Feasibility of using external jugular vein and its branches as Y- and X-shaped vein grafts for bridging of arterial defects and providing additional arterial sources for free flap applications in rat model.

BACKGROUND: Venous grafting has been widely used in microsurgical training. Different types of vascular grafts have been described in experimental models. In this study we describe for the first time the Y- and X-shaped vein grafts (YVG, XVG) with accompanying drain-out branches as a new tool for the microsurgical training and free flap applications in rats. METHODS: Twelve adult male Lewis rats were used in this study. The dissections were performed to determine the average diameter and harvestable length of vein grafts in eight rats. In four rats vein grafts were applied for bridging of the common carotid artery gap, whereas the drain-out branches were used as the arterial source for single and bilateral free groin flap applications. The venous anastomoses of groin flaps were performed in end-to-end fashion to the external jugular vein and its branches. The patency of anastomoses was checked 72 hours after repair. RESULTS: The average length of the harvestable vein branches ranged between 5.2 to 11.8 mm. The average surgery time for repair of the arterial gap with the vein grafts was 40 minutes. The ischemia time for single and bilateral groin flap transfer using YVG and XVG was 30 and 70 minutes, respectively. The patency of the interpositional vein graft was 100%. Flap survival rates were 50%. CONCLUSIONS: These vein grafts can be used as an alternative technique for reconstruction of tissue defects that require arterial gap repair with single or multiple free flap applications and also as a new microsurgical training model.

Repair of the peripheral nerve gap with epineural sheath conduit to prevent muscle denervation atrophy in the diabetic rat model.

UNLABELLED: Muscle denervation atrophy is a result of lower motor neuron injury, thus an early restitution of muscle stimulation is essential in prevention of atrophic changes. THE AIM OF THE STUDY: To evaluate the new application of naturally occurring epineural sheath conduit in repair of the peripheral nerve gap to prevent development of muscle denervation atrophy. MATERIAL AND METHODS: We used the model of 20 mm sciatic nerve gap, resulting in denervation atrophy of the gastrocnemius muscle in the diabetic rats (DM type 2, n=42, Zucker Diabetic Fatty strain). We applied the epineural sheath conduit created from the autologous sciatic nerve for gap repair. Muscle atrophy was assessed with the Gastrocnemius Muscle Index (GMI) and microscopic muscle morphometry (mean fiber area) at 6 and 12 postoperative week. Muscle regeneration in the experimental group was compared to the gold-standard technique of autologous nerve grafting for the repair of created nerve gap. RESULTS: The GMI evaluation revealed comparable muscle mass restoration in groups with nerve repair using both epineural sheath and standard autologous nerve grafting (reaching 28 and 35% of contralateral muscle mass at 12 postoperative week, respectively, p=0.1), and significantly better restoration when compared to the negative control group (no repair, 20%, p<0.01). Micromorphometry confirmed significantly larger area of the regenerated muscle fibers in groups with both nerve grafting and epineural sheath conduit repair (reaching for both ca. 42% of the non-operated side), when compared to severe atrophic outcome when no nerve repair was performed (14% of the control fiber area, p<0.0001). The effectiveness of epineural conduit technique in muscle mass restoration was observed between 6 and 12 weeks after nerve repair--when gastrocnemius muscle mass increased by 12%. CONCLUSIONS: Peripheral nerve gap repair with naturally occurring epineural sheath conduit is effective in prevention of muscle denervation atrophy. This method is applicable in diabetic model conditions, showing results of regeneration which are comparable to the autologous nerve graft repair.

Lymphatic angioma of mesentery of the small intestine: a case report.

The authors presented a rare case of lymphatic angioma of mesentery of the small intestine. The patient underwent successful surgery. The study presents clinical symptoms, diagnostic and therapeutic problems in patients with lymphatic angiomas.

Factors influencing the clinical course of popliteal artery aneurysm.

BACKGROUND: The literature concerning the threshold for intervention in asymptomatic popliteal aneurysm is inconsistent. The purpose of this study was to identify factors related to the clinical course of popliteal aneurysms. MATERIAL/METHODS: We analyzed the influence of patients' age and sex, diameter of the aneurysm, atherosclerotic risk factors, use of antiplatelet medications and statins, lipid profile, and the presence of other aneurysms on the symptoms and status of the popliteal aneurysm (patent or thrombosed). RESULTS: Of 86 cases of popliteal aneurysms in 61 patients, 18 were asymptomatic, 22 were associated with intermittent claudication, 26 with acute limb ischemia, 10 with critical limb ischemia, and 10 with nonischemic symptoms. There was a trend of borderline statistical significance for smaller diameter in asymptomatic popliteal aneurysms. It was not possible to discriminate between cases with and without limb-threatening symptoms, or patent versus thrombosed popliteal aneurysm based on the diameter of the aneurysm. The 58 cases with hypercholesterolemia less frequently presented with limb-threatening symptoms (32.8%) compared with the 28 patients without hypercholesterolemia (60.7%, P=.02), and more often had patent aneurysms (55.2% versus 28.6%, P=.04). Patients with patent popliteal aneurysms were younger (P=.047) and were more frequently on statins (30% versus 12.5%, P=.063). CONCLUSIONS: Expectations regarding clinical course and indications for intervention in popliteal aneurysm should not be based on its diameter. Statins may have a beneficial influence on the clinical course of popliteal aneurysms, but further investigations are required.