González-García José A, Chiesa-Estomba Carlos M, Larruscain Ekhiñe, Álvarez Leire, Sistiaga Jon A
Head and Neck Surgery and Reconstructive Surgery Section of the Oto-rhino-laryngology Department, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, P° Dr. Begiristain 109, 20004 Donostia San Sebastián, Gipuzkoa, Spain.
Head and Neck Surgery and Reconstructive Surgery Section of the Oto-rhino-laryngology Department, Hospital Universitario Donostia-Donostia Unibersitate Ospitalea, P° Dr. Begiristain 109, 20004 Donostia San Sebastián, Gipuzkoa, Spain.
J Plast Reconstr Aesthet Surg. 2020 Jan;73(1):111-117. doi: 10.1016/j.bjps.2019.05.032. Epub 2019 May 22.
Functional free tissue transfer in the form of muscle free flap is a challenging surgical procedure and needs a steep learning curve. A porcine model for free muscle transfer and insetting in a distant area is of great interest in reconstructive microsurgery due to the experience and learning curve necessary to perform these surgeries. The aim of this study was to assess the feasibility of a swine model for gracilis muscle free transfer and to describe the donor site anatomy.
Ten gracilis free flap transfer surgery models were performed under general anesthesia in a porcine model, based on a vascular pedicle depending of the external iliac vessels and a branch of the obturator nerve with microsuture mediated connection to head and neck nerves and vessels.
The gracilis myocutaneous or muscle-only free flap was successfully transferred in all cases using as receptors the vagus nerve, the common carotid artery, and the external or internal jugular veins. In two cases, nervous connection had to be redone. All vascular anastomoses were correctly functioning.
Despite the anatomical and design variations, porcine gracilis free flap transferred to the head and neck area with microvascular anastomosis and nerve connection provides a suitable training model for functional reconstructive microsurgery.
以游离肌肉瓣形式进行的功能性游离组织移植是一项具有挑战性的外科手术,需要较长的学习曲线。由于进行这些手术所需的经验和学习曲线,用于游离肌肉移植并植入远处区域的猪模型在重建显微外科中备受关注。本研究的目的是评估猪股薄肌游离移植模型的可行性,并描述供区解剖结构。
在猪模型中,基于依赖于髂外血管和闭孔神经分支的血管蒂,通过显微缝合介导与头颈部神经和血管相连,在全身麻醉下进行了10例股薄肌游离瓣移植手术模型。
所有病例中,股薄肌肌皮瓣或仅肌肉游离瓣均成功移植,受体为迷走神经、颈总动脉以及颈外或颈内静脉。有2例需要重新进行神经连接。所有血管吻合均功能正常。
尽管存在解剖结构和设计上的差异,但通过微血管吻合和神经连接将猪股薄肌游离瓣转移至头颈部区域,为功能性重建显微外科提供了一个合适的训练模型。