Seromuscular enteric pedicles and prosthetic aortic graft complications in a porcine abdominal trauma model. An experimental study.
OBJECTIVE
Abdominal vascular trauma may require prosthetic grafting despite peritoneal contamination by concurrent visceral injury. This study tested the use of vascularized, seromuscular enteric pedicles (VSEP) against the development of vascular prosthetic complications, in a porcine abdominal trauma model.


METHODS
Eight pigs underwent aortic transection and reconstruction with a Dacron interposition graft (DIG). A standard bacterial inoculum soaked the DIG in situ. An enteric segment was isolated on its mesenteric pedicle, and the mucosa stripped. This VSEP was wrapped around the DIG and oversewn. Animals received antibiotics for 5 days. Endpoints were 2-week survival, or evidence of sepsis. The animals underwent explantation of the DIG, VSEP, and native aorta for the purposes of histological, and microbiological analyses, and scanning electron microscopy (SEM). Outcome measures were graft infection, graft thrombosis, tissue incorporation, and anastomotic integrity.


RESULTS
Two pigs were excluded for perioperative death. All study group animals (n = 6), survived 2 weeks. Infection and thrombosis were found in 0/6 (0%). Incorporation and anastomotic integrity were evident in 6/6 (100%). VSEP had intact blood supplies. SEM demonstrated viable muscle, microcirculation, and fibroplasia in VSEP.


CONCLUSIONS
We conclude that VSEP may help prevent prosthetic graft complications in the contaminated setting.
Anderson
C A
CA
Department of Surgery, Uniformed Services University of the Healthy Sciences, University of Hawaii, Honolulu, Hawaii, USA.
Sawyer
M A
MA
Cordts
P A
PA
Cordts
P R
PR
Demaioribus
C A
CA
Nauschuetz
K N
KN
D000007:Abdominal Injuries / Q000382:microbiology / Q000601:surgery*; D000818:Animals; D001012:Aorta, Abdominal / Q000293:injuries / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000382:microbiology; D004195:Disease Models, Animal; D007421:Intestine, Small / Q000293:injuries / Q000601:surgery; D008855:Microscopy, Electron, Scanning; D011183:Postoperative Complications / Q000517:prevention & control; D016459:Prosthesis-Related Infections / Q000517:prevention & control*; D013524:Surgical Flaps; D013552:Swine