the peroneal nerve was sectioned and the distal stump was connected to the lateral of the tibial nerve (donor) with two 10-0 nylon points. In A-R group two perineurium flaps embraced the donor nerve. In the B-R group a suture embraced the donor nerve. Group B-L was the control. After six months tibial cranial muscle mass and morphometry of the distal stump of the peroneal nerve were evaluated. RESULTS: Muscle mass in groups A-R, A-L and B-R were lower than B-L group (p<0.0001) an equal between themselves (p>0.05). Groups A-R, B-R and A-L had a lower number of nerve fibers when compared with B-L (p=0.0155, p=0.016, p=0.0021). CONCLUSION: The three types of neurorrhaphy showed no differences related to muscle mass and number of nerve fibers suggesting that the embracing with a single suture has great potential due its simplicity and usefulness in deep areas.

OBJETIVO: Comparar dois novos métodos com o método tradicional da neurorrafia término-lateral. MÉTODOS: Os ratos foram separados em quatro grupos. No grupo A-E o nervo peroneal foi seccionado e o coto distal foi suturado à lateral do nervo tibial com dois pontos de nylon 10-0. No grupo A-D duas abas de epi-perineuro abraçaram o nervo doador. No grupo B-D foi realizada sutura com um único ponto abraçando o nervo doador. O grupo B-E foi o controle. Após seis meses foram observados massa do músculo tibial cranial e morfometria do coto distal do nervo peroneal. RESULTADOS: Foi encontrada menor massa muscular nos grupos A-D, A-E e B-D quando comparados com o grupo B-E (p<0.0001) e mesma massa quando comparados entre si (p>0,05). Os grupos A-D, A-E e B-D apresentaram menor número de fibras nervosas quando comparados ao grupo B-E (p=0,0155; p=0,016; p=0,0021) e mesmo número quando comparados entre si. CONCLUSÃO: Os três tipos de neurorrafia não apresentaram diferenças relacionadas à massa muscular e número de fibras nervosas sugerindo que a sutura abraçante com apenas um ponto apresente grande potencial em áreas cirúrgicas mais profundas.

Distal anterior interosseous nerve transfer to the deep ulnar nerve and end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve for treatment of high ulnar nerve injuries: experience in five cases / Transferência do nervo interósseo anterior distal para o ramo profundo do nervo ulnar e sutura término-lateral do nervo ulnar superficial ao terceiro nervo digital comum para tratamento de lesões altas do nervo ulnar: experiência em cinco casos

OBJECTIVE: To demonstrate the results of a double nerve transfer at the level of the hand for recovery of the motor and sensory function of the hand in cases of high ulnar nerve injuries. METHOD: Five patients underwent a transfer of the distal branch of the anterior interosseous nerve to the deep ulnar nerve, and an end-to-side suture of the superficial ulnar nerve to the third common palmar digital nerve. RESULTS: Two patients recovered strength M3 and three cases were graded as M4; recovery of protective sensation (S3+ in three patients and S4 in two) was observed in the fourth and fifth fingers, and at the hypothenar region. The monofilament test showed values of 3.61 or less in all cases and the two-point discrimination test demonstrated values of 7 mm in three cases and 5 mm in two. CONCLUSION: This technique of double nerve transfer is effective for motor and sensory recovery of the distal ulnar-innervated side of the hand.

OBJETIVO: Demonstrar os resultados obtidos com uma dupla transferência nervosa ao nível da mão para tratamento de lesões do nervo ulnar localizadas acima do cotovelo. MÉTODO: Cinco pacientes foram submetidos à transferência do nervo interósseo anterior para o ramo profundo do nervo ulnar, associado à sutura término-lateral do nervo ulnar superficial ao terceiro nervo digital comum. RESULTADOS: Dois pacientes recuperaram força M3 e os outros três casos foram graduados como M4. Recuperação de sensibilidade protetora (S3+ em três pacientes e S4 em dois) foi observada nos quarto e quinto dedos, além da região hipotenar. O teste de monofilamentos demonstrou valores iguais ou menores do que 3,61 em todos os casos e o teste de discriminação de dois pontos apresentou valores de 7 mm em três casos e 5 mm em dois. CONCLUSÃO: A técnica de dupla transferência nervosa é eficaz como modalidade de tratamento para lesões altas do nervo ulnar.

Classification of microvascular anastomosis in oral and maxillofacial reconstruction

A reconstruction following a resection of malignant oral cavity tumors is one of the most difficult problems in recent oral oncology. For a better understanding of oral and maxillofacial reconstructive procedures, basic and advanced microvascular anastomosis techniques must be learned and memorized. The aim of this article was to clarify and define the microvascular anastomosis methods, such as primary closure after an arteriotomy, end to side anastomosis, end to end anastomosis, and side to side anastomosis with an artery and vein. This review article discusses the basic skills regarding microvascular anastomoses with brief schematic diagrams in the Korean language. This article is expected to be helpful, particularly to young doctors in the course of the Korean national board curriculum periods for oral and maxillofacial surgery.

Effect of surgical treatment for patients with large segment defect of ulnar nerve / 国际外科学杂志

Objective To evaluate the clinical effect of surgical operation for recovering the function of ulnar nerve with large segment defect. Methods Twentycases with the large segment defect of ulnar nerve were retrospectively analyzed from September 1999 to December 2006 in the hospital.All the patients were treated by the operation of nerve end-to-side neurorrhaphy . The broken end of ulnar nerve was anastomosed with the median nerve. And observed the recovery of the sensation and motion function of the little finger, interosseous muscles and claw hand, then compared with before. Results All cases were followed up for 8 to 36 months. The mean was 16 months. The sensation and motion function of the little fingers had better restoration after operation. No incision infection, anchylosis or myatrophy was occurred.Excellent(M4 + S4 +) ,Good (M3S3), moderate (M2S2), and poor effects (M1S1) were achieved respectively in 6, 4,2 and 0 cases based on the scale of XU' s grading standard.The excellent and good rate was 83.3%. Conclusion The nerve end-to-side neurorrhaphy was a effective treatment for the patients with large segment defect of ulnar nerve.

Clinical observation of superficial radial nerve transplanting to repair musculospiral nerve defection and functional reconstruction of donor site / 中国综合临床

Objective To observe the effect of superficial radial nerve transplanting to repair musculospiral nerve defection and using end-to-side neurorrhaphy to reconstruct the function of the donor site. Methods Thirtyfour cases underwent superficial radial nerve transplanting to repair musculospiral nerve defection and end-to-side neurorrhaphy was performed to reconstruct the function of the donor site. Results All cases were followed-up for 6 to 18 months,the functional recovery of the recipient of musculospiral nerve was excellent in 23 cases and good in 5 cases,with an excellent and good rate of 82. 53 %. Sensory recovery of donator nerve was excellent in 27 cases and good in 5 cases,with an excellent and good rate of 94. 12%. Conclusions Superficial radial nerve transplanting to repair musculospiral nerve defection and functional reconstruction of donor site is a better choice in treating neurologic defect.

Comparison of Complications in End-to-side and Side-to-side Esophagojejunostomy after Laparoscopy-assisted Total Gastrectomy for Gastric Cancer / 대한내시경복강경외과학회지

PURPOSE: The aim of this study was to compare end-to-side with side-to-side esophagojejunostomy after laparoscopy-assisted total gastrectomy (LATG) for gastric cancer in terms of complications. METHODS: One hundred and fourteen patients who underwent laparoscopy-assisted total gastrectomy for gastric cancer with curative intent from June 2003 to February 2010 at Seoul National University Bundang Hospital were retrospectively reviewed. Comparative analysis of short term outcomes including complications was performed to compare the end-to-side esophagojejunostomy (EJ) and side-to-side EJ groups. RESULTS: Overall morbidity and mortality rates after LATG were 17.5% (20 patients) and 0%, respectively. Comparing the end-to-side EJ group (93 patients) with the side-to-side EJ group (21 patients), there was no significant difference in operating time (242.3 versus 250.7 minutes), estimated blood loss (176.6 versus 133.3 ml), time to first flatus (3.8 versus 4.0 days), time to first soft diet (5.3 versus 5.7 days), postoperative morbidity (15.1% versus 28.6%), and mortality. However, there was a difference in postoperative hospital stay (9.0 versus 12.9 days, p=0.045). Also, the EJ leakage rate of the side-to side EJ group was higher than that of end-to-side EJ group (14.3%, 3 patients, versus 2.2%, 2 patients; p=0.043). CONCLUSION: End-to-side EJ can be recommended after LATG because the EJ leakage rate after end-to-side EJ was lower than that after side-to-side EJ.

Neurotropism following end-to-side neurorrhaphy by neuron retrograde tracing technique / 中华显微外科杂志

Objective To detect whether there is neurotropism following end-to-side neurorrhaphy by means of the neuron retrograde tracing technique. Methods Forty female Sprague-Dawley rats were randomly divided into 4 groups: tracing main branch of musculcutaneous nerve(MC) of end-to-side group, tracing MC main branch of normal group, tracing MC motor branch of end-to-side group and tracing MC motor branch of normal group.In two end-to-side groups, the MC was transeeted, then an 1 mm epineukral window was created on the ulnar nerve. Distal end of MC nerve was sutured to the windowed ulnar nerve by means of end-to-side neurorrhaphy.In two normal control groups, MC and ulnar nerves were just exposed. Five months post operation, by means of retrograde Fluoro-Gold neuron tracing technique,the number of C5～ T1 anterior horn motoneurons and dorsal root ganglion sensory neurons of all groups were counted. Results In two tracing MC main branch groups: the motor neuron counts in end-to-side group was 245.2 ± 93.8, the motor neuron counts in normal group was 846.7 ± 264.8, and counts of end-to-side group was 30.0% of the normal control group (P＜ 0.01). The sensory neuron counts in end-to-side was 434.7 ± 160.4, the sensory neuron counts in normal group was 1545.2 ± 287.4, and counts of end-to-side group was 28.1% of the normal control group (P ＜ 0.01). The per-centage of motor neuron in end-to-side group was 0.36 ± 0.09, there was no difference between end-to-side group and normal control group(P＞ 0.05). In two tracing MC motor branch groups: the motor neuron counts in end-to-side group was 72.3 ± 35.3, the motor neuron counts in normal group was 189.7 ± 57.0, and counts of end-to-side group was 38.1% of the normal control group (P ＜ 0.01). The sensory neuron counts in end-to-side was 110.8 ± 52.5, the sensory neuron counts in normal group was 157.9 ± 50.0, and counts of end-to-side group was 70.2% of the normal control group (P ＞ 0.05). The percentage of motor neuron in end-to-side group was 0.40 ± 0.14, the difference between end-to-side group and normal control group was signifieant(P ＜ 0.01 ). Conclusion Neurotropism in collateral spouting after end-to-side neurorrhaphy is not significant.

Comparison of End-to-side and End-to-end Anastomosis in Circular Stapled Gastroduodenostomy

PURPOSE: The use of automatic circular staplers for gastroduodenostomy after distal gastrectomy is now widely accepted. We compared the clinical outcomes of two different methods. MATERIALS AND METHODS: Between March 2005 and February 2008, 134 patients with gastric cancer underwent distal gastrectomies. Seventy-six consecutive patients received end-to-side gastroduodenostomies (ES) between March 2005 and September 2006. The remaining 58 consecutive patients received end-to-end gastroduodenostomies (EE) between November 2006 and February 2008. We analyzed the surgical outcomes between the two groups (ES versus EE) on the basis of prospectively collected data. RESULTS: Among the clinical factors, there were no differences between the two groups. The overall complication rates were 19.7% in the ES group and 13.8% in the EE group (P=0.489). With respect to anastomosis-related complications, 2 cases had bleeding and 2 cases had stenoses in the ES group, while 2 cases in the EE group had bleeding. Re-operation was needed in the case of intraluminal bleeding in the ES group. There were no mortalities in our study. CONCLUSION: The two methods for gastroduodenostomy were safe and technically feasible. Although there was no statistical difference in the overall complications, including anastomosis-related complications, we demonstrated better outcomes with respect to anastomotic stenosis in the EE group.