Prefabrication of a conjoint flap containing xenogenic tissues: a preliminary report on an experimental model.

Conjoint flaps are the compound flaps possessing multiple independent flaps, each with an independent vascular supply, but linked by a common indigenous source vessel. We have developed a new model of flap prefabrication using autogenic and xenogenic tissues in rats. Flaps were prepared at abdomino-inguinal regions of 20 male wistar albino rats. Autologous muscle, fascia, cartilage, bone grafts and acellular human dermal matrix (Alloderm, LifeCell Corp., Branchburg, NJ) were wrapped on the branches of external iliac, inferior epigastric and femoral arteries. The feasibility of prefabricating autogenic and xenogenic tissue containing flaps was investigated experimentally. Four weeks later, flaps were dissected and histopathological evaluation was undertaken. New blood vessel development was detected in all specimens with varying degrees. To our surprise, acellular dermal matrix (Alloderm), which was used as a xenogenic graft, exhibited a better revascularization potential than autogenic grafts in this prefabrication process, and a relatively dense network of new vessel formation was seen. As acellular dermal matrix is an allogenic tissue for human beings and has a superior revascularization potential, it can be prefabricated together with different autogenic tissues, and this flap can be used to reconstruct massive composite tissue defects, such as the defects occurring after tumor resection in head and neck region. With this method, donor site morbidity will be dramatically reduced. This is the first attempt of conjoint flap prefabrication using autogenic tissues combined with xenogenic tissues, which creates a new type of flap combining tissues from different species. We believe that new flap prefabrication models will be developed in the future, on the basis of this study.

Ligneous inflammation involving the female genital tract.

Ligneous inflammation is a rare disease characterized by progressive growth of ligneous plaques on mucosal surfaces. Involvement of the female genital tract is an unusual condition. We present a patient with multifocal ligneous inflammation involving her genital tract, oral mucosa and conjunctiva. Plasminogen functional activity was 18% of normal (reference: 55-145%). Molecular analysis exhibited that her genetic status is homozygous for a combination of three polymorphisms. But no true mutation could be found in all 19 exons of the plasminogen gene. We did not observe any clinical changes, although plasminogen activity has improved in the course of 5 months of oral contraceptive therapy Most gynecologists are unfamiliar with this diagnosis and pathologists with wide experience in gynecology are unaware of this disease. However, the histology of lesions is characteristic and a diagnosis can be made quite easily once it has been considered.

Postmortem evaluation of 220 prenatally diagnosed fetuses with neural tube defects: detection of associated anomalies in a Turkish population.

OBJECTIVES: The aim of this study is to represent the distribution of disorders resulting from neural tube defects (NTDs). MATERIALS AND METHODS: This study was conducted on 220 prenatally diagnosed cases with NTDs. Fetuses were evaluated by physical examination, anthropometric measurements, X-rays, and photographs after termination of pregnancy. Chromosome analysis and autopsy were performed for 37 fetuses (16.8%) with additional malformations. RESULTS: In 29 out of 37 fetuses (78.4%), additional malformations were detected by prenatal ultrasonography, whereas in eight cases postmortem evaluation produced additional findings that were not detected prenatally. Fourteen of 37 (37.8%) and 65 of 220 (29.5%) fetuses had clubfoot, which was mostly secondary to NTDs. There was no difference in sex distribution between isolated NTDs and the group with additional abnormalities and among the groups anencephaly and anencephaly + anomaly, encephalocele and encephalocele + anomaly, spina bifida and spina bifida + anomaly. There was only one case, a female fetus, with iniencephaly in this group. Anencephaly was more frequent in cases with isolated NTDs (48.1%) than in those with additional anomalies (27%). There was no difference for other groups of NTDs. The most frequent disorder was vertebral segmentation defects, which were detected in 11 out of 37 cases (29.7%). CONCLUSIONS: Evaluation of associated malformations and confirmation of ultrasound findings can be performed by postmortem examination and simple X-ray studies for exact diagnosis, which strongly affects decisions on further pregnancies as well as genetic counseling. This method is straightforward, inexpensive and effective.