Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.
  Table of Contents / Epilogue
  Gersuny in 1887 and later Esser (1917) attempted to circumvent some of the problems associated with pedicles by transferring islands of tissue on isolated vascular stalks. This principle has been expanded recently by Littler (1961, 1963), McGregor (1964), and others to pollicinise digits and restore sensation to fingertips. The Stein-Abbe-Estlander lip switch flap is another example of a large volume of tissue moved with ease on a narrow vascular pedicle. The striking feature common to all of these procedures is the minute size of the feeding vessels, 0-040 in. (I mm.) in external diameter.

The successful repair of slightly larger vessels has already found valuable experimental (Conway et al., 1959 ; Lapchinsky, 1960 ; Snyder et al., 1960 ; Tose, 1961) and clinical (Seidenberg et al., 1959 ; Nakayma et al., 1962) application. There have been several reports of the successful re-attachment of traumatically and experimentally amputated parts (Chung-Wei and Yun-Ching, 1963 ; Douglas and Foster, 1963 ; Kleinert et al., 1963). Little can be said for the use of homografts or heterografts of these large composite grafts until the basic rejection phenomenon is fully understood.

Jacobsen in 1959 was the first to point out the value of the operating microscope in small vessel repairs (Jacobsen and Suarez, 1960). The microsurgical repair of nerves is another example of the practical use of this valuable instrument (Smith, 1964).


The objective of our particular experiments was to develop techniques whereby vessels of 0-040 in. (I mm.) and smaller could be successfully anastomosed. This size is considered to be critical since it approximates the size of the digital vessels and the subdermal vessels which supply tube pedicles and various flaps in man. The rabbit's ear provided an ideal experimental tool. The central ear vessels of a 5 to 7 lb. animal fall within this critical range and are easily accessible for experimental work.

In 1957 Mr Thomas Gibson, Glasgow, first stimulated our interest in the possibility of transplanting tissue by reanastomosing the small feeding vessels. Initial attempts to join the central vessels of the rabbit's ear by intraluminal stents or extraluminal cuffing devices were not successful.2 In larger arterial repairs the systolic pressure to a great extent keeps the anastomosis open. However, in small vessels one must produce a flawless intima-to-intima flexible dynamic repair which can expand and contract

1 Presented at the Kansas City Meeting of the Plastic Surgery Research Council, March 1964. 2 Trevy Fund Grant 274, University of California, 1959-6o-6i.

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