Principles of Microvascular Surgery.

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Damage from needles, sutures and technique • Chow, Br J plast surg 1982 - found greater tolerance for microanastomotic tension. • Acland & Trachtenberg, PRS 1977 - used SEM to evaluate microanastomoses, found 100% patency rate despite: » Intimal loss below the site of clamp pressure. » Medial necrosis at the site of the anastomosis. Some tissue damage is tolerated. Local factors • Lidman & Daniel, Ann Plast Surg 1981- » Anastomoses preformed in the zone of injury. » External compression of the anastomosis by hematoma, tight wound closure, swelling. 14
The clotting mechanism • Platelets do not adhere to undamaged, healthy intimal surfaces. • Intimal injury - exposed collagen - platelet adhesion to the vessel surfaces. • Platelet activation. • Release of platelet granules. • Attract more platelet = aggregation. 1 The clotting mechanism • The activated platelet stimulates receptor site to which fibrinogen adheres. • Fibrinogen forms proteinaceous bridges between platelets. • Activated platelet - promote the change of fibrinogen to fibrin. • Fibrin promotes the “red clot” formation. 2 15
Page 1 and 2: Principles of Microvascular Surgery
Page 3 and 4: History • Malt & McKhann, 1962 -
Page 5 and 6: History • Danil & Taylor + O’br
Page 7 and 8: Basic Science Concepts in Microsurg
Page 9 and 10: Vessel Injury and Regeneration •
Page 11 and 12: Vessel Wall Healing • At the time
Page 13: Damage from needles, sutures and te
Page 17 and 18: Antithrombotic therapy Heparin (con
Page 19 and 20: Antithrombotic therapy Low molecula
Page 21 and 22: Antithrombotic therapy conclusions:
Page 23 and 24: The no-reflow effect • Ames, Am J
Page 25 and 26: • Treatment - The no-reflow effec
Page 27 and 28: • Loupes… • Or microscope? Mi
Page 29 and 30: • Key sutures - Anastomotic techn
Page 31 and 32: End-to-end, end-to-side and end-in-
Page 33 and 34: Laser anastomosis • Various exper
Page 35 and 36: Monitoring perfusion • Doppler ul
Page 37 and 38: The influence of patient factors
Page 39 and 40: Free flaps • Twenty years ago - f
Page 41 and 42: • Free groin flap - Free flaps -
Page 43 and 44: Free flaps - fascia • Useful wher
Page 45 and 46: Free flaps - muscle • Free latiss
Page 47 and 48: Free fibula flap 47

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