Wolff Klaus-D, Kesting Marco, Mücke Thomas, Rau Andrea, Hölzle Frank
Klinik für Mund-, Kiefer- und Gesichtschirurgie, Klinikum rechts der Isar, Ismaninger Str. 22, 81675 München, Germany.
Microsurgery. 2008;28(4):273-8. doi: 10.1002/micr.20484.
Because of its high requirements on dexterity and microsurgical skills and the need of complete understanding of flap anatomy, microvascular free flap transfer belongs to the most demanding surgical procedures. Therefore, courses for flap raising and microvascular exercise are considered a prerequisite to prepare for clinical practise. To achieve teaching conditions as realistic as possible we used a novel cadaver embalming method enabling tissue dissection comparable to the living body. Thirty cadavers which were offered to us by the Institute of Anatomy for the purpose of running flap raising courses were embalmed in the technique described by Thiel. On each cadaver, nine free flaps were dissected according to a structured protocol by each course participant and afterwards used for microvascular exercise. The conservation of fine vascular structures and the suitability of the embalmed tissue for microvascular suturing were observed and photographically documented. The Thiel embalming technique provided flap raising procedures to be performed under realistic conditions similar to the living body. Vessels and nerves could be exposed and dissected up to a diameter of 1 mm and allowed for microvascular suturing even after weeks like fresh specimens. The Thiel embalming method is a unique technique and ideally suited to teach flap raising and microvascular suturing on human material.
由于对灵活性和显微外科技术要求很高,且需要全面了解皮瓣解剖结构,游离微血管皮瓣移植属于要求最苛刻的外科手术。因此,皮瓣切取和微血管操作课程被认为是临床实践准备的先决条件。为了实现尽可能逼真的教学条件,我们采用了一种新型尸体防腐方法,使组织解剖与活体相当。解剖学研究所提供了30具尸体用于开设皮瓣切取课程,按照蒂尔描述的技术进行防腐处理。每位课程参与者按照结构化方案在每具尸体上解剖9个游离皮瓣,之后用于微血管操作。观察并拍照记录精细血管结构的保存情况以及防腐处理后的组织用于微血管缝合的适用性。蒂尔防腐技术使皮瓣切取操作能够在类似于活体的逼真条件下进行。血管和神经可以暴露并解剖到直径1毫米,即使数周后仍能像新鲜标本一样进行微血管缝合。蒂尔防腐方法是一种独特的技术,非常适合在人体材料上教授皮瓣切取和微血管缝合。