Advertisement

Microsurgical reconstruction of the lymphatic and nerve system in small bowel transplantation: the rat model, first results

  • T. P. Szymula von Richter
  • R. G. H. Baumeister
  • C. Hammer
Conference paper

Abstract

The goal in tissue transplantation is the restoration of all natural (physiological) communication pathways between the host and the graft. To this end, the effects of microsurgical reconstruction of artery, vein, lymphatic vessel, and nerve during grafting were investigated. Allogenic (MHC class IIincompatible) and isogenic orthotopic (graft in functional continuity) small bowel recipients with immediate microsurgical lymphatic and nerve anastomosis were observed clinically as well as by immunological and histological examination. To explain the influence of the lymphatic system in allograft survival, short-term therapy was applied with the immunosuppressant cyclosporin A (10 mg/kg i. m.) for only 5 postoperative days. Average allograft survival ended in the control group after 10 days without any therapy, increased up to 20 days after immunosuppressive therapy (in both groups acute rejection and graft-versus-host disease were seen) and increased further to more than 200 days following lymphatic connection of the host and the graft during allografting. In this group no lymphatic edema of the graft was seen. To determine the optimal location of nerve anastomoses between the host and the graft without irritating the host nerve system, isografts in the same model were investigated. No paralysis of graft neighboring tissues was seen when the last ganglion function, and its following nerve plexus, of the host is saved. Nerve reconstruction must be undertaken after this last crossing of regional nerve fibers before entering the organ. The same rule is effective for organ explantation.

Keywords

Rat small bowel transplantation Graft rejection Lymphatic system Nerve system Microsurgical anastomoses 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Sprent J (1974) Migration and lifespan of circulating B lymphocytes of nude (nu/nu) mice. In: Rygaard J, Povlsen CO (eds) Proceedings of the first international workshop on nude mice. Gustav Fischer, Stuttgart, pp 11–22Google Scholar
  2. 2.
    Ader R, Felten DL, Cohen N (1990) Psychoneuroimmunology. Academic Press, San DiegoGoogle Scholar
  3. 3.
    Baumeister RGH, Siuda S (1990) Treatment of lymphedemas by micro-surgical lymphatic grafting: what is proved? Plast Reconstr Surg 85: 213–216CrossRefGoogle Scholar
  4. 4.
    Millesi H (1992) Chirurgie peripherer Nerven. Urban & Schwarzenberg, WienGoogle Scholar
  5. 5.
    Dieffenbach JF (1882) Nonulla de regeneratione et transplantatione. Dissertatio Inauguralis, BerlinGoogle Scholar
  6. 6.
    Lexer E (1911) Über freie Transplantationen. Arch Klin Chir 95: 827Google Scholar
  7. 7.
    Converse JM, Rogers BO (1954–1962) Symposia of the 1st, 2nd, 3rd, 4th, 5th and 6th international tissue homotransplantation research conference at New York Academy of Sciences. Ann NY Acad Sci 5: 277; 64: 735; 73: 539; 87: 1; 99: 335; 162: 64Google Scholar
  8. 8.
    White RJ (1968) Experimental trans- plantation of the brain. In: Rapaport FT, Dausset J (eds) Human transplan- tation. Grune and Stratton, New YorkGoogle Scholar
  9. 9.
    Murray JE (1976) Transplantation biol- 12. ogy — an overview. In: Krizek TJ, Hoopes JE (eds) Symposium on basic sciences in plastic surgery. CV Mosby, Saint LouisGoogle Scholar
  10. 10.
    Converse JM (1977) Reconstructive plastic surgery, 2nd edn. WB Saunders, Philadelphia, pp 126–151Google Scholar
  11. 11.
    Todo S, Tzakis A, Reye J, Abu-Elmagd K, Casavilla A, Fung JJ, Starzl TE (1993) Intestinal transplantation on humans under FK506. Transplant Proc 25: 1198–1199PubMedGoogle Scholar
  12. 12.
    Szymula von Richter TP, Baumeister RGH (1995) Does the microsurgical reconstruction of the lymphatic system influence allograft survival? In: Harii K (ed) Transactions of the 11th congress of the international confederation of plastic, reconstructive and aesthetic surgery, Yokohama, Japan. Kugler, Amsterdam, p 65Google Scholar
  13. 13.
    Olszewski WL (1984) Handbook of microsurgery. CRC Press, Boca Raton, FloridaGoogle Scholar
  14. 14.
    Acland RD, Smith P (1979) Experimental lymphatico-lymphatic anastomoses. In: Abstract book of the VIIth international congress of lymphology, FlorenceGoogle Scholar
  15. 15.
    Harii K (1983) Microvascular tissue transfer. Fundamental techniques and clinical applications. Igakushon, TokyoGoogle Scholar
  16. 16.
    Paul WE (1993) Fundamental immunology, 3rd edn. Raven Press, New YorkGoogle Scholar
  17. 17.
    Shumway SJ, Shumway NE (1995) Thoracic transplantation. Blackwell Science, Cambridge, pp 327; 452–470Google Scholar
  18. 18.
    Grant DR, Wood RFM (1994) Small bowel transplantation. Edward Arnold, LondonGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • T. P. Szymula von Richter
    • 1
  • R. G. H. Baumeister
    • 2
  • C. Hammer
    • 3
  1. 1.MunichGermany
  2. 2.Division of Micro-, Hand and Reconstructive Surgery, Klinikum GrosshadernUniversity of MunichMunichGermany
  3. 3.ICFUniversity of MunichMunichGermany

Personalised recommendations