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scalp flap of a range of mammals
Journal of Plastic, Reconstructive & Aesthetic Surgery (2007) 60, S2eS16
O1. Comparative anatomy of the facial/scalp flap of a range of mammals L. Landin, P.C. Cavadas, C. Navarro, A. Carrera, J. Fontdevila, S. de Francia, B. Berenguer Plastic Surgery Division, Research Unit, ‘‘La Fe’’ University Hospital, Valencia, Spain Aim: To compare the anatomy, harvesting technique and characteristics of the facial flap of a range of mammals. Material and methods: Between September 2004 and March 2006 a total of 104 specimens were dissected, including 87 rats, 4 pigs, 2 dogs, 4 sheep and 2 rabbits and 5 human cadavers. The anatomy of each specimen was reviewed. The pliability, elasticity and composition of the flap were observed. Vascular network of the flap was studied by methylene-blue and gelatin-barium angiographies. Results: A total of 130 hemifacial or full facial flaps were harvested. Each flap harvesting required an average of 4 h (range 2.5e6). The facial flap in the human was thin, pliable and flexible. Its vascularization came from the facial artery, superficial temporal artery and occipital artery, off the external carotid artery. The facial flap in the rat, rabbit and dog was thin, pliable and flexible, their surgical approach was easy, and their vascularization came from the facial artery In contrast, the flaps in pigs and sheep were poorly vascularized, and the surgical approach was difficult, in absence of a facial artery. The flap in the pig was thick and poorly adaptable, with predominance of the fatty tissue. Conclusion: The facial flap in the dog was a thin, pliable and flexible flap, with an easy surgical approach to the main pedicle. We found the absence of the facial artery in the pig model. The rabbit model was similar to the rat model, while the sheep model was poorly vascularized in absence of facial artery. For all these reasons, we think that the facial flap in the dog model is the most similar to that of the human. Significance: We hope this work will aid in the proper selection of a model for further investigations in face allotransplant.
O2. A new technique for repairs of nerves with size discrepancy: Epineural end-in-end neuroraphy H. C ¸epni a, A. Karacalar a, M.S. Engin a, S. Canan b, S. Yildirim c a Ondokuz Mayis University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Kurupelit, Samsun, Turkey b Baskent University, Faculty of Medicine, Department of Physiology, Ankara, Turkey c Cukurova University, Faculty of Medicine, Department of Cardiovascular Surgery, Antalya, Turkey Neurotized flaps are preferred when function is desired besides volume replacement. A common problem encountered during 1748-6815/$ - see front matter doi:10.1016/j.bjps.2007.01.001
neurorraphy is the size discrepancy between nerves, and has an impeding effect on the regenerative process. Our method, end-in-end neuroraphy has been developed for overcoming size discrepancies. A 2 mm long epineural sleeve is dissected on the distal stump. This sleeve is slid over the proximal stump and fixed to the underlying epineurium with two microstiches 1800 apart. In our study, 20 female Wistar albino rats were used in two groups, in accordance with the guidelines of our ethical commitee. In Group I, tibial and peroneal nerves were exposed on both legs. Both nerves were transected, and proximal peroneal nerves were sutured to larger tibial nerves. In group II, proximal tibial nerves were sutured to smaller peroneal nerves. In both groups, nerves on the right side were repaired via our technique. Fellow nerves served as controls and repaired via primary end-to-end repair. Thus, efficiacy of our technique was tested on both types of size discrepancies. After 90 days, repairs were exposed. It was noted that trial nerves have formed negligable adhesions and allowed much easier dissection when compared with controls. Nerve conduction velocities and action potential amplituted were measured. Afterwards, nerves were removed for histomorphological analysis. In general, trial nerves displayed better conduction velocity, amplitudes, axon counts, axon diameters, myelin thickness, myelin thickness and axon diameter ratios and nerve diameter and axon diameter ratios. However, only the difference in conduction velocities in group II was statistically significant, propably due to the broadness of the variance. We believe that our method is superior in means of reducing axonal escape, retaining throphic factors in the repair zone and preventing inflow of inflammmatory mediators, keeping foreign suture material away from regenerating axons and yielding higher conduction velocities. O3. Regulation of functional muscle transfer force production by use of an interposed nerve graft F. Urso-Baiarda, A.O. Grobbelaar RAFT Institute, Mount Vernon Hospital, Northwood HA6 2RN, UK Introduction and aims: Functional muscle transfer (FMT) combined with cross-facial nerve grafting (CFNG) is the gold-standard treatment of long-standing unilateral facial palsy, but clinical series reveal frequent unpredictable underactivity and overactivity. Altering donor motor axon provision has been shown to affect ultimate FMT strength, potentially accounting for diverse clinical results. We therefore investigated the hypothesis that axon delivery to, and strength of, a FMT could be standardised despite varying motor axonal input by altering the calibre of the interposed nerve graft. Methods: New Zealand White rabbits underwent rectus femoris FMTs to the face, reinnervated using either a large or small facial nerve branch via broad or narrow nerve grafts. After 9 months, muscle force measurement and morphometric nerve biopsy analysis were performed.
O1. Comparative anatomy of the facial/scalp flap of a range of mammals L. Landin, P.C. Cavadas, C. Navarro, A. Carrera, J. Fontdevila, S. de Francia, B. Berenguer Plastic Surgery Division, Research Unit, ‘‘La Fe’’ University Hospital, Valencia, Spain Aim: To compare the anatomy, harvesting technique and characteristics of the facial flap of a range of mammals. Material and methods: Between September 2004 and March 2006 a total of 104 specimens were dissected, including 87 rats, 4 pigs, 2 dogs, 4 sheep and 2 rabbits and 5 human cadavers. The anatomy of each specimen was reviewed. The pliability, elasticity and composition of the flap were observed. Vascular network of the flap was studied by methylene-blue and gelatin-barium angiographies. Results: A total of 130 hemifacial or full facial flaps were harvested. Each flap harvesting required an average of 4 h (range 2.5e6). The facial flap in the human was thin, pliable and flexible. Its vascularization came from the facial artery, superficial temporal artery and occipital artery, off the external carotid artery. The facial flap in the rat, rabbit and dog was thin, pliable and flexible, their surgical approach was easy, and their vascularization came from the facial artery In contrast, the flaps in pigs and sheep were poorly vascularized, and the surgical approach was difficult, in absence of a facial artery. The flap in the pig was thick and poorly adaptable, with predominance of the fatty tissue. Conclusion: The facial flap in the dog was a thin, pliable and flexible flap, with an easy surgical approach to the main pedicle. We found the absence of the facial artery in the pig model. The rabbit model was similar to the rat model, while the sheep model was poorly vascularized in absence of facial artery. For all these reasons, we think that the facial flap in the dog model is the most similar to that of the human. Significance: We hope this work will aid in the proper selection of a model for further investigations in face allotransplant.
O2. A new technique for repairs of nerves with size discrepancy: Epineural end-in-end neuroraphy H. C ¸epni a, A. Karacalar a, M.S. Engin a, S. Canan b, S. Yildirim c a Ondokuz Mayis University, Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Kurupelit, Samsun, Turkey b Baskent University, Faculty of Medicine, Department of Physiology, Ankara, Turkey c Cukurova University, Faculty of Medicine, Department of Cardiovascular Surgery, Antalya, Turkey Neurotized flaps are preferred when function is desired besides volume replacement. A common problem encountered during 1748-6815/$ - see front matter doi:10.1016/j.bjps.2007.01.001
neurorraphy is the size discrepancy between nerves, and has an impeding effect on the regenerative process. Our method, end-in-end neuroraphy has been developed for overcoming size discrepancies. A 2 mm long epineural sleeve is dissected on the distal stump. This sleeve is slid over the proximal stump and fixed to the underlying epineurium with two microstiches 1800 apart. In our study, 20 female Wistar albino rats were used in two groups, in accordance with the guidelines of our ethical commitee. In Group I, tibial and peroneal nerves were exposed on both legs. Both nerves were transected, and proximal peroneal nerves were sutured to larger tibial nerves. In group II, proximal tibial nerves were sutured to smaller peroneal nerves. In both groups, nerves on the right side were repaired via our technique. Fellow nerves served as controls and repaired via primary end-to-end repair. Thus, efficiacy of our technique was tested on both types of size discrepancies. After 90 days, repairs were exposed. It was noted that trial nerves have formed negligable adhesions and allowed much easier dissection when compared with controls. Nerve conduction velocities and action potential amplituted were measured. Afterwards, nerves were removed for histomorphological analysis. In general, trial nerves displayed better conduction velocity, amplitudes, axon counts, axon diameters, myelin thickness, myelin thickness and axon diameter ratios and nerve diameter and axon diameter ratios. However, only the difference in conduction velocities in group II was statistically significant, propably due to the broadness of the variance. We believe that our method is superior in means of reducing axonal escape, retaining throphic factors in the repair zone and preventing inflow of inflammmatory mediators, keeping foreign suture material away from regenerating axons and yielding higher conduction velocities. O3. Regulation of functional muscle transfer force production by use of an interposed nerve graft F. Urso-Baiarda, A.O. Grobbelaar RAFT Institute, Mount Vernon Hospital, Northwood HA6 2RN, UK Introduction and aims: Functional muscle transfer (FMT) combined with cross-facial nerve grafting (CFNG) is the gold-standard treatment of long-standing unilateral facial palsy, but clinical series reveal frequent unpredictable underactivity and overactivity. Altering donor motor axon provision has been shown to affect ultimate FMT strength, potentially accounting for diverse clinical results. We therefore investigated the hypothesis that axon delivery to, and strength of, a FMT could be standardised despite varying motor axonal input by altering the calibre of the interposed nerve graft. Methods: New Zealand White rabbits underwent rectus femoris FMTs to the face, reinnervated using either a large or small facial nerve branch via broad or narrow nerve grafts. After 9 months, muscle force measurement and morphometric nerve biopsy analysis were performed.