Experimental and clinical application of microvascular surgery.

The object of these studies was the development of a technique whereby a vessel of 1 mm or smaller could be easily anastomosed. In total replantation of rabbit ears, only 3 ears survived replantation in 80 attempts in the first series. In the second series of 80, 35 ears survived completely, 3 ears partially survived and 8 additional ears survived the postoperative period, but the rabbits died within 2 weeks due to diarrhea. Thirty-five ears failed and venous obstruction was the primary cause. Free transplantation of a great toe and a second toe to recreate a thumb is also described. The operative procedure of the great toe to thumb transplantation does not appear to be difficult. Six months after operation, the function of the newly created thumb was good. The second toe to thumb transfer was more difficult technically compared to the great toe to thumb transfer due to the much smaller size of the digital vessels of the second toe. However, removal of the second toe causes less disadvantage than the removal of the great toe. Nine months postoperatively, the function of the newly created thumb was satisfactory. Digital replantation is described with 36 cases with 65 complete finger amputations. Thirty-two with 45 fingers survived the reattachment. Repair of one artery per digit is sufficient, although two probably are better. A minimum of 2 veins per digit must be repaired. Prompt re-exploration is imperative if postoperative circulatory impairment occurs. In this group, arterial obstruction was more frequent than venous obstruction as the cause of replantation failure. The function of the replanted fingers is satisfactory in the majority of the cases.