Preservation of a digital osteotendinous structure with an omental flap.
Taking into account the angiogenic properties of the omentum to revascularize ischemic tissues, this experimental, longitudinal, prospective, double-blind study in rabbits was designed to revascularize and preserve the mobility of a digital osteotendinous structure surgically devascularized in advance and to compare such omental angiogenic ability with that of the muscle and the panniculus carnosus. Thirty New Zealand rabbits were used. Three toes from the hind feet were surgically amputated from each rabbit. The skin was removed, exposing the bones, tendons, ligaments, and joints, to form what we termed the osteotendinous structure. Through a median laparotomy, the first part of each rabbit's own osteotendinous structure was placed inside the panniculus carnosus (group I), the second under the rectus abdominis muscle (group II), and the third was wrapped in a pediculate omental flap (group III). Three weeks later, each structure was assessed clinically for mobility and fibrosis and microscopically for fibrosis, newly formed vessels, viability, and tissue regeneration. Clinically, the group I structures showed a greater amount of fibrosis. The structures in groups II and III showed minimal fibrosis in all but four cases, which showed moderate fibrosis. Differences in joint mobility were assessed with the Kruskal-Wallis test. There was a statistically significant difference in mobility for the structures from group III, which was higher, followed by those from groups II and I. The exception was the proximal interphalangeal joints in groups II and III, for which the differences had no statistical significance. Microscopically, fibrosis and tissue necrosis were intense in the structures in group I, moderate in the group II structures, and mild in the group III structures. Conversely, vessel neoformation and tissue regeneration were intense in the structures in group III, moderate in group II, and were nil in group I. This study confirms with statistical significance that, in the rabbit, the omentum has a higher ability to revascularize degloved tissues than do the muscle and the panniculus carnosus, thus preserving a higher joint and tendon mobility. Consequently, it is suggested that a free omental flap be used in the treatment of ring avulsion injuries that lead to degloving of the digits.
Iglesias
Department of Plastic Surgery, Instituto Nacional de la Nutrición Salvador Zubirán, México, DF, México.
Butrón
P
P
Cortés
E
E
Angeles
A
A
Robles
J A
JA
Vargas-Vorackova
F
F
D000009:Abdominal Muscles / Q000601:surgery; D000671:Amputation, Surgical; D000818:Animals; D000071938:Fasciotomy; D005355:Fibrosis; D006614:Hindlimb; D008297:Male; D018919:Neovascularization, Physiologic; D009852:Omentum / Q000601:surgery*; D011817:Rabbits; D016059:Range of Motion, Articular; D013524:Surgical Flaps; D014033:Toe Joint / Q000502:physiology; D014034:Toes / Q000098:blood supply / Q000473:pathology / Q000601:surgery*