In 1965, during my third year of residency in National Taiwan University Hospital, I worked with Professor Kuo Yun Hsu to perform a dog hind limb replantation. The anoxia time was about 2 hours. Of 11 dogs, only 2 had successful replantations.
Our surgical technique was as follows: The limb was divided at the inguinal level. The femoral artery, vein, and nerve, and all the musculature, saphenous vein, and sciatic nerve were divided sharply. The femoral bone was divided distal to the trochanter. Replantation was carried out using heavy Kirschner wire fixators of the femur after bone shortening of 5 cm. The muscle was approximated with 5-0 silk suture. The femoral artery, vein, and nerve were repaired macroscopically using 7-0 vascular suture. The sciatic nerve was also repaired. The vascular clamp was released after the anastomosis and circulation was restored. Low molecular weight dextran (LMD) was given intravenously. In the cases that failed, the limb was warm the first day, swollen the second and third days, then suddenly became cool. The dog was also sick during that time. The cause of this failure was never discovered.
After my residency, I was a clinical instructor in National Taiwan University Hospital. I continued my study of replantation, this time using the rabbit ear. At first, I used 2.5 X loop magnification and the smallest vascular suture was 7-0 Ethicon silk. I performed this rabbit ear experiment in the basement of a private clinic, the team being one surgeon and one assistant. I was encouraged by Dr. Harry Buncke's publications. ' He succeeded with one rabbit ear in 40 replantations. The advantage of the rabbit ear replantation was the ability to perform the amputation with ease. The vessel could be observed by the naked eye: It was either patent or not. Two fingers could be used to test the patency through the ear by occluding the central artery at the proximal part. The blood could be expressed distally while the occlusion was released, and blood flow through the anastomosis could be observed. The venous anastomosis was assessed by observing the clot in the tree of the venous