The Superficial Inferior Epigastric Artery Fascia Flap in Rabbits to enhance nerve regeneration
Tara Sara Saffari, MD, MSc1,2; Shin Y Alexander, MD3
1Mayo Clinic, Rochester, MN; 2Radboudumc, Nijmegen, Netherlands; 3Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN
Background: Vascularized flaps wrapped around a nerve graft are thought to enhance outcomes after nerve reconstruction. The purpose of this study was describe the surgical technique and report long-term survivability for the Superficial Inferior Epigastric Artery Fascia (SIEF) flap in rabbits in a peroneal nerve defect model to add vascularization and enhance nerve regeneration.
Methods: Thirty-six New Zealand Rabbits underwent the technique to determine feasibility and long-term survivability. After a 18-cm paramedian abdominal incision, on the ipsilateral side of the nerve reconstruction, the 18x10-cm flap was exposed. After identification of the SIE vessels, the flap was dissected distally, starting on the medial side. The flap was raised towards the proximal branch of the SIE vessels and tunneled through a subcutaneous inguinal tunnel towards the previously exposed peroneal nerve reconstruction site without torsion of the pedicle. After a 30-mm peroneal nerve reconstruction, the SIEF flap was wrapped around the nerves, covering both anastomoses. Without tension and compression on the pedicled flap and reconstructed nerve, the flap was loosely secured. The viability of the SIEF flap was evaluated after survival of 16 and 24 weeks using the milking patency test, color of the flap and active bleeding at the edges of the flap.
Results: All SIEF flaps remained viable and had patent vessels after survival of 16 and 24 weeks. No flap related complications were observed.
Conclusion: A pedicled adipofascial flap model in the rabbit to provide a vascular bed for peroneal nerve reconstruction is detailed with long-term survivability evaluation of the flap. This flap was relatively uncomplicated to harvest, with consistent anatomy, and was suitable for revascularization procedures in the lower abdomen, genital area and thigh in the rabbit, suggesting potential translation to larger animal models.
Figure 1 Schematic drawing of the rabbit superficial vascular abdominal anatomy.
Figure 2 The SIEF flap raised medially, showing the intact SIE vessels.
Figure 3 The 30-mm peroneal nerve reconstruction on top of the prior positioned SIEF flap.
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