There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer...There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.展开更多
Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock ou...Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock outs,we found a differential dependence of manual stimulation effects on growth factors.Thus,insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements,whereas FGF-2 is not.The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally,i.e.within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows ＂synaptic stripping＂.We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein（GFAP） as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2（FGF-2^（-/-） mice）.There was no difference in GFAP-Cy3-fluorescence（pixel number,gray value range17-103） between intact wildtype mice（2.12± 0.37×10~7） and their intact FGF-2^（-/-） counterparts（2.12±0.27×10~7） nor after facial-facial anastomosis ＋handling（wildtype：4.06±0.32×10~7;FGF-2^（-/-）：4.39±0.17×10~7）.However,after facial-facial anastomosis,GFAP-Cy3-fluorescence remained elevated in FGF-2^（-/-）-animals（4.54±0.12×10~7）,whereas manual otimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice（2.63±0.39×10）.We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction,but it is required to minimize astrogliosis in the brainstem and,by implication,restore synaptic coverage of recovering facial motoneurons.展开更多
文摘There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.
基金financially supported by the Koln Fortune Programmthe Jean-Uhrmacher FoundationAkdeniz University Research Fund
文摘Recently,we have shown that manual stimulation of paralyzed vibrissal muscles after facial-facial anastomosis reduced the poly-innervation of neuromuscular junctions and restored vibrissal whisking.Using gene knock outs,we found a differential dependence of manual stimulation effects on growth factors.Thus,insulin-like growth factor-1 and brain-derived neurotrophic factor are required to underpin manual stimulation-mediated improvements,whereas FGF-2 is not.The lack of dependence on FGF-2 in mediating these peripheral effects prompted us to look centrally,i.e.within the facial nucleus where increased astrogliosis after facial-facial anastomosis follows ＂synaptic stripping＂.We measured the intensity of Cy3-fluorescence after immunostaining for glial fibrillary acidic protein（GFAP） as an indirect indicator of synaptic coverage of axotomized neurons in the facial nucleus of mice lacking FGF-2（FGF-2^（-/-） mice）.There was no difference in GFAP-Cy3-fluorescence（pixel number,gray value range17-103） between intact wildtype mice（2.12± 0.37×10~7） and their intact FGF-2^（-/-） counterparts（2.12±0.27×10~7） nor after facial-facial anastomosis ＋handling（wildtype：4.06±0.32×10~7;FGF-2^（-/-）：4.39±0.17×10~7）.However,after facial-facial anastomosis,GFAP-Cy3-fluorescence remained elevated in FGF-2^（-/-）-animals（4.54±0.12×10~7）,whereas manual otimulation reduced the intensity of GFAP-immunofluorescence in wild type mice to values that were not significantly different from intact mice（2.63±0.39×10）.We conclude that FGF-2 is not required to underpin the beneficial effects of manual stimulation at the neuro-muscular junction,but it is required to minimize astrogliosis in the brainstem and,by implication,restore synaptic coverage of recovering facial motoneurons.
