Wolff Klaus-Dietrich, Fichter Andreas, Braun Christian, Bauer Florian, Humbs Martin
Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
Department of Oral and Maxillofacial Surgery (Head: Univ.-Prof. Dr. Dr. Klaus-Dietrich Wolff), Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany.
J Craniomaxillofac Surg. 2014 Oct;42(7):1423-7. doi: 10.1016/j.jcms.2014.04.004. Epub 2014 May 20.
Exercising flap raising procedures on cadavers is considered a prerequisite to prepare for clinical practise. To improve teaching and create conditions as realistic as possible, a perfusion device was developed providing pulsatile flow through the vessels of different donor sites. A plastic bag filled with red stained tab water was placed into a pump, which was driven by an electric motor. The bag was set under rhythmic compression with variable frequency and pressure. The pedicles of the radial forearm, anterolateral thigh, rectus abdominis, fibular and iliac crest flap were cannulated at the origin from their source arteries. Flap raising was performed under pulsatile perfusion in 15 fresh bodies and subsequently in 6 Thiel-embalmed cadavers during a flap raising course. We regularly observed staining of the skin and skin bleeding in fresh bodies and less reliable in embalmed cadavers. All flap pedicles showed pulsatile movements, and the radial pulse became palpable. Most perforators of the anterolateral thigh and osteocutaneous fibular flap could be identified by their pulse. Bleeding from bony tissue and venous return was seldom observed. We conclude that pulsatile perfusion of cadaveric tissue creates more realistic conditions for flap raising and improves teaching for beginners and advanced surgeons.
在尸体上进行皮瓣掀起手术被认为是临床实践准备的先决条件。为了改进教学并创造尽可能逼真的条件，开发了一种灌注装置，可通过不同供区的血管提供搏动血流。一个装有红色染色自来水的塑料袋被放入由电动马达驱动的泵中。袋子在可变频率和压力下进行有节奏的压缩。桡侧前臂皮瓣、股前外侧皮瓣、腹直肌皮瓣、腓骨皮瓣和髂嵴皮瓣的蒂在其起源处从其源动脉进行插管。在皮瓣掀起课程中，在15具新鲜尸体以及随后的6具经蒂尔氏防腐处理的尸体上进行了搏动灌注下的皮瓣掀起操作。我们经常观察到新鲜尸体中皮肤染色和皮肤出血，而在防腐尸体中则不太可靠。所有皮瓣蒂均显示有搏动运动，桡动脉搏动可触及。股前外侧皮瓣和腓骨骨皮瓣的大多数穿支可通过其搏动识别。很少观察到骨组织出血和静脉回流。我们得出结论，尸体组织的搏动灌注为皮瓣掀起创造了更逼真的条件，并改善了对初学者和高级外科医生的教学。
