Full Description
For many years, the operative manipulation of the most minute struc- tures was frustrated by the limitations of the human eye. With the introduction of the operating microscope by Nylen (1921), fine detailed anatomy was made visible, so that structures could be prepared, pre- sented and manipulated. Nylen used the microscope for treating dis- eases of the middle ear. In 1946 Perrit in the U. S. A. introduced the operating microscope into the field of ophthalmic surgery. In 1964, Smith, Kunze and Mitchen published reports on their clinical experi- ence using the operating microscope in nerve surgery. Using this tech- nique, it was possible to divide a peripheral nerve into individual fascicle bundles and reapir each bundle precisely. Following on from these developments, the term" microsurgery" was introduced to cover that branch of surgery which was carried out using the" equiped" eye - either by using 10upe spectacle magnifica- tion or, more commonly, the operating microscope. The term "micro- vascular surgery" developed for the operative treatment of small ves- sels below 2 mm in diameter.
Experimental studies for the use of microsurgery in the clinical situation developed alongside its use on small research animals for transplantation models in immunological study. Microsurgical techniques were used in the transplantation of rat liver, kidneys, pancreas, heart and other organs. The clinical appli- cation of these microsurgical techniques is nowadays called "recon- structive microvascular surgery".
Contents
1 Technique of Microvascular Surgery and Preliminary Experimental Studies.- I. Development of Microvascular Surgery.- II. Technical Equipment.- III. Experimental Microvascular Surgery.- IV. Suture Technique in Microvascular Surgery.- V. Complications of Microvascular Suture.- VI. Micromorphological Evidence at the Site of Anastomosis in Small Vessels.- VII. Medical Prophylaxis and Treatment of Vessel Thrombosis and Spasm.- References.- 2 Clinical Microvascular Surgery.- A Replantation with Microvascular Anastomosis (micro-replantation).- I. Definitions and Nomenclature.- II. Classification of Amputations in the Hand.- III. Indications for Replantation.- IV. Guide-lines for the Primary Treatment of Amputation Injuries.- V. Replantation Technique.- VI. Considerations of Differing Levels and Mechanisms of Amputation.- VII. Primary Replacement of Destroyed Phalangeal Joints.- VIII. Primary Finger Transplantation.- IX. Post-operative Management.- X. Physical Management.- XI. Secondary Operations.- XII. Results.- XIII. Microreplantation of Other Parts of the Body — (e.g., toes, ears, scalping injuries, and penile amputations).- XIV. Replantation Service.- B Tissue Transplantation with Microvascular Anastomosis.- I. Development of Tissue Transplantation Using Microvascular Anastomosis.- II. Definitions and Nomenclature.- III. Indications for Free Tissue Transplantation.- IV. Preparations for Tissue Transplantation.- V. Operating Technique.- VI. Free Flap Transplantation.- VII. Combined Skin and Muscle Flap Transplantation (musculo-cutaneous flaps).- VIII. Combined Skin Flap with Bone Transplantation (osteocutaneous flaps).- IX. Bone Transplantation.- X. Muscle Transplantation.- XI. Transplantation of the Omentum.- XII. Toe Transplantation.- References.
