Influence of Silicone Sheets on Microvascular Anastomosis

Kloeppel, Markus; Hoehnke, Christoph; Staudenmaier, R.

doi:10.1007/s11999-008-0388-z

Cited by 4 publications

(1 citation statement)

References 28 publications

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“…In such a case, a sterile silicone sheet is placed between the flap and the abdominal muscle. The sheet is sutured to the edges of a flap to prevent its movement, which may cause a physical damage to the pedicle [ 147 ]. Although some wound bed isolation studies conducted on single animals showed a significant reduction of flap survival rates [ 148 , 149 ], other investigators did not see a significant difference in functional flap outcome, but agreed that induction of potent pro-inflammatory response by a foreign material might conceal the true driving forces of the healing process [ 150 ].…”

Section: Discussionmentioning

confidence: 99%

Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing

Aksamitiene,

Heffelfinger,

Hoek

et al. 2024

Biol Proced Online

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Background Some of the most complex surgical interventions to treat trauma and cancer include the use of locoregional pedicled and free autologous tissue transfer flaps. While the techniques used for these reconstructive surgery procedures have improved over time, flap complications and even failure remain a significant clinical challenge. Animal models are useful in studying the pathophysiology of ischemic flaps, but when repeatability is a primary focus of a study, conventional in-vivo designs, where one randomized subset of animals serves as a treatment group while a second subset serves as a control, are at a disadvantage instigated by greater subject-to-subject variability. Our goal was to provide a step-by-step methodological protocol for creating an alternative standardized, more economical, and transferable pre-clinical animal research model of excisional full-thickness wound healing following a simulated autologous tissue transfer which includes the primary ischemia, reperfusion, and secondary ischemia events with the latter mimicking flap salvage procedure. Results Unlike in the most frequently used classical unilateral McFarlane’s caudally based dorsal random pattern skin flap model, in the herein described bilateral epigastric fasciocutaneous advancement flap (BEFAF) model, one flap heals under normal and a contralateral flap—under perturbed conditions or both flaps heal under conditions that vary by one within-subjects factor. We discuss the advantages and limitations of the proposed experimental approach and, as a part of model validation, provide the examples of its use in laboratory rat (Rattus norvegicus) axial pattern flap healing studies. Conclusions This technically challenging but feasible reconstructive surgery model eliminates inter-subject variability, while concomitantly minimizing the number of animals needed to achieve adequate statistical power. BEFAFs may be used to investigate the spatiotemporal cellular and molecular responses to complex tissue injury, interventions simulating clinically relevant flap complications (e.g., vascular thrombosis) as well as prophylactic, therapeutic or surgical treatment (e.g., flap delay) strategies in the presence or absence of confounding risk factors (e.g., substance abuse, irradiation, diabetes) or favorable wound-healing promoting activities (e.g., exercise). Detailed visual instructions in BEFAF protocol may serve as an aid for teaching medical or academic researchers basic vascular microsurgery techniques that focus on precision, tremor management and magnification. Graphical Abstract

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Section: Discussionmentioning

confidence: 99%

Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing

Aksamitiene,

Heffelfinger,

Hoek

et al. 2024

Biol Proced Online

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Precise measurement using a new background sheet with crack scales for super microsurgical anastomosis

Saito

Yoshimatsu

Yamamoto

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Comparison of Effective Use of Implanted Vascular Pedicles for Skin Flap Prefabrication

Hoang¹,

Kloeppel²,

Staudenmaier³

et al. 2009

Annals of Plastic Surgery

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Thin, large, well-vascularized, and axial-pattern flaps are often desired in the clinical practice of defect reconstruction to maximize esthetic and functional results. Flap prefabrication based on the neovascularization development following vascular pedicle implantation allows surgeons to create such flaps as required. Using different types of implanted vascular pedicles, the aim of the study was to identify the most effective and suitable types of pedicles for clinical use. Five models of implanted vascular pedicles in Chinchilla Bastard rabbits were investigated as follows: model 1, arteriovenous (AV) pedicle with end ligation (minimal blood flow in the implanted vascular pedicle); model 2, AV pedicle with end anastomosis (new shunt formation between vein and artery stump for creating maximal blood flow in the implanted vascular pedicle); model 3, purely isolated arterialized venous loop; model 4, purely isolated arterial loop; model 5, AV pedicle with end anastomosis (similar to model 2) combined with flap expansion. These different types of vascular pedicles were implanted into a random-pattern abdominal skin flap as large as 8 x 15 cm. Neovascularization in the various prefabricated flaps was evaluated macroscopically, scintigraphically, microangiographically, and histologically. A total of 150 prefabricated flaps were investigated and randomly assigned to 5 models with 30 flaps each. Each model contained 5 groups of 6 flaps corresponding to the various retention times of 4, 8, 12, 16, and 20 days after vascular pedicle implantation. Six flaps were also designated to the control group. Neovascularization was best in model 5, followed by comparable results for models 2, 3, and 4, with the worst results found in model 1, especially for the time intervals of 8, 12, and 16 days. Twenty days remains the minimal length of time required for matured neovascularization in all models (P < 0.05). Models 2 and 3 both appear to be particularly promising for clinical application.

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Influence of Silicone Sheets on Microvascular Anastomosis

Abstract: The

Cited by 4 publications

References 28 publications

Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing

Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing

Precise measurement using a new background sheet with crack scales for super microsurgical anastomosis

Comparison of Effective Use of Implanted Vascular Pedicles for Skin Flap Prefabrication

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