A Pedicle-Lengthening Technique for Free Latissimus Dorsi Muscle Flaps: The ‘‘Y-V-I’’ Principle

This article describes a pedicle-lengthening procedure (the Y-V-I principle) thatreverts a Y-shaped vascular structure into an I-shaped vascular structure, and its applicationto the latissimus dorsi muscle. If the Y-shaped vascular structure is divided proximal to thebranching point and ligated, it becomes a V-shaped vascular structure. To obtain a linearI-shaped vascular structure, the V is opened, and the length of the vascular pedicle willbecome equal to the combined length of both limbs of the V. This report indicates that thelatissimus dorsi flap may be transferred based on the circumflex scapular artery or theserratus branch.KEYWORDS: Latissimus dorsi muscle, pedicle-lengthening-flap

A New Technique For Microvascular Anastomosis Eversion With 3 Horizontal Mattress Sutures

Abstract: In our experimental study of a new microvascular anastomosis technique, we divided 30 Wistar albino rats into 2 groups.We performed the classic interrupted suture anastomosis techniquein group 1 (n  15) and our new technique, using 3 horizontalmattress sutures, in group 2 (n  15). We checked patency immediately following anastomosis, at the end of the first hour, and at theend of the third week postanastomosis.While the patency rates for both techniques were 100% at the endof the first hour, the respective values were 100% and 93.4% by theend of the third week. Using light microscopy, lumen patency,intimal and medial damage, inflammation, and granulation wereevaluated histopathologically.The mean anastomosis time for the experimental group (15 minutes)was shorter than that for the classic group (mean 21 minutes), and thedifference was statistically significant (P 0.01), while the differencebetween the patency rates was not significant (P  0.05). Therefore,provided that the incisions are made correctly, our microvascularanastomosis technique using 3 horizontal mattress sutures can be usedin experimental and clinical studies.Key Words: microsurgery, microvascular surgery, vesselanastomosis, vascular anastomosis method, 3 horizontal mattresssutures

Delay in Neurovenous Flaps Experimental and Clinical Experience

Abstract: The objective of this study was to examine the effects ofthe standard surgical delay in the flaps based on the cutaneousbranches of the vascular axis around a superficial sensory nerve. Thedelay procedure was experimentally tested in rats and subsequentlyused in patients.In the experimental study, the survival of a delayed inferiorepigastric neurovenous flap was compared with that of a nondelayedinferior epigastric neurovenous flap. One type of clinically applicable delay pattern (standard bipedicled technique) was employed. A3  3 cm flap was raised in 20 female Wistar rats assigned randomlyto 2 groups. Each group consisted of 20 flaps. The standard bipedicled delay pattern increased the percentage survival of thedelayed inferior epigastric neurovenous flap. The survival percentage of the delayed flaps was 59.8 185.0 (P 0.5). The histologicfindings of the skin revealed that our delay procedure enhanced theperfusion of the flap by dilating the arterial network.Stimulated by our experimental findings, we used the islandbipedicled surgical flap delay or combined strategic-standard delayin the distally pedicled sural flap successfully on 9 cases.Key Words: delay, neurovenous flap, sural flap, tissue defect


Abstract. A different approach to end in end anastomosis was tested to minimise the undesirable traits of classicand sleeve (telescoping) methods. Our approach aimed to maintain full contact at the level of the anastomosis byusing longitudinal matrix sutures as a new invaginating suture technique in microarterial sleeve anastomosis.Classic end-to-end anastomosis with seven to eight stitches, Lauritzen’s end-in-end anastomosis with fourstitches, and our modified end-in-end anastomosis with two horizontal matrix sutures were made in 10, 20, and 25rat femoral arteries, respectively. Nine, 17, and 18, respectively were patent at early evaluation; and eight, 13, and14 at the time of late evaluation. There was no significant difference in between the patency rates of the groups.Histopathological examination showed large strictures and the formation of intra-luminal organised thrombuswith thin intramural fibrin precipitation in occluded specimens. The longitudinal matrix sutures in the sleeveanastomoses, which passed through all layers of the vascular wall, injured the intima (a vertical rupture) andconstricted the lumen.Key words: microsurgery, microvascular anastomosis, sleeve anastomosis, invaginating matrix suture technique.

Using Human Hair as Suture Material in Microsurgical Practice

For practice in microsurgery, animal models and microsurgical instruments arerequired. The use of some synthetic and non-animal materials such as human placentaand other tissues have also been suggested for practicing. The other material that isneeded is microsuture. These materials are expensive and often not easily obtained. Tomeet this requirement, the authors present human hair as a microsuture material for microsurgical practice.KEYWORDS: Microsuture, hair