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Cowan R, Mann G, Salibian AA. Ultrasound in Microsurgery: Current Applications and New Frontiers. J Clin Med 2024; 13:3412. [PMID: 38929941 PMCID: PMC11204189 DOI: 10.3390/jcm13123412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 06/28/2024] Open
Abstract
Ultrasound has revolutionized reconstructive microsurgery, offering real-time imaging and enhanced precision allowing for preoperative flap planning, recipient vessel identification and selection, postoperative flap monitoring, and lymphatic surgery. This narrative review of the literature provides an updated evidence-based overlook on the current applications and emerging frontiers of ultrasound in microsurgery, focusing on free tissue transfer and lymphatic surgery. Color duplex ultrasound (CDU) plays a pivotal role in preoperative flap planning and design, providing real-time imaging that enables detailed perforator mapping, perforator suitability assessment, blood flow velocity measurement, and, ultimately, flap design optimization. Ultrasound also aids in recipient vessel selection by providing assessment of caliber, patency, location, and flow velocity of recipient vessels. Postoperatively, ultrasound enables real-time monitoring of flap perfusion, providing early detection of potential flap compromise and improved flap survival rates. In lymphatic surgery, ultra-high frequency ultrasound (UHFUS) offers precise mapping and evaluation of lymphatic vessels, improving efficacy and efficiency by targeting larger dilated vessels. Integrating ultrasound into reconstructive microsurgery represents a significant advancement in the utilization of imaging in the field. With growing accessibility of devices, improved training, and technological advancements, using ultrasound as a key imaging tool offers substantial potential for the evolution of reconstructive microsurgery.
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Affiliation(s)
| | | | - Ara A. Salibian
- Division of Plastic and Reconstructive Surgery, University of California, Davis School of Medicine, Sacramento, CA 95817, USA
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Dermisiadou E, Panopoulos I, Psalla D, Georgiou S, Sideri A, Galatos A, Tsioli V. Comparison of Two Surgical Techniques Based on the Semitendinosus Myocutaneous Flap in Cats. Vet Sci 2023; 11:6. [PMID: 38275922 PMCID: PMC10818443 DOI: 10.3390/vetsci11010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/27/2024] Open
Abstract
The objective of this experimental study was to compare the semitendinosus (ST) to the split-semitendinosus (SST) myocutaneous flap in covering distal limb skin defects in cats. Twenty-eight purpose-bred laboratory DSH cats were used and allocated into two groups (ST-group (A); n = 14, SST-group (B); n = 14). ST flaps, based on the distal muscle pedicle, and SST flaps, after longitudinal division of the muscle based on both muscle pedicles, were tested over skin defects created on the medial distal tibia. Clinical assessment, planimetry, CT-angiography (CTA) and histological examination were compared between groups. Days to complete flap healing between ST and SST-flaps (30.36 ± 9.1, 32.29 ± 5.44, respectively) and final total flap areas (68.36% ± 27.18, 51.83% ± 22.48, respectively) revealed no significant differences. On CTAs, the caliber of the distal caudal femoral vein on day 10 was statistically significant higher (p < 0.001) for group A and a significantly higher caliber of the distal caudal femoral artery on day 30 for group B (p = 0.021). Histology revealed statistically higher degeneration at 6 months (p = 0.047) for group A, and statistically higher fibrosis at 12 months (p = 0.019) for group B. Both ST and SST flaps had similar healing times and provided coverage of skin tibial defects in cats.
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Affiliation(s)
- Eleftheria Dermisiadou
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, GR-43100 Karditsa, Greece; (E.D.); (S.G.); (A.S.); (A.G.)
| | - Ioannis Panopoulos
- Alphavet, Veterinary Diagnostic Imaging Center, 40 Filosofon Street, GR-14564 Athens, Greece;
| | - Dimitra Psalla
- Laboratory of Pathology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, GR-54627 Thessaloniki, Greece;
| | - Stefanos Georgiou
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, GR-43100 Karditsa, Greece; (E.D.); (S.G.); (A.S.); (A.G.)
| | - Aikaterini Sideri
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, GR-43100 Karditsa, Greece; (E.D.); (S.G.); (A.S.); (A.G.)
| | - Apostolos Galatos
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, GR-43100 Karditsa, Greece; (E.D.); (S.G.); (A.S.); (A.G.)
| | - Vassiliki Tsioli
- Clinic of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, Trikalon 224, GR-43100 Karditsa, Greece; (E.D.); (S.G.); (A.S.); (A.G.)
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Malik MS, Akoh JA, Houlberg K. The Use of the Implantable Doppler Probe as a Blood Flow Monitoring Device in Clinical Settings: A Narrative Review of the Evidence. EXP CLIN TRANSPLANT 2023; 21:83-92. [PMID: 36919717 DOI: 10.6002/ect.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVES In the past decade, the implantable Doppler probe has been studied widely as a blood flow-monitoring device in reconstructive and transplant surgical specialities. Its utility as an effective postoperative monitoring technique is still debatable, with no clear guidelines in clinical practice. Here, we mapped the current evidence on the usefulness of the implantable Doppler probe as a blood flow-monitoring device. The objective was to present an up-to-date assessment of the benefits and limitations of using implantable Doppler probes in clinical and experimental clinical settings. MATERIALS AND METHODS We conducted a literature search using the Cochrane Library and Healthcare Databases Advanced Search and using implantable Doppler probe, transplant, graft, and flap as key words. The search yielded 184 studies, with 73 studies included after exclusions. We evaluated, synthesized, and summarized the evidence from the studies in tabular form. RESULTS There is clinical equipoise regarding the effectiveness of implantable Doppler probe as a flow sensing technique. The main reason is the lack of information and gaps in the evidence regarding the benefits and limitations of using implantable Doppler probes in clinical practice. CONCLUSIONS The implantable Doppler probe has the potentialto be used as an adjunctpostoperativeblood flow-monitoring device. However, keeping in view of technical limitations, its signals should be interpreted alongside traditional clinical assessment techniques to determine the patency of microvascular anastomosis. Although evidence in this review will inform clinical practice in transplant and reconstructive surgical specialties, a prospective randomized controlled study with a larger patient cohort is required to evaluate the effectiveness of this probe in clinical settings.
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Dermisiadou E, Panopoulos I, Psalla D, Georgiou S, Sideri A, Galatos A, Tsioli V. Use of a semitendinosus myocutaneous flap for the coverage of hindlimb full-thickness skin defects in cats. J Vet Sci 2023; 24:e14. [PMID: 36726279 PMCID: PMC9899943 DOI: 10.4142/jvs.22158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/19/2022] [Accepted: 11/08/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The management of feline hindlimb full-thickness skin defects is challenging. On the other hand, the use of a semitendinosus (ST) myocutaneous flap for their coverage has not been reported. OBJECTIVES To describe the ST flap and compare it with second intention healing for managing hindlimb full-thickness skin defects. METHODS In 12 purpose-bred laboratory domestic short-haired cats, two wounds were made on each tibia. The wounds in group A (n = 12) were covered with ST flaps, and those in group B (n = 12) were left to heal by second intention. In both groups, clinical assessment scoring and planimetry were performed between one-30 d postoperatively. Computed tomography-angiography (CTA) was performed on days zero, 10, and 30, and histological examinations were performed on days zero and 14 and at 6 and 12 mon postoperatively. RESULTS Statistically significant differences in the clinical assessment scores were observed between groups A and B on days 14 (p = 0.046) and 21 (p = 0.016). On the other hand, the time for complete healing was similar in the two groups. CTA revealed significant differences in the muscle width (day 0 compared to days 10 and 30 [p = 0.001, p = 0.026, respectively], and days 10 to 30 [p = 0.022]), ST muscle density, and the caliber of the distal caudal femoral artery and vein (day 0 compared to day 10 [p < 0.001], and days 10 to 30 [p < 0.001]). Histologically significant differences in inflammation, degeneration, edema, neovascularization, and fibrosis were observed on day 14 compared to zero and 6 mon, but no differences were found between the time interval of 6 and 12 mon. CONCLUSIONS An ST flap can be used effectively to manage hindlimb full-thickness skin defects.
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Affiliation(s)
- Eleftheria Dermisiadou
- Department of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, GR-43100 Karditsa, Greece
| | | | - Dimitra Psalla
- Laboratory of Pathology, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, GR-54627 Thessaloniki, Greece
| | - Stefanos Georgiou
- Department of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, GR-43100 Karditsa, Greece
| | - Aikaterini Sideri
- Department of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, GR-43100 Karditsa, Greece
| | - Apostolos Galatos
- Department of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, GR-43100 Karditsa, Greece
| | - Vassiliki Tsioli
- Department of Surgery, Faculty of Veterinary Science, School of Health Sciences, University of Thessaly, GR-43100 Karditsa, Greece.
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Cevik J, Hunter-Smith DJ, Rozen WM. Current Advances in Breast Reconstruction. J Clin Med 2022; 11:jcm11123328. [PMID: 35743399 PMCID: PMC9224946 DOI: 10.3390/jcm11123328] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 01/30/2023] Open
Affiliation(s)
- Jevan Cevik
- Department of Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia; (J.C.); (D.J.H.-S.)
- Plastic and Reconstructive Surgery Group, Peninsula Clinical School, Peninsula Health, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - David J. Hunter-Smith
- Department of Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia; (J.C.); (D.J.H.-S.)
- Plastic and Reconstructive Surgery Group, Peninsula Clinical School, Peninsula Health, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia
| | - Warren M. Rozen
- Department of Surgery, Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia; (J.C.); (D.J.H.-S.)
- Plastic and Reconstructive Surgery Group, Peninsula Clinical School, Peninsula Health, Monash University, 2 Hastings Road, Frankston, VIC 3199, Australia
- Correspondence:
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Silicone-based simulation models for peripheral nerve microsurgery. J Plast Reconstr Aesthet Surg 2018; 72:477-483. [PMID: 30487050 DOI: 10.1016/j.bjps.2018.10.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/12/2018] [Accepted: 10/28/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND There is a need for a peripheral nerve model on which surgeons-in-training can simulate the repair of nerve injuries at their own pace. Although practicing on animal models/cadavers is considered the "gold standard" of microsurgical training, the proposed model aims to provide a platform for improving the technical skills of surgical trainees prior to their practice on cadaver/animal models. In addition, this model has the potential to serve as a standardized test medium for assessing the skill sets of surgeons. METHODS Several formulations of silicone were utilized for the design and fabrication of a model which realizes the hierarchical structure of peripheral nerves. The mechanical properties were characterized via the Universal Testing Machine; the damage caused by the needle on the entry sites was assessed through scanning electron microscopy (SEM). RESULTS Mechanical properties of the formulations of silicone were tested to mimic human peripheral nerves. A formulation with 83.3 wt% silicone oil and 0.1 wt% cotton fiber was chosen to be used as nerve fascicles. Both 83.3 wt% silicone oil with cotton fiber and 66.6 wt% silicone oil without fiber provided a microsuturing response similar to that of epineurium at a wall thickness of 1 mm. SEM also confirmed that the entry of the needle did not introduce significant holes at the microsuturing sites. CONCLUSIONS The proposed peripheral nerve model mimicked human tissues mechanically and cosmetically, and a simulation of the repair of a fifth-degree nerve injury was achieved.
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Kobayashi E, Haga J. Translational microsurgery. A new platform for transplantation research. Acta Cir Bras 2016; 31:212-7. [PMID: 27050793 DOI: 10.1590/s0102-865020160030000010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 02/19/2016] [Indexed: 01/09/2023] Open
Abstract
PURPOSE Clinical microsurgery has been introduced in many fields, while experimental microsurgery has the cross-disciplinary features of the sciences and techniques for growth of medicine, pharmacology, veterinary, engineering etc. Training protocol, proposing a new name as Translational Microsurgery, was introduced. METHODS Reconstructive skills of hepatic artery in pediatric living donor liver transplantation were summarized. Ex vivo training protocol using artificial blood vessel for surgeons was proposed. RESULTS Clinical microsurgery requires anastomosis with delicate arteries and limited field of view. Our training protocol revealed that the relation between the score and speed was seen, while not all the surgeons with enough experience got high score. This training led to muster clinical skills and to apply excellent experimental works. CONCLUSIONS Our microsurgical training protocol has been planned from the points of clinical setting. Training for vascular anastomosis led to rodent transplantation models. These models were used for immunology and immunosuppressant research. Microsurgical techniques led to master catheter technique and to inject various drugs or gene vectors.
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Affiliation(s)
- Eiji Kobayashi
- Department of Organ Fabrication, School of Medicine, Keio University, Tokyo, Japan
| | - Junko Haga
- Department of Organ Fabrication, School of Medicine, Keio University, Tokyo, Japan
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Smeets R, Vorwig O, Wöltje M, Gaudin R, Luebke AM, Beck-Broichsitter B, Rheinnecker M, Heiland M, Grupp K, Gröbe A, Hanken H. Microvascular stent anastomosis using N-fibroin stents: feasibility, ischemia time, and complications. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 121:e97-e103. [DOI: 10.1016/j.oooo.2016.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
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Hocaoğlu E, Emeklİ U, Çİzmecİ O, Uçar A. Suprafascial pre-expansion of perforator flaps and the effect of pre-expansion on perforator artery diameter. Microsurgery 2013; 34:188-96. [DOI: 10.1002/micr.22184] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 08/07/2013] [Accepted: 08/16/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Emre Hocaoğlu
- Istanbul Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery; Istanbul University; Istanbul Turkey
| | - Ufuk Emeklİ
- Istanbul Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery; Istanbul University; Istanbul Turkey
| | - Orhan Çİzmecİ
- Istanbul Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery; Istanbul University; Istanbul Turkey
| | - Adem Uçar
- Istanbul Faculty of Medicine, Department of Radiodiagnostics; Istanbul University; Istanbul Turkey
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Microsurgery and liver research: Lumbricus terrestris, a reliable animal model for training? Clin Res Hepatol Gastroenterol 2013; 37:166-70. [PMID: 22795317 DOI: 10.1016/j.clinre.2012.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 04/17/2012] [Indexed: 02/04/2023]
Abstract
BACKGROUND Experiments using animal models are the most common way to learn microsurgery. This expertise is necessary for liver research, microsurgical reconstruction of the esophagus by free jejunum or reconstruction of the hepatic artery during reimplantation from living donors. The goal of this prospective study is to assess the reliability of an invertebrate model for microsurgical training. METHODS Between November 2011 and January 2012, 150 microsurgical trainings simulating vascular end-to-end microanastomoses were performed on 134 earthworms. The trainings were divided into 10 periods of 1 week each that included 15 simulations of end-to-end vascular microanastomoses: larger than 1.5mm (n=5), ranging in size from 1.0 to 1.5mm (n=5), and size less than 1.0mm (n=5). The technique is presented and documented. RESULTS For diameters greater than 1.5mm, the mean anastomosis time decreased from 17.9 ± 0.9 min to 9.9 ± 0.2 min between the first and last week of training. For training with smaller diameters, the results showed a decrease in execution time of 41.8% (diameters between 1.0 and 1.5mm) and 38.6% (diameters<1.0mm) between the first and last periods. The study underlines an improvement in the dexterity and speed of nodes' execution. CONCLUSION The earthworm appears to be a reliable experimental model for microsurgical training. It is more ethical than using rats, less expensive than vertebrate animal models, and allows the operator to gain in both confidence and time of execution.
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A three-dimensional stereoscopic monitor system in microscopic vascular anastomosis. Microsurgery 2012; 32:571-4. [DOI: 10.1002/micr.22035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/30/2012] [Indexed: 11/07/2022]
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Pratt GF, Rozen WM, Westwood A, Hancock A, Chubb D, Ashton MW, Whitaker IS. Technology-assisted and sutureless microvascular anastomoses: evidence for current techniques. Microsurgery 2011; 32:68-76. [PMID: 22121054 DOI: 10.1002/micr.20930] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 05/12/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Since the birth of reconstructive microvascular surgery, attempts have been made to shorten the operative time while maintaining patency and efficacy. Several devices have been developed to aid microsurgical anastomoses. This article investigates each of the currently available technologies and attempts to provide objective evidence supporting their use. METHODS Techniques of microvascular anastomosis were investigated by performing searches of the online databases Medline and Pubmed. Returned results were assessed according to the criteria for ranking medical evidence advocated by the Oxford Centre for Evidence Based Medicine. Emphasis was placed on publications with quantifiable endpoints such as unplanned return to theatre, flap salvage, and complication rates. RESULTS There is a relative paucity of high-level evidence supporting any form of assisted microvascular anastomosis. Specifically, there are no randomized prospective trials comparing outcomes using one method versus any other. However, comparative retrospective cohort studies do exist and have demonstrated convincing advantages of certain techniques. In particular, the Unilink™/3M™ coupler and the Autosuture™ Vessel Closure System® (VCS®) clip applicator have been shown to have level 2b evidence supporting their use, meaning that the body of evidence achieves a level of comparative cohort studies. CONCLUSION Of the available forms of assisted microvascular anastomoses, there is level 2b evidence suggesting a positive outcome with the use of the Unilink™/3M™ coupler and the Autosuture™ VCS® clip applicator. Other techniques such as cyanoacrylates, fibrin glues, the Medtronic™ U-Clip®, and laser bonding have low levels of evidence supporting their use. Further research is required to establish any role for these techniques.
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Affiliation(s)
- George F Pratt
- Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, University of Melbourne, Melbourne, Vic., Australia
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