ABSTRACT
Objective To establish a mouse ’ s cross-territory ear flap that enables chronic , in-vivo observation of the change of vascular morphology .Methods 30 ICR mice, weighing 25~40 g, were used for this study .Commercial depilatory cream was used to first remove the hair of the mice , after which the vascular pattern in the ears was investigated . According to the observation of the vascular pattern in the mouse ’ s ear, the eye scissors were used the sever the outer 2/3 of the base of the ear , in which process a ear ’ s flap based on a vascular pedicle but crossed three vascular territories was created.After the creation of the flap , the mice were placed on an automatic controlled movable machine with the ear ’ s flaps spread over a customized Plexiglas .Then the flaps were photographed under the stereoscope ( ×25) at the following time points:1,2,3,5,7,10,14,21,30 d.the necrosis of the flap, and the morphological change of the vessels within theflap were analyzed .Results The ICR mouse ’ s ear was supplied three angiosomes , which were respectively named as the cephalic , median and caudal angiosomes from inside out .Five days after the flap’s creating, necrotic rate of(15 ±7)%was developed .The choke vessels between the medial and median angiosomes expanded rapidly in diameter , reaching the plateau 10d after flap creation, resulting the dilated choke veins and arteries at their peak being 3.9 ±0.5 and 3.5 ±0.7, respectively, than their initial sizes.The diameter of the choke veins began to shrink at approximately 10d, stabilizing after 21d.The diameter of the choke arteries plateaued and stabilized at around 10d.Conclusion ①after harvest of extended flap, the dilation of veins seemed to passive , whereas the dilation of arteries seemed to active;②the number of the choke vessels between the dynamic and potential territories that are involved in dilation and extent of the dilation are much smaller than that of the choke vessels between the anatomic and dynamic territories;③the mouse ’ s ear flap is an excellent model of further study of mechanism underlining the dilation of choke vessels and for the screening of vasoactive drugs that augment the survival of the large flap .
ABSTRACT
Describir una técnica quirúrgica para la reparación de la pared abdominal con hernia incisional utilizando colgajos creados con parte del saco herniario mas resección del tejido dermograso patológico. Trabajo realizado en el Hospital Victorino Santaella Ruiz, Los Teques y otros centros privados. Esta técnica se basa en 34 casos de pacientes femeninos, sin uso de malla protésica y 6 casos con malla. Se realiza una incisión suprapúbica transversa, se levanta el complejo dermograso, identificando y liberando el caso herniario, el defecto aponeurótico y la aponeurosis sana circundante. Utilizando parcialmente el saco herniario se elaboran dos colgajos uno adherido al plano peritoneal y el otro a la aponeurosis. La síntesis del plano peritoneo-aponeurótico se realiza con material no absorbible. Al finalizar la pared abdominal tendrá tres columnas de suturas. Se complementa la operación con resección del tejido dermograso patológico y redundante. El saco herniario funciona como una malta biológica y es útil en la forma de colgajo para la reparación efectiva de la hernia incisional con o sin el uso de malla protésica. Y adicionalmente al eliminar el tejido dermograso patológico se logra una mejoría del contorno corporal.
We make a step by step description of a brand new surgical for the treatment of incisional hernias using flaps created with part of the hernia sac. Is based on 34 cases of female patients with and without mesh. At the level of the skin we use a classic dermolipectomy suprapubic arciform incisión and then we dissect until reach the peritoneal and aponeurotic tissues, identifying the hernia sac, the peritoneum and aponeurotic layer. Then, we create 2 flaps: one attached to the peritoneum and the other one to the aponeurotic layer. The cloure of the aponeurotic layer is done with non-absorbable and absorbable sutures. At the and the abdominal wall will be walled by three sutures columns. We complement the surgery with the resection of the redundant and pathologic fat and skin tissue. The hernia sac work as a biologic mesh and is useful in the form of flaps for the effective repair of the incisional hernias with or without prosthetic mesh. Additionally by eliminating the remaining fat and skin (dermolipectomy) we obtain a satisfactory improvement of the abdominal esthetic.