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Maria z siemionow (eds ) plastic and reconstructive surgery experimental models and research designs springer verlag london (2015)

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  • Preface

  • Contents

  • Contributors

  • Part I: Microsurgery Models

    • 1: Microsurgical Techniques in Reconstructive Surgery

      • History

      • Basic Concepts in Reconstructive Microsurgery

        • Vessel Injury and Regeneration

        • Clotting Mechanism

        • Tissue Ischemia and Reperfusion Injury

      • Technical Factors in Microsurgery

        • Magnification

        • Sutures

        • Anastomosis Technique

        • Anastomosis Types

      • Monitoring Perfusion

      • Influence of Patient Factors

      • Conclusion

      • References

    • 2: Arterial and Venous Microanastomosis Models

      • End-to-End Anastomosis, End-to-�Side Anastomosis, Sleeve Anastomosis

        • Introduction

      • End-to-End Anastomosis in Rat Femoral Vessels Model [2]

        • Arterial Repair

          • Placement of Stay Sutures

        • Venous Repair

          • Different Suture Techniques

            • Continuous Suture Technique [3–6]

            • Continuous Locking Suture Technique [7, 8]

            • Continuous Horizontal Mattress Technique [9, 10]

            • Interrupted Horizontal Mattress Technique [11, 12]

            • Spiral-Interrupted Technique [13]

            • Posterior-Wall-First Technique [14–16]

            • Sleeve Technique [17–21]

          • Advantageous and Drawbacks of Different Suture Techniques

          • End-to-Side Anastomosis [2]

            • Placement of Sutures

          • Patency Testing

            • Empty and Refill Test

            • Flicker Test

      • Vein Grafting

        • Venous Grafts in the Experimental Rat Model

        • Vein Grafting Procedure Using the Epigastric Vein in the Rat Model

        • Other Techniques and Devices Facilitating Vein Grafting Procedures in the Rat Model

      • Venous By-Pass

        • Venous By-Passes in Experimental Rat Model

        • Surgical Procedure of Venous By-Pass in the Rat Model

      • Arterial Grafts and Bypasses

        • Arterial Grafts in Experimental Rat Models

        • Common Rat Models of Arterial Grafting

          • Femoral Artery Model

          • Common Carotid Artery Model

          • Aorta Model

          • Common Iliac Artery Model

          • Arterial Bypass in Experimental Rat Model

            • Aortofemoral Bypass

          • Special Considerations: Significant Vessel Size Discrepancy

      • References

    • 3: Lymphaticovenous Anastomosis Training Model in Rat

      • References

    • 4: Fallopian Tube Anastomosis

      • Introduction

      • Experimental Fallopian Tube Anastomosis Model in Rats

      • Technique

      • Patency Evaluation

      • Special Considerations

      • References

    • 5: Vasoepididymostomy Anastomosis

      • Introduction

      • Experimental Vasoepididymostomy in Rats

        • Creation of Epididymal Obstruction

        • Vazoepydidymostomy by Tubule Intussuseption

          • End-To-End Technique [7]

          • End-To-Side Technique

            • Two Double-Armed Suture Transverse Intussusception Vasoepididymostomy [6]

            • Two Double-Armed Suture Longitudinal Intussusception Vasoepididymostomy [6]

            • Three Suture Triangulation Intussusception Vasoepididymostomy [6]

            • Single-Armed Longitudinal Intussusception Vasoepididymostomy [8]

      • Patency Evaluation

      • References

    • 6: The Microsurgical Groin Skin Flap in the Rat Model

      • Background

      • Applied Anatomy

      • Operative Technique

      • Assessment of Flap Viability

      • Modifications of the Groin Flap

      • Closing Remarks

      • References

    • 7: Free TRAM Flap Model

      • Introduction

      • Flaps in Rat Models

      • Free TRAM Flap Model

      • Discussion

      • Conclusions

      • References

  • Part II: Microcirculation Models

    • 8: Application of Microcirculatory Models in Plastic Surgery Research: Review

      • References

    • 9: Standard Cremaster Muscle Model for Ischemia Reperfusion

      • Introduction

      • Surgical Technique of Cremaster Flap Dissection

      • Observation of Microcirculation of Cremaster Flap

        • Evaluation of Hemodynamics and Leukocyte: Endothelial Interactions

        • Evaluation of the Microvascular Permeability

      • References

    • 10: Cremaster Muscle and Effect of Different Anesthetics

      • Rat Cremaster Model

      • Application of the Cremaster Muscle Model to Study the Effect of Anesthetics on the Microcirculation

      • Description of the Experimental Model Used in Studies on Anaesthetic Agents

      • References

    • 11: Microcirculatory Shock Model

      • Controlled Hemorrhagic Shock in Rats

      • Transfusion of Blood and Microcirculation

      • Fluid Resuscitation in Shock

      • References

    • 12: Radiation and Microcirculation Models

      • Radiation Therapy

      • Intravital Microscopy

        • Rabbit Ear Chamber Model

        • Skin Graft Model

        • Skin Flap Model

        • Cremaster Muscle Model

        • Hindlimb-Cremaster Muscle Composite Tissue Transplantation Model

        • Rat TRAM Flap Model

        • In Vitro Model

        • Fat Grafing Model for Radiation Induced Skin Damage

      • References

    • 13: Microcirculation and Smoking

      • Introduction

      • Materials and Methods

      • Flap Preparation

      • Preparation for In Vivo Microcirculatory Observations

      • Cigarette Exposure

      • Microcirculatory Observations

        • Hemodynamics

          • Vessel Diameter

          • Red Blood Cell (RBC) Velocities

          • Leukocyte Activation

          • Functional Capillary Perfusion

        • Microvascular Permeability

          • Fluorescein Microscopy Set-Up

          • Analysis of Macromolecular Leakage

        • Results

          • Vessel Diameters

          • Red Blood Cell Velocity

          • Leukocyte-Endothelial Interaction

          • Functional Capillary Perfusion

          • Microcirculatory Permeability

      • Discussion

      • References

    • 14: Microcirculation Model for Invasive Animal Monitoring

      • Technique

        • Vessel Cannulation

        • Isolation of Cremaster Muscle

        • Measurements at the Microcirculatory Level

          • Vessel Diameter

          • Red Blood Cell Velocities

          • Leukocyte Count in Postcapillary Venules

          • Functional Capillary Density

      • Discussion

      • References

    • 15: Cremaster Chamber Model

      • Introduction

      • Materials and Methods

      • Cremaster Muscle Plexiglas Chamber

      • Cremaster Muscle Isolation and Chamber Implantation

      • Muscle Isolation and Preparation in the Control Group

      • Intravital Microscopy

      • Statistical Evaluation

      • Results

      • Microvascular Observations

      • Discussion

      • Conclusions

      • References

    • 16: Mouse Cremaster Muscle Allograft Model

      • Surgical Technique

      • Preparation of the Donor

      • Preparation of the Recipient

      • Transplantation of the Cremaster Muscle

      • Discussion

      • References

    • 17: Microcirculation and Pace Therapy

      • References

    • 18: Microcirculation and Hypothermia Model

      • Introduction

      • Other Available Models

      • Model of Microcirculation in Hypothermia

        • Exemplary Experiment

      • Summary

      • References

  • Part III: Transplantation Models

    • 19: Vascularized Composite Allotransplantation Models

      • Experimental Models of Allotransplantation

      • Skin and Soft Tissue-Containing VCA Models

      • Hindlimb Allotransplantation Models

      • Immunomodulatory VCA Models

      • Facial VCA Models

      • Large Animal Models

      • Other VCA Models

      • Future Perspectives

      • References

    • 20: Rat Hind Limb and Cremaster Allograft Transplantation Model

      • Surgical Technique

        • Preparation of the Recipient

        • Transplantation Procedure

        • Preparation of the Cremaster Muscle for Intravital Microscopy

        • Physical Evaluation of Transplanted Limbs

      • Discussion

      • References

    • 21: Limb and Microcirculation: Cremaster Flap Model

      • Introduction

      • Material and Methods

        • Animal Model

          • Animal Selection

          • Animal Care

          • Surgical Technique

        • Microcirculatory Observation Technique

          • Microcirculatory Measurements

      • Pitfalls in the Technique

        • Transplantation Related Problems

      • Discussion

      • References

    • 22: Bilateral Vascularized Composite Skin/Bone Transplantation Models

      • Introduction

      • Materials and Methods

      • Surgical Technique

        • Transplantation of Vascularized Skin (VS) Flap (Fig. 22.2a, b)

        • Transplantation of Vascularized Bone (VB) Flap (Fig. 22.2a, b)

        • Transplantation of Vascularized Skin/Bone (VSB) Flap (Fig. 22.2a, b)

      • Evaluation of the Transplants

        • Clinical Evaluation

        • Histological Evaluation

      • Results

      • Discussion

      • References

    • 23: Vascular Thymus and Hind Limb Allotransplantation Model

      • Experimental Model

        • Donor Animal (Lewis-Brown Norway)

        • Recipient Animal (Lewis Rat)

        • Preparation of Donor for Thymus (Lewis-Brown Norway Rat)

        • Preparation of the Creamaster Muscle for In Vivo Microscopic Assessment of Microcirculation (Lewis-Brown Norway to Lewis rat Hindlimb-Thymus)

        • Protocol for Direct In Vivo Observation of Microcirculation

        • White Blood Cell Count in Postcapillary Venules

        • Endothelial Edema Index

        • Physical Evaluation of the Transplanted Limb

      • References

    • 24: Vascular Thymus Transplantation Model

      • Preparation of Recipient

      • Preparation of Donor

      • Evaluation of Viability of Vascular Thymus Transplant

      • References

    • 25: Vascularized Skin/Bone Transplantation Model

      • Introduction

      • Materials and Methods

        • Anatomic Dissection Study

      • Transplantation Study (N = 10)

        • Surgical Technique

          • Disarticulation of the Femoral Bone at the Level of the Knee Joint

          • Disarticulation of the Femoral Bone at the Level of the Hip Joint

          • Transplantation of the Composite Vascularized Skin/Bone (VSB) Flap

        • Clinical Evaluation of the Flap Viability

        • Histological Evaluation

      • Results

        • Anatomic Study Outcome

      • Isograft Transplantation Study

        • Histological Evaluation

        • Radiological Evaluation

      • Discussion

        • Technical Aspects

        • Immunologic Aspects

      • Conclusion

      • References

    • 26: Vascularized Bone-Femur Transplantation Model

      • Introduction

      • Surgical Technique of BVFB Transplantation

        • Harvesting Procedure from the Donor

        • Transplantation Procedure in the Recipient

          • Transplantation into the Inguinal Region

          • Transplantation into the Abdominal Cavity

      • Evaluation

      • Results

        • Transplantation into the Inguinal Region

        • Transplantation into the Abdominal Cavity

      • Discussion

      • References

    • 27: New Composite Tissue Allograft Model of Vascularized Bone Marrow Transplant: The Iliac Osteomyocutaneous Flap

      • Introduction

      • Material and Methods

        • Animal Care

      • Experimental Groups

        • Anatomic Study Group

      • IBOMC Transplant Groups

      • Assessment of Transplant Viability

        • Direct Observation

        • Microangiography

        • India Ink Injection Studies

        • Histology

      • Immunologic Evaluation

        • Flow Cytometry Analysis

      • Immunohistochemical Analysis

      • Results

        • Clinical Assessment of IBOMC Transplants

          • Direct Observation

          • Microangiography

          • India Ink Injection Studies

          • Histologic Examination

          • Immunologic Evaluation

          • Donor-Specific Chimerism in the Lymphoid Tissues of Recipient

      • Discussion

      • Conclusions

      • References

    • 28: New Modification of the Oldest Flap in Rats to Increase Antigenicity of Transplanted Skin: The Extended Groin Flap Model

      • Introduction

      • Material and Methods: Animal Care

      • Experimental Group

        • Anatomic Study Group

        • EG Flap Transplant Groups

      • Assessment of Flap Viability

        • Direct Observation

        • Microangiography

        • India Ink Injection Studies

        • Histology

        • Immunologic Evaluation

      • Results

        • Anatomic Study Group

        • EG Transplant Groups: Direct Observation

        • Microangiography

        • India Ink Injection Studies

        • Histology

        • Chimerism Level in the Peripheral Blood of Vascularized Skin Allograft Recipients

      • Discussion

      • Conclusion

      • References

    • 29: Combined Semimembranosus Muscle and Epigastric Skin Flap Model

      • Introduction

      • Surgical Technique

        • Part I: Anatomic Dissection

        • Part II: Flap Harvesting and Transfer

      • Outcomes

        • Part I

        • Part II

      • Discussion

      • References

    • 30: Composite Osseomusculocutaneous Thymus Allotransplantation Model

      • Introduction

      • Surgical Technique

        • Preparation of the Osseomusculocutaneous Thymus Allograft

        • Preparation of the Recipient and Transplantation

        • Flow Cytometric Analysis

        • Assessment of Bone Marrow Cells in the Sternum

      • Results

      • Discussion

      • Conclusion

      • References

    • 31: Experimental Model for Monitoring of Composite Tissue Transplantation Induced Trauma

      • Introduction

      • Experimental Model

      • Preparation of Cremaster Muscle for Observation in Monitorization

      • Direct In Vivo Microcirculatory Observation in Monitorization

        • Vessel Diameter

        • Red Blood Cell (RBC) Velocities

        • Leukocyte Activation

        • Functional Capillary Perfusion

        • Endethelial Edema Index (EI/ID)

      • Evaluation of Microvascular Permeability

        • Preparation of Fluorescein: Labeled Albumin (FITC: BSA)

        • Fluorescein Microscopy Set Up

        • Analysis of Macromolecular Leakage

      • Histologic Examination

      • Conclusion

      • References

    • 32: Cryopreservation in Plastic Surgery: Our Experience and Review of the Literature

      • Introduction

      • Mechanısms of Cryo-Injury and Cryopreservation

      • Cryopreservatıon of Non-­vascularized Grafts

      • Cryopreservation of Vascularized Grafts (Flaps or Cta)

      • Cleveland Clinic Experience

      • Conclusion

      • References

    • 33: A Xenotransplantation Model for Vascularized Composite Transplantation

      • Introduction

      • Xenotransplantation and Basic Xenotransplantation Immunology

      • Composite Tissue Xenopreservation Model

        • Surgical Procedure

        • First Operation

        • Second Operation

      • Results of Composite Tissue Xenopreservation

        • Macroscopic Evaluation

        • Histologic Evaluation

      • Discussion

      • Conclusion and Future Concerns

      • References

    • 34: Full Face Transplant Model in Rats

      • Introduction

      • Anatomical Studies

      • Surgical Technique

        • Donor Rats

        • Recipient Rats

      • Isotransplantation of the Non-­vascularized, Composite, Full Face Transplantation Model

      • Allotransplantation of the  Non-­vascularized, Composite, Full Face Transplantation Model

      • Isotransplantation of the Vascularized, Composite, Full Face Transplantation Model

      • Allotransplantation of the Vascularized, Composite, Full Face Transplantation Model

      • Modifications of Arterial Anastomoses of the Vascularized, Composite, Full Face Allotransplantation Model

      • Further Studies of the Modification of the Anastomoses

      • Discussion

      • References

    • 35: Hemiface Transplant Model

      • Introduction

      • Surgical Technique

        • Preparation of the Donor

        • Preparation of the Recipient

        • Follow-Up and Evaluation Methods

      • Immunological Aspects

      • Conclusions

      • References

    • 36: Composite Hemiface/Calvarium Transplantation Model in Rat

      • Composıte Hemıface/Calvarıal Allograft Transplantatıon Model in Rat

      • References

    • 37: Maxilla Allograft Transplantation Model in Rat

      • Heterotopic Maxilla Allograft Transplantation Model in Rats

      • References

    • 38: Composite Hemiface/Mandible/Tongue Allotransplantation Model in Rats

      • Introduction

      • Anatomical and Histological Preliminary Studies

      • Isotransplantation Studies of the Composite Hemiface/Mandible/Tongue Transplantation Model

        • Surgical Technique

        • Histological Evaluation

        • Radiological Evaluation

      • Allotransplantation Studies of the Composite Hemiface/Mandible/Tongue Transplantation Model

        • Surgical Technique

        • Immunosuppressive Treatment Protocol

      • Histological Assessment

        • Allotransplantation Treatment Group

        • Radiologic Assessment

        • Allograft Rejection Group

        • Flow Cytometry Analysis

        • Immunohistochemical Staining

      • Discussion

      • Conclusion

      • References

    • 39: Composite Osseomusculocutaneous Midface Allotransplantation Model with Motor and Sensory Units

      • Introduction

      • Surgical Technique

        • Preparation of Donor

        • Preparation of Recipient

        • Transplantation Procedure

      • Evaluation

        • Microangiography

        • Spiral Computed Tomography

        • Somatosensory-Evoked Potential (SSEP)

        • Motor-Evoked Potentials (MEPS)

      • Results

      • Discussion

      • Conclusion and Future Concerns

      • References

    • 40: Transplantation of the Mystacial Pad

      • Introduction

      • The Mystacial Pad

      • The Experiment

      • The Mystacial Pad Flap

      • Preparation of the Recipient

      • Anatomical, Clinical, Electrodiagnostic and Histological Studies

      • Statistical Analysis

      • Results

      • Discussion

      • Conclusion and Future Directions

      • References

    • 41: Heterotopic Transplantation of Total Face/Scalp Flap

      • Introduction

      • Materials and Methods

        • Operative Technique for the Donor (Harvesting of the Composite Face/Scalp Flap)

        • Operative Technique for the Recipient

        • Immunosuppressive Protocol

      • Results

        • Complications

      • Discussion

      • Conclusions

      • References

    • 42: Non-invasive Monitoring of Skin-­Containing Vascularized Composite Allotransplantation

      • Introduction

      • Experimental Model

        • Surgical Technique

        • Immunosuppression Protocol

        • Evaluation

        • Statistical Analysis

        • Findings

      • Conclusıon

      • References

    • 43: Abdominal Wall Transplant Models

      • Introduction

      • Materials and Methods

        • Animal Care

        • Surgery

        • Anatomic Studies

        • Experimental Group

        • Assessment of Flap Viability

          • Direct Observation

        • Microangiography

        • Indian Ink Injection Studies

        • Histology

        • Immunologic Evaluation

      • Results

        • Anatomic Studies

        • Experimental Group

          • Direct Observation

        • Microangiography

        • Histology

        • Immunologic Evaluation

      • Discussion

      • Conclusion

      • References

    • 44: Penis Allotransplantation Model

      • Introduction

      • Materials and Methods

        • Anatomic Study

        • Isotransplantation

        • Allotransplantation

      • Operative Technique of Harvesting of the Penile Isograft and Alograft

      • Operative Technique for the Recipient

      • Evaluation of Viability of the Transplant

      • Results

        • Anatomic Studies

        • Isotransplantation

        • Allotransplantation

      • Discussion

      • Conclusion

      • References

    • 45: Composite Orbital and Periorbital Allotransplantation Model

      • Introduction

      • Experimental Model

        • Surgical Technique

        • Immunosuppression Protocol

        • Evaluation

        • Findings

      • Conclusion

      • References

    • 46: Ear Transplantation

      • Introduction

      • Surgical Technique

        • Preparation of the Donor

        • Preparation of the Recipient

      • Immunosuppressive Regimen

      • Immunologic and Functional Considerations

      • Conclusions

      • References

    • 47: Heterotopic Vascularized Ovarian Autotransplantation Model in the Sheep

      • Introduction

      • Operative Technique

        • Laparoscopic Oophorectomy

        • Vascularized Ovarian Autotransplantation

          • Assessment of Ovarian Functions

        • Patent Vascularized Ovarian Autotransplantation

        • Non-patent Vascularized Ovarian Autotransplantation

      • Remarks on the Heterotopic Autotransplantation Model

      • Autotransplantation of Intact Frozen-Thawed Sheep Ovaries with Microvascular Anastomosis

      • Review of Investigations on Vascularized Ovarian Transplantation

      • Closing Remarks

      • References

    • 48: Spleen Transplantation Model

      • Introduction

      • The History of Spleen Transplantation

      • The Spleen Anatomy, Histology and Function

        • Vascularization

      • Different Methods of Spleen Transplantation

        • Anesthesia Protocol

        • Harvesting the Spleen

        • Recipient Place Preparation and Transplantation

          • Orthotopic Spleen Allotransplantation Procedure

          • Heterotopic Spleen Allotransplantation Procedure

      • The Immunologic Potential of the Spleen in Tolerance Induction

        • Spleen Split Tolerance

        • Splenic Chimerism Induction

      • The Future Perspective for Spleen Allotransplantation

      • References

  • Part IV: Peripheral Nerve Surgey Models

    • 49: Vascularized Lymph Node Transplantation Models

      • Introduction

      • Vascularized Cervical Lymph Node Transplantation Model (Fig. 49.1a)

      • Vascularized Mesenteric Lymph Node Transplantation Model (Fig. 49.1b)

      • Vascularized Inguinal Lymph Node Transplantation Model (Fig. 49.1c)

      • References

    • 50: A Contemporary Overview of Peripheral Nerve Research from Cleveland Clinic Microsurgery Laboratory

      • Introduction

      • Locally Supplied Factors to Enhance Nerve Regeneration

        • Axonal Fluid

        • Vascular Endothelial Growth Factor (VEGF)

        • Dehydroepiandrosterone (DHEA)

      • Technical Maneuvers to Enhance Nerve Regeneration

        • Epineural Sleeve Neurorraphy

      • Bridging Nerve Defects

        • Autogenous Nerve Grafts

        • Monocable vs Multicable and Thin vs Thick Nerve Grafts

        • Epineural Tubes

        • Epineural Sheath Grafts

        • Vein Grafts (Standard, Reversed and Filled with BMSC)

        • Nerve Allografts

      • Decompression of Peripheral Nerves in Diabetics

      • References

    • 51: Epineural Sleeve End-to-End Repair

      • Introduction

      • Experimental Model

        • Surgical Technique

        • Evaluation

        • Statistical Analysis

        • Findings

      • Conclusion

      • References

    • 52: Somatosensory Evoked Potential Model for Assessment of Nerve Regeneration

      • Introduction

      • Anesthetic Considerations for Intraoperative Measurements

        • Drugs

        • Skin and Core Temperature

      • Technique

        • Placing Stimulating Electrodes

        • Placing Recording Electrodes

        • Placing a Ground Electrode

      • SEPs Measurements

      • Maximal Nerve Conduction Velocity Measurements

      • References

    • 53: Epineural Sleeve Nerve Grafting Technique

      • Introduction

      • Idea of Epineural Sleeve Technique

      • Technique and Experimental Model

        • Surgical Approach

        • Technique of Epineural Sleeve for Nerve Graft Reconstruction

      • Experimental Study on Epineural Sleeve Technique for Nerve Graft

        • Materials and Methods

          • Technique of Conventional Epineural Repair

          • Functional and Morphological Evaluation of Nerve Recovery

          • Pinprick Test

          • Toe-Spread Test

          • Walking Track Analysis

          • Somatosensory-Evoked Potentials (SEP)

          • Muscle Weight

          • Histomorphometry

        • Results

          • Pinprick Test

          • Toe-Spread Test

          • Walking Track Analysis

          • Somatosensory Evoked Potentials (SEP)

          • Muscle Weight

          • Histomorphometry

          • Statistical Analysis

      • Discussion

      • Summary

      • References

    • 54: Single Fascicle Graft Repair Model

      • Introduction

      • Experimental Model

      • Operative Technique

      • Summary of our Publications and the Literature Review

      • Conclusion

      • References

    • 55: Nerve Decompression Models in Diabetic Rats

      • Introduction

      • Material and Methods

      • The Model

        • Surgical Technique

          • Tarsal Tunnel Release

          • Common Peroneal Nerve Release

      • Experimental Design

        • Groups

          • Short-Term Follow-Up Groups

          • Long-Term Follow-Up Groups

      • Functional Evaluation

        • Clinical Assessment

        • Pin Prick Test

        • Toe-Spread Test

        • Walking Track Analysis (WTA)

        • Somatosensory Evoked Potential (SSEP) Test

      • Histomorphometric Evaluation

        • Evaluation of Gastrocnemius Muscle Atrophy

      • Statistical Analysis

      • Results

        • Functional Evaluation

          • Pin-Prick Test

          • Toe-Spread Test

          • Walking Track Analysis (WTA)

          • Somatosensory Evoked Potential Test

      • Histomorphometric Evaluation

        • Gastrocnemius Muscle Evaluation

      • Discussion

      • References

    • 56: Epineural Sheath Grafts for Nerve Regeneration

      • Introduction

      • The Model

        • Surgical Technique

        • Experimental Groups

      • Evaluation Techniques

        • Functional Evaluation

        • Pin Prick Test

        • Toe-Spread Test

        • Electrophysiological Test

      • Histomorphometric Evaluation

        • Evaluation of Gastrocnemius Muscle Atrophy

        • Evaluation of Nerve Morphometry and Morphology

        • Statistical Analysis

      • Results

        • Functional Evaluation

          • Pin-Prick Test

          • Toe Spread Test

          • Somatosensory Evoked Potential

      • Histomorphometric Evaluation

        • Gastrocnemius Muscle Evaluation

        • Nerve Histomorphometry

      • Discussion

      • References

    • 57: Epineural Tube Repair

      • Introduction

      • Surgical Technique

      • Methods of Assessment

      • Large Animal Study

      • Preliminary Cadaveric Study

      • Discussion

      • Conclusions

      • References

    • 58: Tissue Engineered Conduit

      • Introduction

      • Bone Marrow Stromal Cells

      • Nerve Growth Factor

      • Materials and Methods

        • Animals

        • Experimental Groups

        • Operative Technique

        • Bone Marrow Stromal Cell Isolation

        • Functional Analysis

        • Electrophysiologic Assessment

        • Muscle Denervation Atrophy and Evaluation

        • Statistical Methods

      • Results

        • Macroscopic Observation

        • Pin Prick Test

        • Toe Spread Test

        • Gastrocnemius Muscle Index

        • Somatosensory Evoked Potentials

      • Discussion

      • Conclusion

      • References

    • 59: Venous Conduit as a Model for Nerve Regeneration

      • Introduction

      • Vein Graft

      • Vein Muscle Graft

      • Cellular Additive

      • Main Conclusion and Future Perspective

      • References

    • 60: DRG Decompression Model

      • Introduction

      • Materials and Methods

        • Harvesting Technique of Epineural Sheath for Immunohistochemical and Real Time PCR Analysis

          • Epineural Sheath Harvest

          • Epineural Sheath Naïve Control

        • Application of the Epineural Sheath as a Neuroprotective Patch Following Lumbar Laminectomy

          • Experimental Model

      • Study Groups

        • Assessment of Immunological and Neuroregenerative Properties of the Harvested Naïve Epineural Sheath

          • Epineural Sheath Staining for Immunofluorescence with VEGF, GFAP, vWF, NGF, Laminin, MHC Class I, MHC Class II, CD45, CD3 and S100

        • Assessment of Proangiogenic and Neuroregenerative Properties of the Epineural Sheath Applied as a Patch Following Lumbar Laminectomy (Experimental Group II)

          • Preparation of Paraffin Sections for VEGF, vWF, GFAP, NGF, S100 and Laminin Histoimmunostaining

          • Assessing the Number of VEGF-­Immunoreactive Cells

          • Assessment of VEGF Gene Expression by Real Time PCR. RNA Isolation

          • cDNA Synthesis

          • Relative Quantification Real-Time PCR

      • Conclusion

      • References

    • 61: Epineural Patch Applications in Dorsal Root Ganglion Decompression Model

      • Introduction

      • Conclusion

      • References

    • 62: Sheep as a Large Animal Model for Nerve Regeneration Studies

      • Introduction

      • Surgical Technique

      • Evaluation Methods

      • Evaluation of the Nerve Function

      • Nerve Conduction Velocity

      • Histomorphology and Immunostaining

      • References

    • 63: Peripheral Nerve Surgery Models Sciatic Nerve Crush Injury Model

      • Introduction

      • Surgical Technique

      • Nerve Recovery Evaluation Methods

        • Clinical Evaluation

          • Functional Assessment

        • Electrophysiologic Test

        • Histomorphometric Evaluation

          • Gastrocnemius Muscle Weight Index (GMI)

      • Nerve Morphometry and Morphology

      • References

    • 64: Peripheral Nerve Surgery Models Crush Injury and Epineural Patch

      • Introduction

      • Surgical Techniques

        • Harvesting Epineural Sheath Patch

      • Application of Epineural Sheath Patch

      • Evaluation Methods

      • References

    • 65: Neuroma Model

      • Introduction

      • Experimental Models of Neuroma Protection in the Rat Model

      • Surgical Procedure of Epineural Sheath Jacket (ESJ) Application

        • Group 1: Nerve Stump Protected by Epineural Sheath Jacket (ESJ)

        • Group 2: Nerve Stump Protected by Epineural Sheath Jacket (ESJ) and Buried into the Adjacent Muscle

        • Group 3: Nerve Stump Protected by Epineural Sheath Jacket (ESJ) and Filled with Autologous Fat Graft

        • Group 4: Nerve Stump Protected by Epineural Sheath Jacket (ESJ) and Filled with Autologous Fat Graft and Buried into the Adjacent Muscle

        • Group 5: Control-Nerve Stump Left Without Any Protection

        • Group 6: Nerve Stump Buried into the Adjacent Muscle

      • References

    • 66: Diabetic Rat Model

      • Historic Development of Diabetic Animals for Experimental Studies

      • Type 1 Diabetes Rat Models

        • Bio Breeding (BB) Rat

        • Long Evans Tokushima Lean (LETL) and Komeda Diabetic Prone (KDP) Rats

        • LEW.1AR1/Ztm-iddm Rat

        • Chemically-Induced Diabetes in Rat

        • Virally-Induced Diabetes in Rat

      • Type 2 Diabetes Rat Models

        • Zucker Diabetic Fatty (ZDF) Rat

        • Goto-Katazaki (GK) Rat

        • Otsuka Long-Evans Tokushima Fatty (OLETF) Rat

        • Muridae Family

      • Other-Type Diabetic Rat Models

        • Transgenic and Knock-Out Metabolic Models

        • Gestational Diabetes Models

      • Blood Glucose Levels in Diabetic Rats

        • Blood Acquisition Method

      • Organ-Specific Complications of Diabetes in Rats

      • Nerve Regeneration in Diabetes-­Induced Neuropathy

      • References

    • 67: Nerve Allograft Transplantation Model

      • Allotransplant Model

        • Treatment Protocol

        • Assessment and Results

          • Functional Analysis

        • Electrophysiologic Assessment

        • Histologic and Morphometric Studies

        • Muscle Denervation Atrophy Evaluation

        • Immunocompetence of Animals

      • Other Contemporary Models

      • References

  • Part V: Microsurgical Robot Applications

    • 68: Nerve Allograft Transplantation

      • Introduction

      • Nerve Allotransplantation

        • Immunologic Causes of Nerve Allograft Rejection

        • Prevention of Allograft Rejection

        • Allograft Pretreatment Methods

        • Major Histocompatibility Matching

        • Recipient Immunosuppression

        • Tolerance Inducing Strategies

        • Non-selective T-Cell Depletion

        • Selective T-Cell Depletion

        • Co-stimulatory Blockade

      • Current Status

      • Current Protocol for Nerve Allograft Immunosuppression in Humans

      • Future Developments

      • Conclusion

      • References

  • Part VI: Cellular Therapy Models

    • 69: Application of the Microsurgical Robot RAMS in Plastic and Reconstructive Surgery

      • Introduction

      • Robot as an Assistant Tool in Microsurgery

      • Current Status of Medical Robotics

      • Summary

      • References

    • 70: Cellular Therapies in Vascularized Composite Allograft: Review

      • Introduction

      • Hematopoietic Cells as an Integral Part of VCA

      • Experimental Models of Supportive Therapy with Donor Bone Marrow Cells (BMC)

      • Protolerogenic T-Regulatory Cells Therapies

      • Mesenchymal Stem Cells Therapies

      • Clinical Application of Cellular Therapies in VCA

      • References

    • 71: In Vivo Chimera Model: Creation of Primary and Secondary Chimera

      • Chimerism and Its Importance in Tolerance Induction

      • Chimerism Based Strategies for Tolerance Induction

      • Chimerism as a Base for Developing Chimeric Cell Therapy: Creation of Primary and Secondary Chimeric Animals

      • Mechanism of Chimeric Cell Creation In Vivo

      • References

    • 72: Cellular Therapy Models: Ex Vivo Chimera Model by Cell Fusion

      • The Phenomenon of Cell Fusion

      • In Vitro Cell Fusion

      • Application of Cell Fusion as a Research Tool

        • Application of Cell Fusion as a Treatment Option

      • Cell Fusion in the Field of Transplantation

      • Ex Vivo Cell Fusion as a New Approach for Tolerance Induction

      • Ex Vivo Creation of the Donor-­Recipient Chimeric Cells: Animal Model

      • Hematopoietic Donor-Recipient Chimeric Cells from Animal Model to Human

      • References

    • 73: Cellular Therapies via Vascularized Bone Marrow Transplantation

      • Introduction

      • The Multi-Tissue Models Containing Vascularized Bone Marrow

        • The Limb Allograft as Vascularized BMT Model

          • CsA Monotherapy Protocol in Limb Allograft Model

          • Immunodepletive Protocols in Limb Allograft Model

        • Face Allograft Model Containing Vascularized Bone Component

          • Chimerism in Hemiface/Calvaria Model

          • Chimerism in Maxilla Model

          • Hemiface/Mandible/Tongue Model

        • The Vascularised Iliac Osteomyocutaneous Flap Model

        • Sternum as a Model of Vascularized BMT

      • Isolated Vascularized Bone Marrow Transplants: Single Component of VCA Containing Bone Marrow Cells

      • The Impact of Vascularized BMT in Chimerism Induction in VCA

      • Advantages and Disadvantages of Vascularized BMT

        • Disadvantages

        • Advantages

      • References

    • 74: Cellular Therapies in Vascularized Composite Allograft

      • Introduction

      • Cellular Therapy with “Crude” BMT

        • “Crude” Bone Marrow Transplantation Technique

        • The Effect of “Crude” BMT for Skin Allograft Survival

      • Cellular Therapy with Selected Population of Donor BMC

        • Bone Marrow Progenitor Cell Separation

        • Supportive Therapy with CD90+ Cells on Limb Allograft Survival

      • Cellular Therapy with Unselected Population of Donor BMC

        • Donor Bone Marrow Isolation and Transplantation Procedures

        • Effects of Intraosseous Vs Intravenous BMT

      • Supportive Therapy with Bone Marrow Cells for Face Allograft Survival

      • Cell-Based Therapy into Immunoprivileged Compartments

        • Transplantation Procedure of Vascular Skin Allograft and Donor BMT

        • Bone Marrow Transplantation Technique into Immunoprivileged Compartments

          • Intracapsular BMC Transplantation

          • Intragonadal BMC Transplantation

          • Intrathecal BMC Transplantation

        • Results of BMT into Immunoprivileged Sites

      • Selective Immunodepletive Protocol with Anti-ΑΒ-TCR MAB and Chimerism Induction After Hematopoietic Cell Transplantation

      • References

    • 75: Cellular Therapies in Post-­radiation Syndrome

      • The Effect of Ionizing Radiation and Development of Acute Radiation Syndrome

      • Alternatives to Cellular Therapeutics

      • Blood Products

      • Hematopoietic Stem Cell Transplantation

      • Ex Vivo Created Fused Chimeric Cells

      • References

    • 76: Cellular Therapies in Nerve Regeneration

      • Cellular Therapies in Nerve Regeneration

      • Sources of Cells for Nerve Regeneration

        • Schwann Cells

        • Mesenchymal Stem Cells

      • Future Potential Sources of Cells for Nerve Regeneration

        • Very Small Embryonic-Like Stem Cells

        • Induced Pluripotent Stem Cells

      • The Effects of Biological Conduit and Cellular Therapy Interplay

        • The future of cellular therapies in peripheral nerve regeneration

      • References

  • Index

Nội dung

Author(s): Maria Z. Siemionow (eds.) Publisher: SpringerVerlag London, Year: 2015 ISBN: 9781447163343,9781447163350 Description: There is a paradigm shift in plastic and reconstructive surgery from the interest of developing new surgical techniques into the application of new technologies via research based studies on stem cells, tissue engineering and new field of reconstructive transplantation such as e.g. face, hand or larynx transplants. This approach is relatively novel and introduced to plastic surgery within past decade. Thus there is an urgent need to facilitate access to this new knowledge which was not traditionally a part of plastic surgery curriculum. The most efficient way of introducing these new approaches is via presentation of pertinent to different fields (stem cell, transplantation, nerve regeneration, tissue engineering) experimental models which can be used as a tool to develop technologies of interest by different groups of surgeons. These surgical specialities which will be interested and benefit from the book include: plastic and reconstructive surgeons, microsurgeons, hand surgeons, orthopaedic surgeons, neurosurgeons and transplant surgeons.

Maria Z Siemionow Editor Plastic and Reconstructive Surgery Experimental Models and Research Designs 123 Plastic and Reconstructive Surgery Maria Z Siemionow Editor Plastic and Reconstructive Surgery Experimental Models and Research Designs Editor Maria Z Siemionow Department of Orthopaedics University of Illinois at Chicago Chicago, IL USA ISBN 978-1-4471-6334-3 ISBN 978-1-4471-6335-0 DOI 10.1007/978-1-4471-6335-0 Springer London Heidelberg New York Dordrecht (eBook) Library of Congress Control Number: 2014960234 © Springer-Verlag London 2015 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher's location, in its current version, and permission for use must always be obtained from Springer Permissions for use may be obtained through RightsLink at the Copyright Clearance Center Violations are liable to prosecution under the respective Copyright Law The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) I dedicate this book to all my Fellows, residents, and students over the past 30 years who spent part of their education and life in my Microsurgery Laboratory and contributed to the most innovative research in microsurgery, microcirculation, and nerve regeneration and pioneering studies on vascularized composite allotransplantation Their enthusiasm, intelligence, and skills made significant impacts on the development of reconstructive surgery and research Maria Z Siemionow Preface It is a great privilege and pleasure to introduce the book Plastic and Reconstructive Surgery: Experimental Models and Research Designs The idea behind writing this book was to document over 30 years of my research interest in the fields of microsurgery, peripheral nerve surgery, and vascularized composite allotransplantation and to acknowledge the contribution of over 150 of my international trainees participating and contributing to the development of my research program I invited all my Fellows, residents, and students, who have made major contributions to my research, to write the chapters on experimental models and designs which were the subject of their fellowship and training during the time they spent in my Research Laboratories at the University of Utah, the Cleveland Clinic, and the University of Illinois at Chicago This generated enthusiastic response from 60 of my trainees and resulted in the delivery of 76 chapters, each on the different experimental model and design which represented their research work during the time they spent in my laboratories The book is unique since many experimental models and designs presented here are being introduced to the literature for the first time, and this is specifically true for the models of vascularized composite allotransplantation, such as face, larynx, vascularized bone, limb, abdominal wall, penis, and ovarian transplants The book content is divided into six sections describing different models and relevant experimental designs All chapters introduce unique experimental models which are relevant to the field of plastic and reconstructive surgery and vascularized composite allotransplantation research The sections include: Microsurgery Models, Microcirculation Models, Transplantation Models, Peripheral Nerve Surgery Models, Microsurgical Robot Applications, and Cellular Therapy Models For each of the experimental model designs, the technique of model application is presented as well as the research protocol which was tested by the particular experimental model The idea of bringing this book to the plastic and reconstructive surgery readership is to introduce an up-to-date comprehensive review of both standard and new techniques and technologies, such as face and hand transplantation or stem cell therapies, which were introduced in recent years The aim of the book is to provide a comprehensive review system which will help vii Preface viii residents and young surgeons to prepare for board exams as well as provide access to the comprehensive material of surgical research and design The book emphasizes innovations and new technologies as well as research approaches as applied to general plastic surgery, hand surgery, peripheral nerve surgery, microsurgery, reconstructive surgery, and reconstructive transplantation To the best of my knowledge, this is the first book of this kind, which in one volume presents a novel and most updated approach to the application of experimental models and designs to test clinically relevant questions Each chapter is well illustrated and provides an outline of the experimental design as well as descriptions of new surgical techniques with drawings, images, and references I hope this book will be of interest to young surgeons in training and those interested in research, since they will be able to get a quick comprehensive overview of new surgical techniques and technologies which will be applied in the near future to surgical practice and thus will help them decide on their area of specialization It has been a great pleasure to work once again with all my trainees, who have developed their own careers and become experts in the fields which they have outlined in the chapters of this book From the perspective of the many years which have passed, I am proud that my effort to teach them about the importance of research and science in our professional and everyday life has had an impact on both their lives and their career choices I also hope that this book will help a new generation of surgeon-scientists to make continued contributions to the new, developing fields of reconstructive surgery with the ultimate goal of helping patients by introducing new, minimally invasive, and safer surgical procedures Chicago, IL, USA Maria Z Siemionow, MD, PhD, DSc Contents Part I Microsurgery Models Microsurgical Techniques in Reconstructive Surgery Maria Z Siemionow and Fatih Zor Arterial and Venous Microanastomosis Models Maria Z Siemionow, Greg J Kwiecien, Safak Uygur, and Adam Bobkiewicz 11 Lymphaticovenous Anastomosis Training Model in Rat Ilker Yazici and Maria Z Siemionow 33 Fallopian Tube Anastomosis Greg J Kwiecien 39 Vasoepididymostomy Anastomosis Safak Uygur 45 The Microsurgical Groin Skin Flap in the Rat Model Raffi Gurunluoglu and Maria Z Siemionow 53 Free TRAM Flap Model Jerzy Jankau 63 Part II Microcirculation Models Application of Microcirculatory Models in Plastic Surgery Research: Review Krzysztof Kusza, Maria Z Siemionow, and Małgorzata Cyran 71 Standard Cremaster Muscle Model for Ischemia Reperfusion Michal Molski, Ilker Yazici, and Maria Z Siemionow 83 10 Cremaster Muscle and Effect of Different Anesthetics Mariusz Mielniczuk and Krzysztof Kusza 89 11 Microcirculatory Shock Model Jacek Szopinski and Krzysztof Kusza 97 12 Radiation and Microcirculation Models 103 M Sühan Ayhan and Hakan Bulam ix .. .Plastic and Reconstructive Surgery Maria Z Siemionow Editor Plastic and Reconstructive Surgery Experimental Models and Research Designs Editor Maria Z Siemionow Department... continuous horizontal mattress, interrupted M .Z Siemionow (ed .), Plastic and Reconstructive Surgery: Experimental Models and Research Designs, DOI 10.1007/978-1-4471-6335-0_2, © Springer- Verlag London. .. Part I Microsurgery Models Microsurgical Techniques in Reconstructive Surgery Maria Z Siemionow and Fatih Zor Arterial and Venous Microanastomosis Models Maria Z Siemionow,

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