Can fetal and newborn allografts survive in an immunocompetent host?

This study explores methods of prolonging allograft survival by varying the ontogeny of the donor tissue (fetal, newborn, and adult), and the recipient (newborn and adult) in a series of outbred Sprague-Dawley rats. Allografts of renal or adrenal tissue (1 mm2) were implanted under the renal capsule of the recipient animal. Six experimental groups were constructed with the adult as the recipient in the first three, and four-to six-day-old newborn rat pups in the last three groups. A total of 212 animals were grafted and the animals were killed between 7 and 83 days later, and we carried out morphometric and histologic analyses of all grafts. In Group I (adult donor----adult host), all 17 grafts implanted for ten days or longer were completely rejected. In Group II, newborn tissue was implanted into 23 adults. By nine days after implantation, 17 grafts were fully rejected and the average graft had decreased in size by 68% +/- 78.7% (P less than .05 compared with their initial size). In contrast, when fetal renal or adrenal grafts were implanted into 93 adults (Group III) we saw a 17.6 +/- 9.7 fold increase in graft size when recipients were killed at least 7 days after implantation (P less than .05 compared with their initial size). When we used the newborn as a recipient, we found that all 20 adult grafts (Group IV) were rejected within 10 days. When newborn tissue was implanted into 15 newborns (Group V) all 15 animals rejected their grafts within ten days.(ABSTRACT TRUNCATED AT 250 WORDS)     

Healing of implanted expanded polytetrafluoroethylene vascular access grafts with different internodal distances: a histologic study in dogs.

OBJECTIVE: We assessed characteristics of healing, over time, of two types of expanded polytetrafluoroethylene grafts. STUDY DESIGN: An experimental histological study in dogs. METHODS: The graft types studied had the same internal diameter (5 mm) but different internodal distances. In one, the internodal distance was 60 microm in the external surface and 20 microm in the luminal surface. In the other, the internodal distance was 30 microm throughout the material. Sixteen grafts of each type were implanted between the femoral artery and vein in 16 dogs; explanted 1, 2, 4 or 12 weeks later; and examined histologically. RESULTS: In both graft types, infiltrating-cell density and maximum cell-penetration depth increased significantly between 1 and 2 weeks after implantation, but no significant increases occurred after 2 weeks. The number of inflammatory cells peaked 1 week after implantation and decreased significantly by 2 weeks. Subsequently, there were no significant changes in inflammatory cell numbers, suggesting that the inflammatory phase was over by 2 weeks after implantation and the grafts had become attached to surrounding tissue. There were no significant differences between the two graft types in cell density, cell-penetration depth, or number of inflammatory cells at any assessment time. CONCLUSION: Our results provide histologic support for guidelines recommending that synthetic vascular grafts for hemodialysis access should not be cannulated until 2 weeks after implantation. Since increasing the internodal distance to 60 microm in the external surface had no effect on graft healing, methods other than manipulation of internodal distance should be used in developing a graft suitable for early cannulation.     

高密度毛发移植治疗瘢痕性秃发

目的 探索高密度毛发移植治疗因各种因素所引起的瘢痕性秃发的新技术。方法 于头颅的后、侧部优势供区内，切取含有完整毛发的条形头皮组织。分割成微小毛发移植物（含4－6根毛发）和显微毛发移植物（含1－3根毛发）。然后，植入头皮瘢痕脱发区内预制的相应孔洞中。结果 1998年4月－2000年2月，将此项技术，应用于96例128个瘢痕性秃发区。32例仅需一期手术；64例需行二期手术完成治疗。术后12个月以上的远期随访，恢复快，毛发生长自然、密集，即使在瘢痕区域的受体上移植的毛发常常也能良好地生长，是治疗瘢痕性秃发的又一理想手段。     

Chronically decreased oxygen tension in rat pancreatic islets transplanted under the kidney capsule

BACKGROUND: A factor of potential importance in the failure of islet grafts is poor or inadequate engraftment of the islets in the implantation organ. This study measured the oxygen tension and blood perfusion in 1-, 2-, and 9-month-old islet grafts. METHODS: The partial pressure of oxygen was measured in pancreatic islets transplanted beneath the renal capsule of diabetic and nondiabetic recipient rats with a modified Clark electrode (outer tip diameter 2-6 microm). The size of the graft (250 islets) was by purpose not large enough to cure the diabetic recipients. The oxygen tension in islets within the pancreas was also recorded. Blood perfusion was measured with the laser-Doppler technique. RESULTS: Within native pancreatic islets, the partial pressure of oxygen was approximately 40 mm Hg (n=8). In islets transplanted to nondiabetic animals, the oxygen tension was approximately 6-7 mm Hg 1, 2, and 9 months posttransplantation. No differences could be seen between the different time points after transplantation. In the diabetic recipients, an even more pronounced decrease in graft tissue oxygen tension was recorded. The mean oxygen tension in the superficial renal cortex surrounding the implanted islets was similar in all groups (approximately 15 mm Hg). Intravenous administration of glucose (0.1 gxkg(-1)x min(-1)) did not affect the oxygen tension in any of the investigated tissues. The islet graft blood flow was similar in all groups, measuring approximately 50% of the blood flow in the kidney cortex. CONCLUSION: The oxygen tension in islets implanted beneath the kidney capsule is markedly lower than in native islets up to 9 months after transplantation. Moreover, persistent hyperglycemia in the recipient causes an even further decrease in graft oxygen tension, despite similar blood perfusion. To what extent this may contribute to islet graft failure remains to be determined.     

Polarized Light-Emitting Diode Magnification for Optimal Recipient Site Creation during Hair Transplant

Background. For several years, magnification has been used to separate follicular groupings from donor strips to minimize transection of hair follicles. There has been no discussion regarding the use of magnification to create recipient sites to limit transection of existing hair follicles in recipient zones.
Objective. The study was performed to evaluate the role of magnification when creating hundreds or thousands of recipient sites in patients with existing hair.
Methods. A 2× magnified polarized light-emitting diode (LED) for graft and recipient site creation (Syris Scientific, Gray, Maine) was used in 75 consecutive male and female patients. A team of four experienced surgical assistants and the author evaluated the device for graft creation, recipient site creation, and insertion of grafts.
Results. There was no perceived advantage in creating grafts or placing grafts compared with other magnification devices and traditional methods. There was less eye strain and greater ease in creating recipient sites using polarized magnification compared with traditional surgical lights and no magnification.
Conclusion. In an era of medications that slow or stop hair loss, magnification in recipient sites can reduce transection of existing hair follicles in recipient zones, leading to maximum density from a procedure. Further studies are needed to confirm the reduced transection rate of hair follicles and determine the ideal magnification. The use of magnification with LED polarized light in the recipient zone is an important new tool in hair transplant.     

Elliptografting: The Right Fit

BACKGROUND: A number of new recipient grafting techniques have evolved employing micrografting, minigrafting, and follicular unit technologies as larger hair transplantation sessions incorporating smaller grafts have evolved. OBJECTIVE: To introduce a new recipient graft device-the elliptograft-and compare it to standard circular minigrafts and laser-generated slot grafts. METHODS: A blinded study was performed of 30 patients (mean age 44 years) with grades II-V male pattern Norwood or medium Ludwig female pattern androgenetic alopecia. Ten patients were transplanted with the second-generation elliptograft punch, 10 were treated with 2 mm circular minigrafts, and 10 were transplanted with the recipient sites created by the hybrid Er:YAG/CO2 laser in a slot configuration. The front three rows in each patient were transplanted utilizing No-Kor needle-generated micrografts in all three patient study subgroups. RESULTS: Comparable hair growth density was achieved utilizing conventional circular minigraft, freehand laser slit, and elliptograft technologies. Healing time was slightly prolonged in the laser transplant subgroup; however, the time for initial hair growth was comparable in all three patient populations. Aesthetic improvement was judged superior in the elliptograft population by blinded physician observers, which correlated with good patient satisfaction. CONCLUSION: Combined micro-mini elliptografting utilizing the newly described elliptograft punch produces excellent hair density correlated with high patient satisfaction.     

Accelerated Healing of Dacron Grafts Seeded by Preclotting with Autologous Bone Marrow Blood

> Studies have suggested that bone marrow-derived cells in the circulation may have the capacity and potential to endothelialize and heal vascular graft surfaces. We have investigated whether accelerated endothelialization could be achieved for Dacron grafts seeded by preclotting with bone marrow blood (BMB). Five 8 mm x 6 cm Dacron grafts seeded and preclotted with BMB and four controls preclotted with peripheral blood were implanted in the descending thoracic aorta (DTA) of mongrel dogs for 2 and 4 weeks. Two additional BMB DTA grafts were studied for 3 months. Five pairs of BMB and control grafts (4 mm x 6 cm) were bilaterally implanted into the carotids of dogs for 1 week and five pairs for 4 weeks. All grafts remained patent. BMB seeding/preclotting was a simple, effective method to accelerate early graft endothelialization without increasing thrombogenicity. Further studies are needed before clinical application can be recommended.     

Assessment of factors determining graft size in transplant of cadaver kidneys from child donors

BACKGROUND: Kidneys from child donors are very efficient at adapting to the recipient organism. This research aims to verify the size of kidney grafts from pediatric donors after transplant and to identify factors responsible for the size attained by these kidneys. Moreover, it aims to seek relationships between size and function of the transplanted pediatric kidney. METHODS: Seventy-seven renal transplants performed at least 6 months earlier, with cadaver donor 15 years old or younger, had ultrasound measurements of the graft and renal function assessment. Potential factors for graft volume were analyzed using bivariate analysis, followed by multiple linear regression. RESULTS: After a follow up of 4.2+/-3.3 years posttransplant, the grafts presented the following range of measures: length 10.61+/-1.13 cm, width 4.67+/-0.84 cm, and depth 4.76+/-0.99 cm. Graft volumes were 126.62+/-47.76 cm. Bivariate analysis showed that (1) age of both donor and recipient at transplantation; (2) sex of recipient; (3) occurrence of acute rejection episodes were statistically significant. After multivariate analysis, age and sex of recipients were the only significant factors influencing graft volume; child kidneys reached greater volumes when transplanted into adult and male individuals. Larger volume kidneys presented significantly more proteinuria. No difference was evident with regard to creatinine clearance values or urinary retinol binding protein among kidneys of differing sizes. CONCLUSIONS: The size of the recipient (age and sex) is the main factor responsible for volumes achieved by kidneys from pediatric donors. The volume attained by these kidneys demonstrated no relationship with glomerular or tubular function of the organ.     

Experimental study of oversized grafts in a canine living-donor lobar lung transplantation model

BACKGROUND: For infants and small children, organ transplantation is limited by the size discrepancy between donor and recipient. To address this problem, the use of over-sized grafts from living-relative donors could potentially expand the donor pool. The aim of this experimental study was to evaluate the effect of oversized grafts on early pulmonary function and to identify an indicator for acceptable size discrepancy. METHODS: Fourteen bilateral lobar lung allotransplant operations were performed without cardiopulmonary bypass in weight mismatched pairs of dogs. Animals were divided into 2 groups: Group I (n = 7), donor/recipient lung volume ratio < 2.85; Group II (n = 7), donor/recipient lung volume ratio >2.85. Pulmonary function of the recipient was measured before chest closure, after chest closure, and after the ventilator was removed. RESULTS: Pulmonary vascular resistance and airway pressure significantly increased in Group II after chest closure (1493 +/- 195 dynes sec cm(-5) and 14.4 +/- 0.9 mm Hg vs 2784 +/- 140 dynes sec cm(-5) and 23.4 +/- 1.2 mm Hg, p < 0.001). After the ventilator was removed, all recipients in Group I showed PaO2 > 239 mm Hg and PaCO2 < 76 mm Hg, whereas, all recipients in Group II showed PaO2 < 116 mm Hg and PaCO2 > 169 mm Hg. The donor/recipient chest circumference ratio was less than 1.3 in all but 1 dog in Group I. CONCLUSIONS: Acceptable, oversized grafts provide adequate pulmonary function, although excessively oversized grafts cause significant impairment in pulmonary function after chest closure. Chest circumference provides useful size-match criteria when oversized grafts are used in this canine experimental model.     

翻转筋膜皮下瓣修复四肢创面

目的介绍应用局部远端蒂翻转筋膜皮下瓣修复四肢远端中小面积创面的临床经验。方法总结1994年1月～2003年12月应用局部远端蒂翻转筋膜皮下瓣加植皮的方法,修复深部结构暴露的四肢远端创面患者33例,其中男25例,女8例,年龄13～65岁。前臂创面19例,小腿14例。33例均在创面近侧切取局部筋膜皮下瓣,以远端蒂纵向切取的筋膜皮下瓣,包含1条皮神经和(或)浅静脉干,长度(蒂+瓣)9～18cm,筋膜皮下蒂宽3～4cm,长宽比例3～5∶1。将筋膜皮下瓣翻转180°,脂肪层朝下移位至受区,再在深筋膜面上植皮。结果术后33例筋膜皮下瓣(轴型瓣26例,随意型瓣7例)均完全成活。供区皮肤直接缝合,期愈合29例,余经换药均良好愈合。受区植皮覆盖均愈合良好。结论翻转筋膜皮下瓣修复四肢非受压摩擦部位的中小创面,临床应用简便可靠。     

Securing aesthetic outcomes for composite grafts to alar margin and columellar defects: A long term experience

Introduction:

Composite grafts for nasal reconstruction have been around for over a century but the opinion on its virtues and failings keeps vacillating with a huge difference on the safe size of the graft for transfer. Alar margin and columellar defects are more distinct than dorsal nasal defects in greater difficulty in ensuring a good aesthetic outcome. We report our series of 19 consecutive patients in whom a composite graft was used to reconstruct a defect of alar margin (8 patients), alar base (7 patients) or columella (4 patients).

Patients and Methods:

Patient ages ranged from 3-35 years with 5 males and 14 females. The grafts to alar margin and base ranged 0.6-1 cm in width, while grafts to columella were 0.7-1.2 cm. The maximum dimension of the graft in this series was 0.9 mm x 10 mm. Composite grafts were sculpted to be two layered (skin + cartilage), three layered wedges (skin + cartilage + skin) or their combination (two layered in a portion and three layered in another portion). All grafts were cooled in postoperative period for three days by applying an indigenous ice pack of surgical glove. The follow up ranged from 3-9 months with an average of 4.5 months.

Results:

All of our 19 composite grafts survived completely but they all shrank by a small percentage of their bulk. Eleven patients rated the outcome between 90-95% improvement. We noticed that composite grafts tended to show varied pigmentation in our patients, akin to split skin grafts.

Conclusion:

In our opinion, most critical to graft survival is its size and the ratio of the marginal raw area to the graft bulk. We recommend that graft width should not exceed 1 cm to ensure complete survival even though larger sized grafts have been reported to survive. We recommend cooling of the graft and justify it on the analogy of ‘warm ischemia time’ for a replantation, especially in warmer climes like ours in India. We have outlined several considerations in the technique, with an analysis of differing opinions that should facilitate a surgeon in making an informed choice.KEY WORDS: Alar defect, columellar defect, composite grafts, nose defects     

高密度自体毛发移植治疗脂溢性秃发的疗效观察

目的 探讨应用高密度显微外科毛发移植技术,综合移植多种微小型毛胚,治疗脂溢性秃发的临床效果.方法 切取患者头发生长浓密的枕、颞部头皮作为毛发移植供体,5倍专用手术显微镜下分离毛囊,制成多种微小移植毛胚,以三棱针、微型刀片和卵圆形打孔器在受区打孔,用显微外科移植镊,由前向后顺序将移植毛胚植入受区孔隙,术后定期随访.结果 32例脂溢性秃发,移植毛发的平均成活率为90%,Ⅰ期手术后患者满意度为81%,6例不满意患者行Ⅱ期手术后均达到了满意的治疗效果.随访12～24个月,毛发生长自然、密集,发质良好无脱落.结论 应用高密度显微毛发移植技术,综合移植多种微小型毛胚,具有手术时间短、植发密度高、覆盖效果好等优点,大部分患者Ⅰ期手术后即可获得满意的治疗效果.     

高密度自体毛发移植治疗脂溢性秃发的疗效观察

目的 探讨应用高密度显微外科毛发移植技术,综合移植多种微小型毛胚,治疗脂溢性秃发的临床效果.方法 切取患者头发生长浓密的枕、颞部头皮作为毛发移植供体,5倍专用手术显微镜下分离毛囊,制成多种微小移植毛胚,以三棱针、微型刀片和卵圆形打孔器在受区打孔,用显微外科移植镊,由前向后顺序将移植毛胚植入受区孔隙,术后定期随访.结果 32例脂溢性秃发,移植毛发的平均成活率为90%,Ⅰ期手术后患者满意度为81%,6例不满意患者行Ⅱ期手术后均达到了满意的治疗效果.随访12～24个月,毛发生长自然、密集,发质良好无脱落.结论 应用高密度显微毛发移植技术,综合移植多种微小型毛胚,具有手术时间短、植发密度高、覆盖效果好等优点,大部分患者Ⅰ期手术后即可获得满意的治疗效果.     

高密度自体毛发移植治疗脂溢性秃发的疗效观察

目的 探讨应用高密度显微外科毛发移植技术,综合移植多种微小型毛胚,治疗脂溢性秃发的临床效果.方法 切取患者头发生长浓密的枕、颞部头皮作为毛发移植供体,5倍专用手术显微镜下分离毛囊,制成多种微小移植毛胚,以三棱针、微型刀片和卵圆形打孔器在受区打孔,用显微外科移植镊,由前向后顺序将移植毛胚植入受区孔隙,术后定期随访.结果 32例脂溢性秃发,移植毛发的平均成活率为90%,Ⅰ期手术后患者满意度为81%,6例不满意患者行Ⅱ期手术后均达到了满意的治疗效果.随访12～24个月,毛发生长自然、密集,发质良好无脱落.结论 应用高密度显微毛发移植技术,综合移植多种微小型毛胚,具有手术时间短、植发密度高、覆盖效果好等优点,大部分患者Ⅰ期手术后即可获得满意的治疗效果.     

The technique of unilateral double lobar lung transplantation in a canine model

OBJECTIVE: Bilateral living-donor lobar lung transplantation has become an accepted alternative to cadaveric lung transplantation. Because only one lobe is implanted in each chest cavity, this procedure seems to be best suited for children and small adults. The purpose of this study was to develop a technique of unilateral double lobar lung transplantation that can be applied to large adult patients. METHODS: Unilateral double lobar lung transplantation was performed in 6 weight-matched pairs of dogs. In donor animals the right middle, lower, and cardiac lobes were separated as a right graft, and the left lower lobe was separated as a left graft. In recipient animals these 2 grafts were implanted in the right hemithorax after right pneumonectomy. The left graft was implanted as a right upper lobe, having been rotated 180 degrees along the vertical axis and then 180 degrees along the horizontal axis. The right graft was implanted in the natural anatomic position. Function of the transplanted grafts was assessed for 3 hours after ligation of the left main pulmonary artery while the animals were ventilated with 100% oxygen. RESULTS: Morphologic adaptation of the 2 grafts in the right hemithorax was found to be excellent. All 6 animals survived the assessment period with excellent pulmonary function. At the end of the 3-hour assessment period, the arterial oxygen tension was 519 +/- 31 mm Hg, and the mean pulmonary artery pressure was 30.5 +/- 1.7 mm Hg. CONCLUSIONS: Unilateral double lobar lung transplantation was technically possible and associated with satisfactory early pulmonary function in a canine experimental model.     

Intense Pulsed Light for Hairy Grafts and Flaps

BACKGROUND: Intense pulsed light (IPL) is an effective and safe method of hair removal. OBJECTIVE: To evaluate the clinical response of hairy grafts and flaps of different anatomic areas to an IPL source. METHODS: Four patients (three men, one woman; 17-72 years old) with hairy skin grafts (n = 2) or flaps (n = 2) were included. Donor skin areas included the forehead (n = 1), supraclavicular (n = 1), abdomen (n = 1), and groin (n = 1). Excisional surgery was performed because of basal cell carcinoma (BCC) of the nasal wall (n = 1), squamous cell carcinoma (SCC) of the forehead (n = 1), congenital nevus of the malar region (n = 1), and breast carcinoma (n = 1). The treatment was IPL with the following parameters: wavelength 695-755 nm, pulse width 3.8-4.5 msec, delay 20-30 msec, spot size 10 mm x 45 mm, fluence 38-42 J/cm2, and an interval of 4 weeks. A total of one to six treatment sessions were administered. RESULTS: A progressive decrease in terminal hair and delayed hair growth rate (more than 8 months) were observed in all the patients. Improvement of skin coarseness, pigmentation, and erythema was also observed in the graft and its periphery in one patient. Persistent erythema (more than 48 hours) was the only side effect, observed in one patient. CONCLUSION: IPL is an effective method to depilate hairy grafts and flaps.     

Optimal graft diameter: effect of wall shear stress on vascular healing

Arterial walls tend to adapt to maintain a specific wall shear stress. The formation of neointimal hyperplasia and endothelial cell healing of polytetrafluoroethylene grafts may also be governed by wall shear stress, which suggests that an optimal graft diameter may exist. To test this, 40 polytetrafluoroethylene grafts with internal diameters of 3, 6, and 8 mm were inserted end to end in the femoral and carotid arteries of 10 mongrel dogs. Total flow and diameter were measured, and grafts were stained with Evans blue dye, fixed by pressure perfusion, and analyzed by computer for anastomotic neointimal thickening, graft pseudointimal thickening, and degree of endothelial coverage. Mean calculated shear stress was 41 dyne/cm2 for the 3 mm grafts, 7 dyne/cm2 for the 6 mm grafts, and 3 dyne/cm2 for the 8 mm grafts. Fifteen weeks later the patency rate was 0 of 10 for the 3 mm grafts, 16 of 20 for the 6 mm grafts, and 7 of 10 for the 8 mm grafts. The mean graft shear stress was calculated to be 10 dyne/cm2 for the 6 mm grafts and 4 dyne/cm2 for the 8 mm grafts. Pseudointima lining the graft was composed of disorganized protein and cell remnants. The rough surface contained no overlying endothelium. Anastomotic neointima contained a layer of well-organized smooth muscle cells covered by a single layer of polygonal-shaped endothelial cells. A transition zone of thrombus, which is sandwiched by a wedge of smooth muscle cells near the graft surface and covered by endothelial cells, is described. Mean thickness of pseudointima of the patent 8 mm grafts was 150 microns thicker than that of the 6 mm grafts. Anastomotic neointimal thickness was 110 microns thicker in the 8 mm grafts compared with the 6 mm grafts. Among the 6 mm grafts, the carotid grafts had an average initial shear stress of 10 dyne/cm2, whereas the femoral grafts averaged a lower 5 dyne/cm2 and yielded pseudointima and neointima that were 40 microns thicker. The percent graft surface area covered with neointima did not differ among the grafts of differing diameter either proximally or distally. Lower shear stresses produced greater amounts of pseudointimal thickening within polytetrafluoroethylene grafts and neointimal thickening at their anastomoses. Conversely, the high shear stress from small-diameter grafts was associated with poor graft patency. These results suggest that an optimal graft diameter may help to prevent neointimal hyperplasia and graft thrombosis.     

Experimental replacement of the thoracic inferior vena cava with a high-porosity expanded polytetrafluoroethylene graft wrapped in an omental pedicle flap

We examined the patency and healing of a highporosity expanded polytetrafluoroethylene (ePTFE) graft implanted as an interposition graft in the thoracic inferior vena cava (IVC) and wrapped in an omental pedicle flap. High-porosity ePTFE grafts of 60 μ fibril length, with an internal diameter of 10 mm and a length of 4 cm, were implanted in 12 mongrel dogs. In 6 dogs, the grafts were wrapped in omental pedicle flap, and in the remaining 6 the grafts were unwrapped. The animals were killed 4 weeks after the replacement and the grafts were removed for examination. Patency of the graft in both groups was 100%; however, the thrombusfree area in the omentum-wrapped group was significantly larger (P<0.05) than that in the unwrapped group. Light microscopy revealed the marked infiltration of cells and capillaries within the graft interstices in the omentum-wrapped group. These findings suggest that encapsulation of the highporosity ePTFE graft is promoted by an omental pedicle flap.     

Anatomical and technical aspects of hepatic artery reconstruction in living donor liver transplantation

BACKGROUND: We describe our experience with arterial reconstruction in living donor liver transplantation (LDLT) focusing on anatomic and technical aspects. METHODS: From June 1994 to February 2003, 132 grafts were implanted in 130 LDLT recipients including 1 re-transplant and 1 dual graft transplantation. Donor and recipient records were retrospectively reviewed. Anatomical variations in graft arteries were classified as: Type I, single pedicle with (Ia) or without (Ib) aberrant artery (left hepatic artery (HA) from left gastric artery or right HA from superior mesenteric artery); Type II, double pedicles with (IIa) or without (IIb) aberrant artery; Type III, equal to or greater than 3 pedicles. Statistical analyses were carried out using Mann-Whitney U-test. RESULTS: There were 72 male and 58 female recipients. The median age at transplantation was 3 years (range, 0.5 to 61). In left grafts, there were 34 Type Ia, 6 Type Ib, 33 Type IIa, 13 Type IIb, and 3 Type III; whereas in right grafts, there were 35 Type Ia, 6 Type Ib, 1 Type IIa, and 1 Type IIb. Two-in-one (2-in-1) segmental resection technique in graft HA harvest was carried out whenever there were tiny arteries supplying the donor graft. All HA reconstructions were done under microvascular techniques. There was no donor mortality and 1 recipient in-hospital mortality. There was no graft or patient loss due to HA occlusion. Donor complications included 3 biloma, 1 bile leak, 1 biliary stricture, and 1 late intestinal obstruction secondary to postoperative adhesions that were all successfully managed by non-operative interventions, except the biliary stricture that needed a revision to Roux-en-Y hepatico-jejunostomy. The 1-year and 5-year recipient survivals were 98% and 94%, respectively. CONCLUSIONS: Successful HA reconstruction can be safely carried out in LDLT recipients and live donors with multiple graft arteries using the 2-in-1 segmental resection of donor HA under microvascular techniques.     

Recipient Area Hair Direction and Angle in Hair Transplanting

BACKGROUND: A variety of recommendations for creating "natural" hair directions and angles in hair transplanting have been described. Objective. A method of accomplishing that goal is outlined. METHODS: Hair direction and angle are determined by multiple partings of the hair during the course of making recipient sites. Incisions are made to mimic such directions and angles. The direction is usually somewhat coronal and the use of grafts containing more than one follicular unit is particularly advantageous in producing a denser appearance. RESULTS: If the above technique is employed, one does not accelerate the rate at which existing hair in the recipient area is lost and the hair flows in a natural easy to manage fashion. CONCLUSION: Surgeons should nearly always mimic the scalp hair directions and angles seen in nature.