The superficial inferior epigastric artery fascia flap in the rabbit

Giessler, Goetz A.; Friedrich, Patricia F.; Shin, Richard; Bishop, Allen T.

doi:10.1002/micr.20413

Cited by 16 publications

(12 citation statements)

References 31 publications

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“…In groups one and two, vascularized whole knee grafts were microsurgically transplanted from male Dutch Belted rabbits to New Zealand White (NZW-) recipients using our previously described method (6). Additionally, a pedicled fascial flap (superficial inferior epigastric artery fascia [SIEF] flap (7)) from the recipient abdomen was introduced in the femur and an arteriovenous saphenous bundle including the surrounding fascia was implanted in the tibia to induce surgical angiogenesis (figure 1). These tissues were then ligated distally and pulled through the bone using a pull through suture.…”

Section: Methodsmentioning

confidence: 99%

Surgical Angiogenesis with Short-Term Immunosuppression Maintains Bone Viability in Rabbit Allogenic Knee Joint Transplantation

Kremer

Giessler

Friedrich

et al. 2013

Plastic and Reconstructive Surgery

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Background Vascularized Composite Allotransplantation (VCA) has potential for reconstruction of joint defects, but requires life-long immunosuppression (IS), with substantial risks. This study evaluates an alternative, using surgical angiogenesis from implanted autogenous vessels to maintain viability without long-term immunotherapy. Methods Vascularized knee joints were transplanted from Dutch Belted donors to New Zealand White rabbit recipients. Once positioned and revascularized microsurgically, a recipient-derived superficial inferior epigastric fascial (SIEF) flap and a saphenous AV bundle were placed within the transplanted femur and tibia, respectively, to develop a neoangiogenic, autogenous circulation. Ten transplants comprised Group 1. Group 2 (n=9) were no-angiogenesis controls with ligated flaps and AV bundles. Group 3 rabbits (n=10) were autotransplants with patent implants. Tacrolimus was used for 3 weeks to maintain nutrient flow during angiogenesis. At 16 weeks, we assessed bone healing, joint function, bone and cartilage mechanical properties and histology. Results Group 1 allotransplants had more robust angiogenesis, better healing, improved mechanical properties and better osteocyte viability than ligated controls (group 2). All 3 groups developed knee joint contractures and arthritic changes. Cartilage thickness and quality were poorer in allograft groups than autotransplant controls. Conclusions Surgical angiogenesis from implanted autogenous tissue improves bone viability, healing and material properties in rabbit allogenic knee transplants. However, joint contractures and degenerative changes occurred in all transplants, regardless of antigenicity or blood supply. Experimental studies in a larger animal model with improved methods to maintain joint mobility are needed before the merit of living joint allotransplantation can be judged.

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Section: Methodsmentioning

confidence: 99%

Surgical Angiogenesis with Short-Term Immunosuppression Maintains Bone Viability in Rabbit Allogenic Knee Joint Transplantation

Kremer

Giessler

Friedrich

et al. 2013

Plastic and Reconstructive Surgery

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“…The saphenous arteriovenous bundle was raised from the fascia of the lower leg, was ligated distally and was introduced into the tibial metaphysis to lie within its intramedullary canal. A superficial inferior epigastric fascial flap was harvested from the lower abdominal wall and placed within the femur as previously described 35 (figure 1). An adequate amount of fascia was included to fill the intramedullary canal for sufficient neoangiogenesis.…”

Section: Methodsmentioning

confidence: 99%

Knee joint transplantation combined with surgical angiogenesis in rabbits—A new experimental model

et al. 2011

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Summary Purpose We have previously described a means to maintain bone allotransplant viability, without long-term immune modulation, replacing allogenic bone vasculature with autogenous vessels. A rabbit model for whole knee joint transplantation was developed and tested using the same methodology, initially as an autotransplant. Materials/Methods Eight New Zealand White rabbit knee joints were elevated on a popliteal vessel pedicle to evaluate limb viability in a non-survival study. Ten additional joints were elevated and replaced orthotopically in a fashion identical to allotransplantation, obviating only microsurgical repairs and immunosuppression. A superficial inferior epigastric facial (SIEF) flap and a saphenous arteriovenous (AV) bundle were introduced into the femur and tibia respectively, generating a neoangiogenic bone circulation. In allogenic transplantation, this step maintains viability after cessation of immunosuppression. Sixteen weeks later, x-rays, microangiography, histology, histomorphometry and biomechanical analysis were performed. Results Limb viability was preserved in the initial 8 animals. Both soft tissue and bone healing occurred in 10 orthotopic transplants. Surgical angiogenesis from the SIEF flap and AV bundle was always present. Bone and joint viability was maintained, with demonstrable new bone formation. Bone strength was less than the opposite side. Arthrosis and joint contractures were frequent. Conclusion We have developed a rabbit knee joint model and evaluation methods suitable for subsequent studies of whole joint allotransplantation.

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“…The surgical technique for the rat SIEF flap harvest was described and evaluated. While this flap has been reported previously in a few animal studies, 17,19,20 long-term viability has not been adequately assessed or determined. Additionally, a succinct and detailed description of this technique in rats has not been illustrated or reported.…”

Section: Discussionmentioning

confidence: 99%

“…An additional benefit is that the transplanted adipofascial tissue can improve blood flow in adjacent tissues such as bone, nerve, and muscles and be a readily applied pedicle flap for studies on vascularization. 20,31 The inclusion of adipofascial tissue in the flap decreases intravascular resistance of the bundle, resulting in improved blood flow in the flap which decreases the risk of thrombosis. 20,31 Immunohistochemical qualitative analysis of the nerve samples confirms the increase in vascularity in the SIEF group (vascularized flap wrapped around the processed nerve allograft) in both H&E and anti CD-34 sections at 12 weeks.…”

Section: Discussionmentioning

confidence: 99%

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The Superficial Inferior Epigastric Artery Fascia Flap in Rats

Saffari

Bishop

Shin

2020

J Reconstr Microsurg Open

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Background An adipofascial flap in the rat may provide new options for adding vascularization to scarred or nonvascularized beds for a variety of research studies. Current literature lacks sufficient description for a simple reproducible flap model for a vascularized pedicled flap in rats, in particular for neovascularization of allograft nerves for the reconstruction of sciatic nerve defects. The purpose of this study was to describe a surgical technique and determine long-term survivability for the pedicled superficial inferior epigastric artery fascial (SIEF) flap in the rat to meet requirement for a tunneled adipofascial flap to add vascularization to the sciatic nerve area. Methods The technique and use of a 4 × 3-cm SIEF flap are described. Twenty Lewis rats underwent the technique to determine feasibility. The flap was wrapped around processed allograft nerve reconstructions and viability of the flap was evaluated after 12 and 16 weeks. To visualize vessels, nerve grafts were harvested at 12 weeks and stained with hematoxylin-eosin and an antibody against microvessels (CD-34). Results All flaps remained viable after survival of 12 and 16 weeks. Complications included one hematoma formation and two lymphocele formations that did not have any impact on the flap. Immunohistochemistry confirmed an increase in microvessels and Schwann cell nuclei in the SIEF group compared with nerve samples from the unoperated, contralateral side. Conclusion A pedicled adipofascial flap model in the rat to provide a vascular bed for sciatic nerve reconstruction is detailed with long-term survivability evaluation of the flap. This flap is technically simple to be harvested and is suitable for revascularization procedures of various tissues in the lower abdomen, genital area, thigh, or upper limb of the rat.

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The superficial inferior epigastric artery fascia flap in the rabbit

Cited by 16 publications

References 31 publications

Surgical Angiogenesis with Short-Term Immunosuppression Maintains Bone Viability in Rabbit Allogenic Knee Joint Transplantation

Surgical Angiogenesis with Short-Term Immunosuppression Maintains Bone Viability in Rabbit Allogenic Knee Joint Transplantation

Knee joint transplantation combined with surgical angiogenesis in rabbits—A new experimental model

The Superficial Inferior Epigastric Artery Fascia Flap in Rats

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