Information about Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves (typically 1 mm in diameter) which have allowed transfer of tissue from one part of the body to another and re-attachment of severed parts.
Nakayama, a Japanese cardiothoracic surgeon, reported the first true series of microsurgical free-tissue transfers using vascularized intestinal segments to the neck for esophageal reconstruction after cancer resections using 3-4mm vessels. [2]
Contemporary reconstructive microsurgery was introduced by an American, Dr. Harry J. Buncke. In 1964, Buncke reported a rabbit ear replantation, famously using a garage as a lab/operating theatre and home-made instruments.[3] This was the first report of successfully using blood vessels 1 millimeter in size. In 1966, Buncke used microsurgy to transplant a primate's great toe to its hand.[4]
The late sixties and early 1970's ushered in many new microsurgical innovations that were previously unimaginable. The first human microsurgical transplantation of the great toe (big toe) to thumb was performed in April 1968 by Mr. John Cobbett, in England. [5] In Australia work by Dr. Ian Taylor [6] saw new techniques developed to reconstruct head and neck cancer defects with living bone from the hip or the fibula.
A number of surgical specialties now use microsurgical techniques. Otolaryngologists (ear, nose, and throat doctors) perform microsurgery on structures of the inner ear or the vocal cords. Cataract surgery, corneal transplants, and treatment of conditions like glaucoma are performed by ophthalmologists. Urologists and gynecologists can frequently now reverse vasectomies and tubal ligations to restore fertility.
Initially, when the techniques were developed to make replantation possible, success was defined in terms of a survival of the amputated part alone. However, as more experience was gained in this field, surgeons specializing in replantation began to understand that survival of the amputated piece was not enough to ensure success of the replant. In this way, functional demands of the amputated specimen became paramount in guiding which amputated pieces should and should not be replanted. Additional concerns about the patients ability to tolerate the long rehabilitation process that is necessary after replantation both on physical and psychological levels also became important. So, when fingers are amputated, for instance, a replantation surgeon must seriously consider the contribution of the finger to the overall function of the hand. In this way, every attempt will be made to salvage an amputated thumb, since a great deal of hand function is dependent on the thumb, while an index finger or small finger may not be replanted, depending on the individual needs of the patient and the ability of the patient to tolerate a long surgery and a long course of rehabilitation.
However, if an amputated specimen is not able to be replanted to its original location entirely, this does not mean that the specimen is unreplantable. In fact, replantation surgeons have learned that only a piece or a portion may be necessary to obtain a functional result, or especially in the case of multply amputated fingers, a finger or fingers may be transposed to a more useful location to obtain a more functional result. This concept is called "spare parts" surgery.
Microsurgeon.org History of Microsurgery
7. Martins PN, Montero EF.Organization of a microsurgery laboratory. Acta Cir Bras. 2006 May-Jun;21(3):187-9.
The fibula or calf bone is a bone located on the lateral side of the tibia, with which it is connected above and below.
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History
The advances in the techniques and technology that popularized microsurgery began in the early 1960s. The first microvascular surgery, using a microscope to aid in the repair of blood vessels, was described by vascular surgeon, Jules Jacobson, of the University of Vermont in 1960. Using an otolaryngology microscope, he performed coupling of vessels as small as 1.4 mm and coined the term "microsurgery."[1] Hand surgeons Kleinert and Kasdan performed the first revascularization of a partial digital amputation in 1963.[1]Nakayama, a Japanese cardiothoracic surgeon, reported the first true series of microsurgical free-tissue transfers using vascularized intestinal segments to the neck for esophageal reconstruction after cancer resections using 3-4mm vessels. [2]
Contemporary reconstructive microsurgery was introduced by an American, Dr. Harry J. Buncke. In 1964, Buncke reported a rabbit ear replantation, famously using a garage as a lab/operating theatre and home-made instruments.[3] This was the first report of successfully using blood vessels 1 millimeter in size. In 1966, Buncke used microsurgy to transplant a primate's great toe to its hand.[4]
The late sixties and early 1970's ushered in many new microsurgical innovations that were previously unimaginable. The first human microsurgical transplantation of the great toe (big toe) to thumb was performed in April 1968 by Mr. John Cobbett, in England. [5] In Australia work by Dr. Ian Taylor [6] saw new techniques developed to reconstruct head and neck cancer defects with living bone from the hip or the fibula.
A number of surgical specialties now use microsurgical techniques. Otolaryngologists (ear, nose, and throat doctors) perform microsurgery on structures of the inner ear or the vocal cords. Cataract surgery, corneal transplants, and treatment of conditions like glaucoma are performed by ophthalmologists. Urologists and gynecologists can frequently now reverse vasectomies and tubal ligations to restore fertility.
Free tissue transfer
Free tissue transfer is a surgical reconstructive procedure using microsurgery. A region of "donor" tissue is selected that can be isolated on a feeding artery and vein; this tissue is usually a composite of several tissue types (e.g., skin, muscle, fat, bone). Common donor regions include the rectus abdominis muscle, latissimus dorsi muscle, fibula, and radial forearm bone and skin lateral arm skin. The composite tissue is transferred (moved as a free flap of tissue) to the region on the patient requiring reconstruction (e.g., mandible after oral cancer resection, breast after cancer resection, traumatic tissue loss, congenital tissue absence). The vessels that supply the free flap are anastomosed with microsurgery to matching vessels (artery and vein) in the reconstructive site. The procedure was first done in the early 1970s and has become a popular "one-stage" (single operation) procedure for many surgical reconstructive applications.) Traumatic foot/ankle soft tissue wound from motor vehicle accident | ) Anterior-Lateral thigh flap free-tissue transfer reconstruction |
Replantation
Replantation is the reattachment of a completely detached body part. Fingers and thumbs are the commonest but the ear, scalp, nose, arm and penis have all been replanted. Generally replantation involves restoring blood flow through arteries and veins, restoring the bony skeleton and connecting tendons and nerves as required.Initially, when the techniques were developed to make replantation possible, success was defined in terms of a survival of the amputated part alone. However, as more experience was gained in this field, surgeons specializing in replantation began to understand that survival of the amputated piece was not enough to ensure success of the replant. In this way, functional demands of the amputated specimen became paramount in guiding which amputated pieces should and should not be replanted. Additional concerns about the patients ability to tolerate the long rehabilitation process that is necessary after replantation both on physical and psychological levels also became important. So, when fingers are amputated, for instance, a replantation surgeon must seriously consider the contribution of the finger to the overall function of the hand. In this way, every attempt will be made to salvage an amputated thumb, since a great deal of hand function is dependent on the thumb, while an index finger or small finger may not be replanted, depending on the individual needs of the patient and the ability of the patient to tolerate a long surgery and a long course of rehabilitation.
However, if an amputated specimen is not able to be replanted to its original location entirely, this does not mean that the specimen is unreplantable. In fact, replantation surgeons have learned that only a piece or a portion may be necessary to obtain a functional result, or especially in the case of multply amputated fingers, a finger or fingers may be transposed to a more useful location to obtain a more functional result. This concept is called "spare parts" surgery.
Transplantation
Microsurgical techniques have played a crucial role in the development of transplantation immunological research because it allowed the use of rodents models, which are more appropriate for transplantation research (there are more reagents, monoclonal antibodies, knockout animals, and other immunological tool for mice and rats than other species). Before it was introduced, transplant immunology was studied in rodents using the skin transplantation model, which is limited by the fact it is not vascularized. Thus, microsurgery represents the link between surgery and transplant immunological research. The first microsurgical experiments (porto-caval anastomosis in the rat) were performed by Dr. Sun Lee (pioneer of microsurgery) at the University of Pittsburgh in 1958. After a short time, many models of organ tranplants in rat and mice have been established. Today, virtually every rat or mouse organ can be transplanted with relative high success rate. Microsurgery was also important to develop new techniques of transplantation, that would be later performed in humans. In addition, it allows reconstruction of small arteries in clinical organ transplantation (e.g. accessory arteries in cadaver liver transplantation, polar arteries in renal transplantation and in living liver donor transplantation).Links
E-Medicine Microsurgery PrinciplesMicrosurgeon.org History of Microsurgery
References
1. ^ Kleinert HE, Kasdan ML (sept 1963). "Resoration of Blood Flow in Upper Extremity Injuries". J Trauma: 461-76. PMID 14062037.
2. ^ NAKAYAMA K, YAMAMOTO K, TAMIYA T, MAKINO H, ODAKA M, OHWADA M, TAKAHASHI H. (1964). "EXPERIENCE WITH FREE AUTOGRAFTS OF THE BOWEL WITH A NEW VENOUS ANASTOMOSIS APPARATUS.". Surgery (June): 796-802. PMID 14167999.
3. ^ Buncke H, Schulz W (1966). "Total ear reimplantation in the rabbit utilising microminiature vascular anastomoses.". Br J Plast Surg 19 (1): 15-22. PMID 5909469.
4. ^ Buncke H, Buncke C, Schulz W (1966). "Immediate Nicoladoni procedure in the Rhesus monkey, or hallux-to-hand transplantation, utilising microminiature vascular anastomoses.". Br J Plast Surg 19 (4): 332-7. PMID 4959061.
5. ^ Cobbett JR. (1969). "TFree digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb.". J Bone Joint Surg Br. 51 (4): 677-9. PMID 5371970.
6. ^ Taylor GI, Miller GD, Ham FJ. (1975). "The free vascularized bone graft. A clinical extension of microvascular techniques.". Plast Reconstr Surg. 55 (5): 533-44. PMID 1096183.
2. ^ NAKAYAMA K, YAMAMOTO K, TAMIYA T, MAKINO H, ODAKA M, OHWADA M, TAKAHASHI H. (1964). "EXPERIENCE WITH FREE AUTOGRAFTS OF THE BOWEL WITH A NEW VENOUS ANASTOMOSIS APPARATUS.". Surgery (June): 796-802. PMID 14167999.
3. ^ Buncke H, Schulz W (1966). "Total ear reimplantation in the rabbit utilising microminiature vascular anastomoses.". Br J Plast Surg 19 (1): 15-22. PMID 5909469.
4. ^ Buncke H, Buncke C, Schulz W (1966). "Immediate Nicoladoni procedure in the Rhesus monkey, or hallux-to-hand transplantation, utilising microminiature vascular anastomoses.". Br J Plast Surg 19 (4): 332-7. PMID 4959061.
5. ^ Cobbett JR. (1969). "TFree digital transfer. Report of a case of transfer of a great toe to replace an amputated thumb.". J Bone Joint Surg Br. 51 (4): 677-9. PMID 5371970.
6. ^ Taylor GI, Miller GD, Ham FJ. (1975). "The free vascularized bone graft. A clinical extension of microvascular techniques.". Plast Reconstr Surg. 55 (5): 533-44. PMID 1096183.
7. Martins PN, Montero EF.Organization of a microsurgery laboratory. Acta Cir Bras. 2006 May-Jun;21(3):187-9.
surgery (from the Greek χειρουργική meaning "hand work") is the medical specialty that treats diseases or injuries by operative manual and instrumental treatment.
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Anastomosis (plural anastomoses) refers to a form of network in which streams both branch out and reconnect. The term is used in medicine, biology, and geology.
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Medicine
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19 (1): 15-22. PMID 5909469.
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19th century - 20th century - 21st century
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1961 1962 1963 - 1964 - 1965 1966 1967
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1930s 1940s 1950s - 1960s - 1970s 1980s 1990s
1961 1962 1963 - 1964 - 1965 1966 1967
- Also Nintendo emulator: 1964 (emulator).
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Rabbits are small mammals in the family Leporidae of the order Lagomorpha, found in several parts of the world. There are seven different genera in the family classified as rabbits, including the European rabbit (Oryctolagus cuniculus), cottontail rabbit (genus
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19th century - 20th century - 21st century
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1965 1966 1967 - 1968 - 1969 1970 1971
Year 1968 (MCMLXVIII
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1930s 1940s 1950s - 1960s - 1970s 1980s 1990s
1965 1966 1967 - 1968 - 1969 1970 1971
Year 1968 (MCMLXVIII
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- For other uses see fibula (disambiguation)
The fibula or calf bone is a bone located on the lateral side of the tibia, with which it is connected above and below.
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A finger is a type of digit, an organ of manipulation and sensation found in the hands of humans and other primates. Normally humans have five digits on each hand (exceptions are polydactyly, hypodactyly and digit loss).
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The thumb is one of the five fingers.
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Anatomy of the thumb
Bones
The thumb consists of 3 bones:- distal phalanx (of the first digit)
- proximal phalanx (of the first digit)
- first metacarpal
Muscles
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outer ear is the most external portion of the ear. The outer ear includes the pinnae (also called auricle), the ear canal, and the very most superficial layer of the ear drum (also called the tympanic membrane).
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- ''For other uses of the word, see Scalp (disambiguation)
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nose is a protuberance in vertebrates that houses the nostrils, or nares, which admit and expel air for respiration in conjunction with the mouth.
In most humans, it also houses the nosehairs, which catch airborne particles and prevent them from reaching the lungs.
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In most humans, it also houses the nosehairs, which catch airborne particles and prevent them from reaching the lungs.
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An arm is an upper limb of the body.
Arm (or arms) may also refer to:
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Arm (or arms) may also refer to:
- Armaments, weapons; as in Small arms, Right to bear arms
- Eta Capricorni, a star, traditional name "Arm"
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- For the symbol of the erect penis, see phallus.
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Arteries are muscular blood vessels that carry blood away from the heart.[1] All arteries, with the exception of the pulmonary and umbilical arteries, carry oxygenated blood.
The circulatory system is extremely important for sustaining life.
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The circulatory system is extremely important for sustaining life.
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vein is a blood vessel that carries blood toward the heart. The majority of veins in the body carry low-oxygen blood from the tissues back to the heart; the exceptions being the pulmonary and umbilical veins which both carry oxygenated blood.
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