By Leonard Gordon
On April 23, 1906, Alexis Carrel offered his manuscript entitled "The surgical procedure of Blood Vessels" to the Johns Hopkins clinical Society. His paintings at the tech nique of small vessel anastomosis and the transplantation of visceral organs earned him the Nobel Prize in 1912. using magnification in operative surgical procedure started in 1921 with the paintings of Nylen, who first hired the microscope for reconstructive methods within the heart ear. Jacobson and Suarez released their preliminary observa tions at the use of microsurgery for the anastomosis of small vessels in 1960, and years later, Malt stated the ancient replantation of an higher extremity. To surgeons considering reconstruction of the extremities, the evolution of micro surgical procedure has supplied the main major advances of the earlier 3 many years. The dramatic scientific successes of replantation surgical procedure and loose tissue move have considerably better practical and beauty leads to addition to decreas ing morbidity in sufferers who current with advanced reconstructive difficulties. Mi crosurgical Reconstruction of the Extremities crosses the normal surgical discip traces and should be helpful to orthopaedic surgeons, plastic surgeons, hand sur geons, and normal surgeons, in addition to to citizens and fellows.
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Additional info for Microsurgical Reconstruction of the Extremities: Indications, Techniques, and Postoperative Care
Muscle Transplantation g. The proximal and distal tendons are divided, the pedicle is divided, and the muscle is transplanted to the recipient area. ) The muscle is loosely sutured at a few points to avoid accidentally moving it during the vascular anastomoses. 1 Anatomy (Plates 1-III to 1-V) The latissimus dorsi is a broad, triangular muscle. It originates from the spinous processes of the lower six thoracic vertebrae and the posterior third of the iliac crest. Between these two attachments, it fuses with the thoracolumbar fascia, and can have muscular slips of origin from the lower three or four ribs.
The patient is shown on the operating table in the lateral decubitus position, ready for either a serratus anterior or latissimus dorsi transplant. The entire extremity is draped free and rests on a well-padded Mayo stand. The surgeon should position the patient in a way that avoids stretching of the brachial plexus. The area prepared includes the spinous processes of the vertebrae; the thigh is included if it is needed as a donor site for a split-thickness skin graft. a b. The important structures are marked.
Ii) The anterior tibial artery, found originating from the fibular side in this patient (in the vessel loop), was dissected as a donor vessel (Plate 4-111). d. The muscle was set into the defect, filling its depths. e. The transplant 1 month later. It takes approximately 6-12 months for the muscle to atrophy and profile evenly with the surrounding skin. 2 Functional Muscle Transplantation (Manktelow and McKee 1979, O'Brien et al. 1982) The need for functional muscle transplantation arises where massive muscle loss has occurred, such as after Volkmann's ischemia or a crush, blast, or avulsive injury.