|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| The ear was then immediately reimplanted by overlapping the cartilage 1 cm. in a flange-like manner to give stability to the transplant. Next the severed ends of the vein were brought into the double clamp. The blood and fibrin clots were irrigated out of the segment between the clamp with Heparin solution 1,000 units per ml. The microminiature repair was begun under 16 to 25 magnification; suture handling and tying was performed at 10 diameters magnification. A variety of suture repairs have been attempted-interrupted everting mattress, continuous everting mattress, simple continuous whip-stitch between stay sutures. The last type is most easily performed and is demonstrated in Figure 6, A to F. The artery was repaired in a similar fashion. A well-performed anastomosis is haemostatic as soon as the clamps are removed. Any leakage at this time indicates a mechanical defect in the repair and heralds future thrombosis.
Results.-To date in over forty attempts one ear has totally survived transplantation (Fig. 7, A and B). Partial survival of 20 to 50 per cent. was common.
1 Dumont, Switzerland. 2 Beaver, ¢8o Trepelo Road, Belmont 79, Massachusetts.
| FIG. 6. Microvascular repair of 0.8 mm. vessel or 0.032 in.
A, Vessel cut oblique - near stay suture in place.
B, Far stay suture in place.
C, Anterior repair completed between stay sutures.
D, Clamp rotated 180 degrees for posterior repair.
E, Repair completed, stay sutures cut.
F, Clamps removed. Haemostatic suture line lies between marks on millimetre scale.
FIG. 7. A, Ear completely amputated, stump seen through hole in drape. B, Total survival, two weeks after reimplantation and microminiature vascular repair.
FIG. 8. A, Ear completely mobilised on vascular pedicle. B, Immediately after transfer to midline of neck on intact vascular pedicle which was rotated 180 degrees and angulated over 90 degrees in two planes. C, Two weeks later, complete survival.
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