Seromuscular Enteric Pedicles andProsthetic Aortic Graf t Complications in a Porcine Abdominal Trauma Model

Abstract

Background/Aims: 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. Conclusion: We conclude that VSEP may help prevent prosthetic graft complications in the contaminated setting.

A Novel Method of Intra-Abdominal Cavity Obliteration: A Case Report of a Colonic Seromuscular Flap

“…Muscle flaps have long been used to control infection by filling the potential dead space or organized abscess cavity because of their malleable nature, allowing flexibility of inset and rich vascularity delivering immune cells and antibiotics to the lesion. 2 , 6 , 7 Obliteration of subphrenic-organized abscess cavities after hepatectomy is a great challenge because the commonly used flaps are not feasible. In this case, the abscess cavity was located over the posteromedial part of the right liver lobe just underneath the diaphragm, and use of the latissimus dorsi muscle flap would have required a thoracotomy and making an incision in the diaphragm.…”

“…1–5 For the purpose of filling the hepatic abscess, this flap was considered as an innovative option because of its proximity to the abdominal pathology, flexibility in the volume of the flap harvested, potential antibacterial ability of the muscle flap, and preservation of trunk musculature. 2,6,7 Here, we illustrate the use of a pedicled colonic seromuscular flap for filling such an abscess cavity and demonstrate its long-term volume change.…”