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Background: Auricular avulsion can cause severe psychological effects. There are no established protocols for surgical treatment for such injuries. Acute care involves various procedures like graft reattachment, skin flap reconstruction, Baudet approach, and microvascular repair. Objectives: Reviewing the literature regarding various reattachment techniques for managing complete auricular avulsion was the goal of this review. It also aimed to help the surgeon choose the best total reconstruction method considering the available materials and to assess the advantages and disadvantages of each technique. Methods: We thoroughly reviewed relevant research on publications describing total auricular avulsion repaired with reattachment which were indexed in PubMed, MEDLINE, and Scopus. The study accepted and reviewed English-language papers without determining their publication date, using a database search based on key words. Conclusions: According to the literature, microvascular restoration is more successful for avulsed ears, although composite grafts are better aesthetically. Early hyperbaric oxygen and surgical treatment can improve patient outcomes. Recently, 3D printing is a big step forward in auricular reconstruction, providing a patient-specific, customizable, and efficient alternative for people with auricular loss. [ABSTRACT FROM AUTHOR]

Abstract Background Auricular avulsion can cause severe psychological effects. There are no established protocols for surgical treatment for such injuries. Acute care involves various procedures like graft reattachment, skin flap reconstruction, Baudet approach, and microvascular repair. Objectives Reviewing the literature regarding various reattachment techniques for managing complete auricular avulsion was the goal of this review. It also aimed to help the surgeon choose the best total reconstruction method considering the available materials and to assess the advantages and disadvantages of each technique. Methods We thoroughly reviewed relevant research on publications describing total auricular avulsion repaired with reattachment which were indexed in PubMed, MEDLINE, and Scopus. The study accepted and reviewed English-language papers without determining their publication date, using a database search based on key words. Conclusions According to the literature, microvascular restoration is more successful for avulsed ears, although composite grafts are better aesthetically. Early hyperbaric oxygen and surgical treatment can improve patient outcomes. Recently, 3D printing is a big step forward in auricular reconstruction, providing a patient-specific, customizable, and efficient alternative for people with auricular loss.

Objective To observe the effect of using a pre-auricular flap with vessels to repair the secondary nasal defects after the treatment of nasal tumors. Methods A reversed pre-auricular flap had been performed on six patients with the secondary nasal defects from the tumor removal including five patients with alar defects and one patient with the nasal tip defect. The size of the flap ranged from 3.0 cm×2.5 cm to 6.0 cm×2.5 cm. The reversed superficial temporal vessels of the flap were anastomosed with the recipient facial vessels. Results All the flaps survived uneventfully in the six patients and satisfactory results were achieved during the follow-up. The donor-site defect was minimal after the primary closure. Conclusion The free pre-auricular flap delivers a good solution to the problem of the secondary nasal defects arising from the tumor surgery in the nose. [ABSTRACT FROM AUTHOR]

Abstract Objective(s) Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries. Methods A PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5‐point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques. Results Microvascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant. Conclusion Microvascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged. Level of Evidence 4

Objective(s): Multiple surgical techniques exist in the acute management of auricular avulsion injuries, including reattachment of the tissue as a composite graft, reconstruction using local skin flaps, the pocket principle, the Baudet method, and microvascular repair. This review aimed to compare the success rates of reattachment methods in auricular avulsion injuries. Methods: A PubMed search systematically identified cases in which (a) an auricular avulsion injury occurred and (b) reattachment was attempted. Search results were combined with an extensive review of references from published studies. In total, 148 cases were identified. Three reviewers independently graded the final aesthetic result of each case using a 5‐point scale. The average grade of each repair was compared to the reattachment method to identify successful techniques. Results: Microvascular repair was associated with a statistically significant higher success rate compared to all other reattachment methods. Composite graft reattachment also tended to generate better final aesthetic outcomes, but this difference was not statistically significant. Conclusion: Microvascular repair of the avulsed segment consistently demonstrated higher success rates. Composite graft reattachment should also be considered under the right circumstances. Overall, microvascular repair and composite graft reattachment should be considered the best options in cases of auricular avulsion repair. The authors share a major concern that other methods that rely on the use of periauricular skin will compromise any future attempts for secondary reconstruction, such as staged procedures using costal cartilage grafts. Manipulation of these tissues and in particular burying of the avulsed ear cartilage is discouraged. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

BACKGROUND: Microvascular anastomosis is very risky. There have been many studies of solid, non-degradable stent-assisted small vessel anastomosis, but there are still temporary, traumatic issues. Thereafter, degradable woven-type stent becomes an issue of concern. OBJECTIVE: To investigate the feasibility of polylactic acid microvascular stent anastomosis for repairing micro vessels. METHODS: Polylactic acid fiber-loops were multi-directionally hot-stretched and formed to prepare micro-stent of “M” shape. The diameter of the stent was 0.5 or 1mm. It was applied to the root and middle of the tail artery of 24 Sprague-Dawley rats (provided by Shanghai Xipuer-Beikai Experimental Animal Co., Ltd.). These rats were randomly divided into a stent anastomosis (group A) and a non-stent anastomosis (group B). The time of vascular anastomosis, the immediate patency rate of anastomotic vessels and the survival rate in both groups were recorded. Ultrasound Doppler observation was performed to observe the tail artery circulation at postoperative 2 weeks. The tail artery was histologically observed at postoperative 4 weeks. The experiment was approved by the Animal Ethics Committee of Fengxian Branch of the Sixth People’s Hospital of Shanghai (approval number: 20160225124025). RESULTS AND CONCLUSION: (1) The immediate patency rate of anastomotic vessels in both groups was 100%. The anastomosis time in the group A was significantly shorter than that in the group B [(3.0±0.5) vs. (5.0±0.6) minutes, P < 0.05]. The survival rate of replantation in the group A was significantly higher than that in the control group [(95.8±1.5)% vs. (91.7±1.7)%, P < 0.05]. (2) Ultrasound Doppler examination showed blood flow passed through the anastomotic orifice and its distal and proximal side in the group A, while in the group B, there was thrombosis at the anastomotic orifice and distal side, and the lumen was occluded. (3) Hematoxylin-eosin staining showed that there was no thrombus in the tail artery in the group A, the stent and the anastomosis were completely covered with the intima, and the lumen was smooth. The lumen in the group B was oblate, which showed a thrombus formation and a narrow lumen. (4) These results suggest that polylactic acid micro-stent can meet the requirements of microvascular anastomosis replantation, and can significantly shorten the time of vascular anastomosis, improve the effect of anastomosis and suture, and increase the survival rate of replantation. [ABSTRACT FROM AUTHOR]

Microvascular loss may be a root cause of chronic rejection in lung transplants, which leads to the bronchiolitis obliterans syndrome. Previous research implicates T regulatory cell (Treg) as a key component of immune modulation, however, Treg has never been examined as a reparative mediator to salvage microvasculature during transplantation. Here, we reconstituted purified Tregs in to allografts, and serially monitored allografts for tissue oxygenation, microvascular perfusion for four weeks. We demonstrated that Tregs reconstitution of allografts significantly improve tissue oxygenation, microvascular flow, epithelial repair, number of CD4 + CD25 high FOXP3 + Tregs, followed by an upregulation of proinflammatory, angiogenic and regulatory genes, while prevented subepithelial deposition of CD4 + T cells at d10, and collagen at d28 post-transplantation. Altogether, these findings concluded that Treg-mediated immunotherapy has potential to preserve microvasculature and rescue allograft from sustained hypoxic/ischemic phase, limits airway tissue remodeling, and therefore may be a useful therapeutic tool to prevent chronic rejection after organ transplantation. [ABSTRACT FROM AUTHOR]

The internal microenvironment in peripheral nerves is highly regulated in order to maintain normal axonal impulse transmission to or from the central nervous system. In humans, this regulation is facilitated by specialized tight junction (TJ)-forming endoneurial microvascular endothelial cells and perineurial myofibroblasts that form multiple concentric layers around nerve fascicles. The endoneurial endothelial cells come in direct contact with circulating blood and, thus, can be considered the blood-nerve barrier (BNB). Studies on the molecular and biophysical properties of the human BNB in vivo or in situ are limited. Owing to the recent isolation of primary human endoneurial endothelial cells and the development of simian virus 40 large T-antigen immortalized cell lines, data are emerging on the structural and functional characteristics of these cells. These data aim to increase our understanding of how solutes, macromolecules, nutrients and hematogenous leukocytes gain access into or are restricted from the endoneurium of peripheral nerves. These concepts have clinical relevance in understanding normal peripheral nerve homeostasis, the response of peripheral nerves to external insult and stresses such as drugs and toxins and the pathogenesis of peripheral neuropathies. This review discusses current knowledge in this nascent and exciting field of microvascular biology. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background. We present a case report of a patient with history of subglottic carcinoma who underwent chemoradiation and subsequently developed subglottic stenosis (SGS). Methods and Results. She was treated with an anterior cricoid split maintained by septal cartilage wrapped in a partially deepithelialized radial forearm free flap (RFFF). To date, with a follow-up of 6 months, the patient has been fully decannulated and has not experienced airway collapse or any other complications. Conclusions. Upper airway reconstruction using a single-stage autogenous cartilage graft wrapped in a vascularized carrier is a real option for those patients with extensive SGS in the setting of an irradiated and devascularized tissue bed. © 2010 Wiley Periodicals, Inc. Head Neck, 2010 [ABSTRACT FROM AUTHOR]

Acute inflammatory cell-capillary endothelial cell interactions, related to injury and repair, were investigated light and electron microscopically in acute human bacterial pyelonephritis. In inflammatory infiltrate-adjacent microvessels, the small capillaries were completely occluded by leukocyte plugs and the large capillaries were densely filled with acute inflammatory cells adhering to the endothelium. Severe damage to small and large capillaries was observed around endothelium adherent, degranulated neutrophil granulocytes containing phagocytosed bacteria. There were spaces in the endothelium, degradation of the vascular basement membrane, of the perivascular interstitial matrix and of collagen fibrils, with fibrin deposition and vessel wall fragmentation. In the small capillaries relatively distant from the interstitial infiltrates, emigration of leukocytes was frequently seen. Around the escaping cells the endothelial lining displayed occasional discontinuities, allowing leakage of vascular fluid into the interstitial space. Some small capillaries not related to the infiltrate were occluded by fibrin thrombi with apparent damage to the endothelial cells and disruption of the capillary wall. Various reparative changes were noticed in association with this change including capillary neovascularization. The findings confirm the existence of polymorphonuclear leukocyte-mediated injury of capillaries during the development of inflammatory responses in acute pyelonephritis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Cortical venous injury can occur during any intracranial procedure with potentially severe consequences. We describe a simple technique that allowed for successful repair of a large cortical draining vein. Case description: A 43-year-old, right-handed woman presented with 6 months of headaches and progressive difficulty with right-sided hemiparesis. She had significant loss of hand coordination and writing ability. Computed tomography and MR imaging revealed a parasagittal meningioma in the left, posterior frontal region. The patient underwent craniotomy with resection of the lesion. Conclusion: When a cortical vein is injured, collateral drainage pathways may prevent the development of a clinical problem. Because of the unpredictability of these collateral channels, venous reconstruction may be feasible and even straightforward in some cases. [Copyright &y& Elsevier]