Jejunum/DIEP Composite Flap: A Novel Rat Model of Viscerocutaneous Flap Prefabrication.
Background Reconstruction of complex pharyngoesophageal defects presents a major challenge, particularly in soft tissue deficient and previously scarred surgical sites. In recent years, the free jejunum flap method has emerged as a reliable means of esophageal reconstruction. However, it may require cutaneous coverage with an additional flap in extensively scarred, secondary reconstructions. Prefabrication of an intestinal/cutaneous composite flap can potentially solve this problem. Materials and Methods Total 28 Sprague Dawley rats were used in the study protocol. A vascularized jejunal segment was transposed beneath the deep inferior epigastric perforator (DIEP) flap. Contact with underlying abdominal fascia was prevented using a silicone sheet. Animals were distributed into five groups based on the timing of deep inferior epigastric vessel ligation to determine the time required for successful revascularization. The viability and the vascular anatomy of the prefabricated structures were analyzed using histology and microangiography. Results A jejunum/DIEP composite flap was successfully prefabricated based on mesenteric vessels. The skin component survived intact after 5 days of contact with serosal surface of the jejunal segment. Conclusion The clinical application of this technique can provide an alternative means of single-stage esophageal reconstruction, especially in patients with soft tissue deficiency and donor vessel unavailability.
Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
Omer
O
Ekin
Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
Ozan
O
Bitik
Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
Dicle
D
Aksoyler
Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
Ali
A
Aliyev
Department of Pathology, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
Samir
S
Abdullazade
Department of Plastic Reconstructive and Aesthetic Surgery, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey.
Ali Emre
AE
Aksu
D000792:Angiography; D000818:Animals; D004195:Disease Models, Animal; D019074:Epigastric Arteries; D058752:Free Tissue Flaps / Q000098:blood supply*; D006085:Graft Survival; D007583:Jejunum / Q000098:blood supply / Q000637:transplantation*; D008833:Microcirculation / Q000502:physiology*; D008866:Microsurgery; D018919:Neovascularization, Physiologic; D061525:Perforator Flap / Q000098:blood supply*; D051381:Rats; D017207:Rats, Sprague-Dawley; D012039:Regional Blood Flow / Q000502:physiology