Early history of skin preservation and transplantation; the role of Carl August Ljunggren

During the late 19th and the early 20th century there was an unprecedented development in medical research. Tissue and cell culture rapidly developed into areas with many contributing scientists. The same is true for tissue transplantation. When these achievements are described afterwards in a historical context and a mainline development is constructed, there are researchers whose pioneering work is forgotten. The present paper attempts to correct this and to present a correct description of the start of tissue preservation and transplantation. We have traced relevant original publications in international journals between 1870 and 1920. The traditional view is that Alexis Carrel was the first He received a Nobel Prize 1912 for his work on vascular suture and the transplantation of blood vessels and organs. The same year he published an article on human skin storage and transplantation. This was more than a decade later than Carl August Ljunggren (1860-1934) who 1898 published his pioneering but long forgotten work on human skin preservation and transplantation, and with a vision of tissue banks. Our article contains a brief biography of Ljunggren, and further reconstructs the processes that resulted in the lack of awareness today of his achievements. Conclusion: Carl August Ljunggren was the first to preserve human skin in vitro for prolonged periods, followed by transplantation of the specimens to other patients. He was also the first to propose the use of tissue banks.

Review article: History of venous trauma

ABSTRACT

This is a literature review on the history of venous trauma since the 1800s, especially that to the common femoral, femoral and popliteal veins, with focus on the early 1900s, World War I, World War II, Korean War, Vietnam War, and then civilian and military reviews (1960-2020). In the latter two groups, tables were used to summarize the following: incidence of venous repair versus ligation, management of popliteal venous injuries, patency of venous repairs when assessed <30 days from operation, patency of venous repairs when assessed >30 days from operation, clinical assessment (edema or not) after ligation versus repair, incidence of deep venous thrombosis after ligation versus repair, and incidence of pulmonary embolism after ligation versus repair.There is a lack of the following in the literature on the management of venous injuries over the past 80 years: standard definition of magnitude of venous injury in operative reports, accepted indications for venous repair, standard postoperative management, and timing and mode of early and later postoperative assessment.Multiple factors have entered into the decision on venous ligation versus repair after trauma for the past 60 years, but a surgeon's training and local management protocols have the most influence in both civilian and military centers. Ligation of venous injuries, particularly those in the lower extremities, is well tolerated in civilian trauma, although there is the usual lack of short- and long-term follow-up as noted in many of the articles reviewed.

LEVEL OF EVIDENCE

Review article, levels IV and V.

Innominate Artery Ligation: A History From Mott to Matas

Innominate artery ligation emerged in the 19th century as an early operation for right subclavian aneurysm. Clinical outcomes were often dire, but undeterred surgeons believed that ligation represented an opportunity that outweighed the risks of nonoperative aneurysm management. Valentine Mott of New York performed the procedure in 1818; his patient died 26 days later. Variations on Mott's approach were undertaken 13 more times from 1822 to 1861 by surgeons in the United States and abroad, all of which proved fatal. Andrew Woods Smyth of New Orleans was the first to successfully control a subclavian artery aneurysm with innominate ligation in 1864. The Charity Hospital house surgeon used a series of ligations on the innominate, common carotid, vertebral, and internal mammary arteries to prevent collateral and recurrent blood flow to the aneurysmal sac. These physiologically-oriented operations kept Smyth's patient alive and functional for ten years. New Orleans became an internationally-recognized hub for advancements in aneurysm surgery. One of Smyth's students, Rudolph Matas, went on to revolutionize vascular surgery. Along his path to becoming the Father of modern vascular surgery, Matas documented his own performance of Smyth's operation at Charity 4 times over the course of his career. Although later supplanted by primary vascular anastomosis and grafting, the first successful innominate ligation was a collaborative effort between New York and New Orleans that served as a foundation for the development of modern aneurysm repair.

The history of microsurgery

Microsurgery is a term used to describe the surgical techniques that require an operating microscope and the necessary specialized instrumentation, the three "Ms" of Microsurgery (microscope, microinstruments and microsutures). Over the years, the crucial factor that transformed the notion of microsurgery itself was the anastomosis of successively smaller blood vessels and nerves that have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts. Currently, with obtained experience, microsurgical techniques are used by several surgical specialties such as general surgery, ophthalmology, orthopaedics, gynecology, otolaryngology, neurosurgery, oral and maxillofacial surgery, plastic surgery and more. This article highlights the most important innovations and milestones in the history of microsurgery through the ages that allowed the inauguration and establishment of microsurgical techniques in the field of surgery.

[Development of surgery of combined gun-shot osteo-vascular injuries of extremities (middle XIX century - middle XX century)]

The presented review by the example of a long historical period traces the development of surgery of combined gun-shot osteo-vascular injuries of extremities, also describing both objective and subjective causes of unsatisfactory outcomes of treatment and presenting ways of solving the problem of treatment of these injuries during the period after World War II.

My Continuing Evolution as a Surgeon-Scientist: A Decade after the Jacobson Promising Investigator Award

THE SECOND JOAN L AND JULIUS H JACOBSON PROMISING INVESTIGATOR AWARDEE, EDITH TZENG MD, FACS: In 2005, the Surgical Research Committee of the American College of Surgeons was tasked with selecting the recipient of a newly established award, "The Joan L and Julius H Jacobson Promising Investigator Award." According to the Jacobsons, the award funded by Dr Jacobson should be given at least once every 2 years to a surgeon investigator at "the tipping point," who can demonstrate that his or her research shows the promise of leading to a significant contribution to the practice of surgery and patient safety. Every year, the Surgical Research Committee receives many excellent nominations and has the difficult task of selecting one awardee. The first awardee was Michael Longaker MD, FACS, who 10 years later reflected on the award and the impact it had on his career.¹ This year, Edith Tzeng, MD, FACS, the second Jacobson awardee, reflects on her 10-year journey after receiving the award. Dr Tzeng is now a national and international figure in the field of vascular surgery and has studied the effect of nitric oxide and carbon monoxide on intimal hyperplasia. Kamal MF Itani, MD, FACS and Leigh Neumayer, MD, FACS, on behalf of the Surgical Research Committee of the American College of Surgeons.

Clipping techniques in cerebral aneurysm surgery

The history of cerebral aneurysm surgery owes a great tribute to the tenacity of pioneering neurosurgeons who designed and developed the clips used to close the aneurysms neck. However, until the beginning of the past century, surgery of complex and challenging aneurysms was impossible due to the lack of surgical microscope and commercially available sophisticated clips. The modern era of the spring clips began in the second half of last century. Until then, only malleable metal clips and other non-metallic materials were available for intracranial aneurysms. Indeed, the earliest clips were hazardous and difficult to handle. Several neurosurgeons put their effort in developing new clip models, based on their personal experience in the treatment of cerebral aneurysms. Finally, the introduction of the surgical microscope, together with the availability of more sophisticated clips, has allowed the treatment of complex and challenging aneurysms. However, today none of the new instruments or tools for surgical therapy of aneurysms could be used safely and effectively without keeping in mind the lessons on innovative surgical techniques provided by great neurovascular surgeons. Thanks to their legacy, we can now treat many types of aneurysms that had always been considered inoperable. In this article, we review the basic principles of surgical clipping and illustrate some more advanced techniques to be used for complex aneurysms.

The first resection of an aortic aneurysm

In 1951 the report from Paris that an abdominal aortic aneurysm had been successfully resected greatly influenced surgeons throughout the world who, until then, had regarded such an operation as being outside the bounds of surgery. Indeed, as a young surgeon I could hardly believe such a procedure would be possible, having seen an unsuccessful attempt at producing thrombosis of the aneurysm by introducing coils of wire into the sac, (Colt's operation) and, in other cases, merely standing by helplessly as the patient exsanguinated from rupture of the aneurysm.

The first identical twin renal transplant

There is no doubt that it was the work of one man, Alexis Carrel, which laid the foundations of modern organ transplantation. Working first in his native city of Lyons, then in Chicago and finally at the Rockefeller Institute New York, he developed the techniques of successful anastomosis of blood vessels, using extremely fine silk sutures and tiny needles. As early as 1892, he successfully grafted a kidney into the neck of a dog. He was soon able to demonstrate that, although a dog's kidney transplanted into its own neck could survive, even when the opposite kidney was excised, transplant of a kidney to another animal would fail after a few days. Further experiments included transplantation of other organs, including ovary, thyroid, lower limb and heart. In 1914 he wrote to fellow Nobel Prize winning Swiss surgeon, Theodor Kocher about his experiments; "Concerning homoplastic transplantation (from one animal to another) of organs such as the kidney, I have never found positive results to continue after a few months, whereas ir autoplastic transplants the results were always positive. The biological side of the question has to be investigated very much more and we must find out by what means to prevent the reaction of the organism against a new organ" (my italics). This, in fact, was going to occupy the next half century of worldwide research!

Alexis Carrel (1873-1944): visionary vascular surgeon and pioneer in organ transplantation

Alexis Carrel was a French surgeon in the 20th century. He made significant contributions to many advances in the fields of vascular surgery, cardiothoracic surgery and organ transplantation. He demonstrated that blood vessels can be united end-to-end and pioneered the triangulation suturing technique in vascular anastomosis. The methods he developed are still in use to this day. He insisted on the importance of absolute asepsis in vascular surgery when such practices were almost unheard of. He was also considered the father of solid organ transplantation. He was awarded the Nobel Prize in recognition of his work. Together with Charles Lindbergh, he developed the extracorporeal perfusion pump to keep organs alive outside the human body. His contribution to medicine also extended to tissue culture and wound management. He was one of the most controversial figures of his generation, believing in the idea of genetic superiority and eugenics and he was associated with fascism in the 1930s.

[Stages of development of surgical treatment for insufficiency of venous valves of lower limbs]

Insufficiency of the valvular apparatus of the lower-limb veins is one of the main causes of the development of chronic venous insufficiency. This disease is commonly prevalent in developed countries including Russia and is an urgent and socially significant problem. Insufficiency of the venous valves may be corrected by a wide variety of approaches and methods however they all are not universal or have low efficacy and in some cases cannot be applied at all. This article is dedicated to the review of the existing methods of surgical correction of valvular insufficiency of lower-limb veins, as well as a review of the studies of the most promising trend of this problem, i.e. prosthetic repair of venous valves.

[Contribution of military surgeons participants of the great patriotic war to solving the problem of rendering medical care to the wounded with lesions of blood vessels]

review in the article are opinions and experience of outstanding academic military surgeons, participants of the Great Patriotic war: Burdenko N N., Kupriyanov P.A., Akhutin M.N., Banaitis A.I., Elansky N.N, Petrovsky B.V., and others. The methods they worked out and practically implemented made it possible to substantially improve the outcomes of gunshot wounds and vascular lesions.

[Czech angiology and its transformation]

Over the last 25 years, Czech angiology has changed dramatically with respect to the diseases and conditions managed by angiologists as well as available therapeutic modalities. Such developments also required substantial expansion of the extent and character of specialist knowledge required from angiologists. Angiology manages to effectively correlate a clinical profession with non-coronary endovascular therapy and this has brought about a significant improvement in treatment efficacy and comfort. Physicians thus crossed a boundary of purely conservative treatment and focus on life and organ-threatening vascular diseases. Recent years have also seen an emergence of sub-specialities ofinterventional and acute angiology. The use of diagnostic and therapeutic catheterisation enabled angiologists to contribute to the care of patients previously managed by vascular surgeons and interventional radiologists; angiologists have become important contributors to the medical care provided by comprehensive cardiovascular centres.

Uncomplicated type B dissection: are there any indications for early intervention?

Currently thoracic endovascular repair (TEVAR) has a limited role in uncomplicated type B aortic dissection. Aggressive medical therapy is deemed appropriate for most of these patients allowing one-year survival rate of 80-90%. Outcomes are less than optimal in the long term, however, since aorta related complications (disease progression, rapid deterioration, acute rupture and elevated mortality) may occur in up to 50% of patients at five years. Subgroups of patients with uncomplicated type B dissection may benefit from early stent-graft placement, but identification of these remains difficult. Only future studies, especially randomized trials, will clarify the utility of early TEVAR in the setting of uncomplicated acute type B dissection.