The Experts below are selected from a list of 3753 Experts worldwide ranked by ideXlab platform
Anton H. Schwabegger - One of the best experts on this subject based on the ideXlab platform.
-
functional sphincter ani externus reconstruction for treatment of fecal stress incontinence using free Latissimus Dorsi Muscle transfer with coaptation to the pudendal nerve preliminary experimental study in dogs
2007Co-Authors: Anton H. Schwabegger, Peter Kronberger, Peter Obrist, Endre Brath, I MikoAbstract:The external anal sphincter (EAS) is a skeletal Muscle capable of voluntary contraction to prevent accidental defecation. Current reconstructive options for a severely damaged EAS using local Muscle flaps are not always adequate for functional repair. The present preliminary experimental model was designed to assess the feasibility of a neuromicrovascular Latissimus Dorsi Muscle transfer for functional external spincter Muscle reconstruction. In nine mongrel dogs, the anal sphincter Muscles were totally resected, leaving a mucosal canal in place. A segmental Latissimus Dorsi Muscle was shaped around the anal canal in a circular fashion, with coaptation to the pudendal nerve, and vessel anastomosis at the ischiorectal fossa. Functional evaluation was performed using electromyogram, sphincter manometry, video documentation, and histologic examination with standard and immunohistochemical staining. After 8 months, the remaining three eligible dogs were continent. Muscle function was verified by means of electromyogram, sphincter manometry, and a video record. Histologic and immunohistochemical examination confirmed the functional results, showing only minor zones of fatty and fibrous degeneration. Transplantation of a segmental Latissimus Dorsi Muscle with vascular anastomosis and coaptation to the pudendal nerve has proved to be successful in restoring (voluntary) anal continence experimentally in dogs. Its feasibility for perfect orientation as a neosphincter seems to be superior to any pedicled Muscle flap. However, these preliminary results deserve further investigation prior to considering application in humans.
-
free neurovascular transfer of Latissimus Dorsi Muscle for the treatment of bladder acontractility ii clinical results
2003Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Anton H. Schwabegger, Georg Bartsch, R ProsserAbstract:ABSTRACTPurpose: Until now patients with bladder acontractility were destined to lifelong clean intermittent catheterization with all of its inherent risks. Previous experimental studies demonstrated that voluntary voiding can be restored by microneurovascular free transfer of a carefully selected Muscle flap. We present the selection criteria, modifications in technique, followup schedule and long-term results in 20 patients treated with transplantation of Latissimus Dorsi Muscle to the bladder.Materials and Methods: In 20 patients with bladder acontractility requiring intermittent catheterization for at least 2 years we performed Latissimus Dorsi detrusor myoplasty. Preoperative evaluation included urodynamic assessment, cystoscopy, upper tract imaging and electromyography of the rectus Muscle. The procedure involves transfer of a free neurovascular Latissimus Dorsi Muscle flap to the pelvis where it is anastomosed to the lowest motor branches of the intercostal nerve and deep inferior epigastric vessel...
-
Muscle sparing Latissimus Dorsi myocutaneous flap with maintenance of Muscle innervation function and aesthetic appearance of the donor site
2003Co-Authors: Anton H. Schwabegger, Christoph Harpf, Christian RainerAbstract:In this report, the authors describe the application of a Muscle-sparing technique to harvest a myocutaneous Latissimus Dorsi Muscle flap, including only a tiny lateral Muscle segment but carrying a large skin paddle, with the advantage of leaving intact innervation and function of the remaining Latissimus Dorsi Muscle. According to the experiences and complications associated with the pure thoracodorsal artery perforator harvest at the authors' institution, the necessity of increasing the reliability of the vascular pedicle demands that a small Muscle strip be left embedding the perforator vessels attached to the skin paddle. This procedure was applied in eight cases with only one minor complication, which was a distal flap tip necrosis in the largest flap used. The Muscle function and aesthetic contour of the posterior axillary fold were preserved in every case. Harvesting a large skin paddle flap that is carried by a diminutive longitudinal segment of Latissimus Dorsi Muscle circumvents thoracodorsal nerve damage and maintains Muscle function. In contrast to a thoracodorsal artery perforator flap without Muscle, the harvesting of which is a delicate procedure, this procedure is regarded as easier and safer.
-
functional urinary bladder wall substitute using a free innervated Latissimus Dorsi Muscle flap
1997Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Michael W. Hess, Anton H. Schwabegger, K. Colleselli, Georg Bartsch, H Feichtinger, Hans AnderlAbstract:This study was designed to investigate the ability of the Latissimus Dorsi Muscle in situ to evacuate a bladder reservoir and to study the functional anatomic, and histopathologic results of partial or subtotal bladder reconstruction with an innervated free Latissimus Dorsi Muscle in mongrel dogs. In group I (four dogs), the Latissimus Dorsi Muscle was dissected and tailored in situ. Then the so-formed pedicled Latissimus Dorsi Muscle flap was wrapped around tissue expanders of varying sizes (volumes of 50, 100, and 150 cc, respectively) to form a bladder-like reservoir. Electromyography and intraluminal pressure measurements were done at the time of surgery and 6 months thereafter using a standard electromyograph and a Dantec urodynamic unit. In group II (four dogs), the dome of the bladder wall was removed, with up to 50 percent of the mucosal layer being left intact. The resulting muscular defect was repaired with a free innervated Latissimus Dorsi Muscle flap. The transformed Latissimus Dorsi Muscle was shaped and wrapped around the bladder in a spiral form, with particular attention to the resting tension. The thoracodorsal vessels were anastomosed to the pelvic branches of the hypogastric vessels, and the thoracodorsal nerve was coapted to a pelvic motor nerve that was selected by use of nerve stimulator. Cystography and urodynamic studies were performed after 3, 6, and 9 months. Electromyography was done after 9 months, before sacrifice of the animals, which was followed by regular histologic and electron microscopic examinations. Stimulation of the thoracodorsal nerve of the reconfigured Latissimus Dorsi Muscle reservoirs in situ after 6 months yielded average intraluminal pressures of 190 cmH 2 O at maximum capacity and 35 cmH 2 O at a minimum capacity of 10 to 15 cc. Stimulation of the Latissimus Dorsi muslce transferred to the bladder resulted in a visible and measurable contraction of the transplanted Muscle after 9 months. Urodynamic values preoperatively and postoperatively were basically unchanged. During cystography, the bladder outline was smooth during both filling and voiding. Light and electron microscopic examinations confirmed viable, reinnervated Muscle. The reconfigured pedicled Latissimus Dorsi Muscle has the ability to evacuate a bladder-like reservoir after nerve stimulation. A detrusor function of the bladder can be induced through the contractility of a reinnervated free Latissimus Dorsi Muscle that was wrapped around the bladder. An innervated free Latissimus Dorsi Muscle flap does not undergo severe Muscle fibrosis, contracture, and atrophy such as occur after transfer of completely or partially denervated, pedicled Muscle. This means that a functional bladder reconstruction/augmentation can be achieved by microneurovascular transfer of a Latissimus Dorsi Muscle flap.
-
Free Neurovascular Transfer of Latissimus Dorsi Muscle to the Bladder. I. Experimental Studies
1997Co-Authors: Arnulf Stenzl, Milomir Ninkovic, Johann Willeit, Michael W. Hess, Hans Feichtinger, Anton H. Schwabegger, K. Colleselli, Margit Pavelka, Hans Anderl, Georg BartschAbstract:ABSTRACTObjectives: Experimental studies were undertaken to investigate the practicability of a microneurovascular transfer of Latissimus Dorsi Muscle to the bladder, and to look for possible techniques enhancing evacuation of a reservoir such as the bladder by striated Muscle.Materials and Methods: Twelve dogs were used for the studies. They were divided into 3 groups. Group I: Evacuation proficiency of a re-configured Latissimus Dorsi under tension was hydrodynamically tested after 6 months. Group II: Microneurovascular Latissimus Dorsi transposition anastomosing thoracodorsal vessels and nerve to circumflexa ilium profunda vessels and a lumbar plexus motor nerve, respectively, was performed to cover the bladder devoid of up to 50% of the detrusor Muscle. Group III: Microneurovascular Latissimus Dorsi transposition was used to reconstruct the bladder after supratrigonal cystectomy. Urodynamic and radiographic in vivo studies were done after 6 and 9 months.Results: Stimulation of the thoracodorsal nerve ...
Milomir Ninkovic - One of the best experts on this subject based on the ideXlab platform.
-
free neurovascular transfer of Latissimus Dorsi Muscle for the treatment of bladder acontractility ii clinical results
2003Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Anton H. Schwabegger, Georg Bartsch, R ProsserAbstract:ABSTRACTPurpose: Until now patients with bladder acontractility were destined to lifelong clean intermittent catheterization with all of its inherent risks. Previous experimental studies demonstrated that voluntary voiding can be restored by microneurovascular free transfer of a carefully selected Muscle flap. We present the selection criteria, modifications in technique, followup schedule and long-term results in 20 patients treated with transplantation of Latissimus Dorsi Muscle to the bladder.Materials and Methods: In 20 patients with bladder acontractility requiring intermittent catheterization for at least 2 years we performed Latissimus Dorsi detrusor myoplasty. Preoperative evaluation included urodynamic assessment, cystoscopy, upper tract imaging and electromyography of the rectus Muscle. The procedure involves transfer of a free neurovascular Latissimus Dorsi Muscle flap to the pelvis where it is anastomosed to the lowest motor branches of the intercostal nerve and deep inferior epigastric vessel...
-
free innervated Latissimus Dorsi Muscle flap for reconstruction of full thickness abdominal wall defects
1998Co-Authors: Milomir Ninkovic, Peter Kronberger, Christoph Harpf, Astrid Rumer, H AnderlAbstract:Full-thickness abdominal wall defects continue to be a challenge for the reconstructive surgeon. The most frequently used reconstructive techniques are transfer of a pedicled, local abdominal flap or a distant flap from the thigh region. The purpose of this paper is to present a new approach to full-thickness abdominal wall reconstruction using an innervated free Latissimus Dorsi musculocutaneous flap. Four patients with large full-thickness abdominal wall defects underwent reconstruction with a free innervated Latissimus Dorsi Muscle flap. In two patients, staged abdominal wall reconstruction was performed. Primary closure was first obtained with a skin graft. During the subsequent definitive reconstruction (with an innervated free Latissimus Dorsi Muscle flap), this skin graft was not excised. Instead, deep dermabrasion of the skin graft was performed, leaving a residual dermal layer. This layer was then covered with a free innervated Latissimus Dorsi Muscle flap. In these two cases, there was no need for the use of a prosthetic mesh. A single stage reconstruction was performed in the other two cases. After abdominal wall sarcoma resection, Prolene mesh was placed and subsequently covered with a free innervated Latissimus Dorsi Muscle flap. There were no free flap failures. The average time of surgery. was 4 hours, 50 minutes. The average hospital stay was 14 days. No significant complications occurred except for one donor site seroma. No hernias have occurred postoperatively. The mean follow-up was 21 months. Postoperatively, electromyographic testing was performed regularly in all patients to document reinnervation of the Latissimus Dorsi Muscle flap. With reinnervation and intensive Muscle training, the transplanted Latissimus Dorsi Muscle offers enough contractile capacity and strength to adequately replace the function of the missing abdominal wall Muscles. In complicated staged reconstructions, dermabrasion of the temporary skin graft allows for the use of a residual dermal layer as a fascia-like substitute to aid in the restoration of structural integrity. The combination of the dermal layer with an innervated free Latissimus Dorsi Muscle provides a strong, vascularized fascial repair as well as an overlying vascularized soft-tissue coverage. In conclusion, adequate functional dynamic reconstruction of full-thickness abdominal wall defects is possible using an innervated free Latissimus Dorsi Muscle flap. The reintegrated Latissimus Dorsi Muscle is suitable for reconstitution of the missing functional and anatomic components of complex abdominal wall defects.
-
functional urinary bladder wall substitute using a free innervated Latissimus Dorsi Muscle flap
1997Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Michael W. Hess, Anton H. Schwabegger, K. Colleselli, Georg Bartsch, H Feichtinger, Hans AnderlAbstract:This study was designed to investigate the ability of the Latissimus Dorsi Muscle in situ to evacuate a bladder reservoir and to study the functional anatomic, and histopathologic results of partial or subtotal bladder reconstruction with an innervated free Latissimus Dorsi Muscle in mongrel dogs. In group I (four dogs), the Latissimus Dorsi Muscle was dissected and tailored in situ. Then the so-formed pedicled Latissimus Dorsi Muscle flap was wrapped around tissue expanders of varying sizes (volumes of 50, 100, and 150 cc, respectively) to form a bladder-like reservoir. Electromyography and intraluminal pressure measurements were done at the time of surgery and 6 months thereafter using a standard electromyograph and a Dantec urodynamic unit. In group II (four dogs), the dome of the bladder wall was removed, with up to 50 percent of the mucosal layer being left intact. The resulting muscular defect was repaired with a free innervated Latissimus Dorsi Muscle flap. The transformed Latissimus Dorsi Muscle was shaped and wrapped around the bladder in a spiral form, with particular attention to the resting tension. The thoracodorsal vessels were anastomosed to the pelvic branches of the hypogastric vessels, and the thoracodorsal nerve was coapted to a pelvic motor nerve that was selected by use of nerve stimulator. Cystography and urodynamic studies were performed after 3, 6, and 9 months. Electromyography was done after 9 months, before sacrifice of the animals, which was followed by regular histologic and electron microscopic examinations. Stimulation of the thoracodorsal nerve of the reconfigured Latissimus Dorsi Muscle reservoirs in situ after 6 months yielded average intraluminal pressures of 190 cmH 2 O at maximum capacity and 35 cmH 2 O at a minimum capacity of 10 to 15 cc. Stimulation of the Latissimus Dorsi muslce transferred to the bladder resulted in a visible and measurable contraction of the transplanted Muscle after 9 months. Urodynamic values preoperatively and postoperatively were basically unchanged. During cystography, the bladder outline was smooth during both filling and voiding. Light and electron microscopic examinations confirmed viable, reinnervated Muscle. The reconfigured pedicled Latissimus Dorsi Muscle has the ability to evacuate a bladder-like reservoir after nerve stimulation. A detrusor function of the bladder can be induced through the contractility of a reinnervated free Latissimus Dorsi Muscle that was wrapped around the bladder. An innervated free Latissimus Dorsi Muscle flap does not undergo severe Muscle fibrosis, contracture, and atrophy such as occur after transfer of completely or partially denervated, pedicled Muscle. This means that a functional bladder reconstruction/augmentation can be achieved by microneurovascular transfer of a Latissimus Dorsi Muscle flap.
-
Free Neurovascular Transfer of Latissimus Dorsi Muscle to the Bladder. I. Experimental Studies
1997Co-Authors: Arnulf Stenzl, Milomir Ninkovic, Johann Willeit, Michael W. Hess, Hans Feichtinger, Anton H. Schwabegger, K. Colleselli, Margit Pavelka, Hans Anderl, Georg BartschAbstract:ABSTRACTObjectives: Experimental studies were undertaken to investigate the practicability of a microneurovascular transfer of Latissimus Dorsi Muscle to the bladder, and to look for possible techniques enhancing evacuation of a reservoir such as the bladder by striated Muscle.Materials and Methods: Twelve dogs were used for the studies. They were divided into 3 groups. Group I: Evacuation proficiency of a re-configured Latissimus Dorsi under tension was hydrodynamically tested after 6 months. Group II: Microneurovascular Latissimus Dorsi transposition anastomosing thoracodorsal vessels and nerve to circumflexa ilium profunda vessels and a lumbar plexus motor nerve, respectively, was performed to cover the bladder devoid of up to 50% of the detrusor Muscle. Group III: Microneurovascular Latissimus Dorsi transposition was used to reconstruct the bladder after supratrigonal cystectomy. Urodynamic and radiographic in vivo studies were done after 6 and 9 months.Results: Stimulation of the thoracodorsal nerve ...
Zekiye Bigat - One of the best experts on this subject based on the ideXlab platform.
-
reconstruction of midfoot bone and soft tissue loss with chimeric partial scapula and Latissimus Dorsi Muscle flap and short perforator based skin flap following gunshot injuries report of two cases
2016Co-Authors: Arzu Akcal, Kerim Unal, Tahsin Gorgulu, Mehmet Akif Akcal, Zekiye BigatAbstract:Introduction In this report we present two cases of gunshot injury related midfoot defects, reconstructed with a chimeric partial scapula and Latissimus Dorsi Muscle flap and short perforator-based skin flap. The first case, a 14 years old male, had 10 × 8 cm medial plantar and 6 × 4 cm dorsal foot defects and the second case, a 55 years old female, had only 8 × 6 cm dorsal foot defect. In both cases the defects were associated with fractures, one with lateral cuneiform and cuboid with 90% bone loss and the other with navicular bone, respectively. After 6 months, the patients could walk well without support, and radiographs confirmed bony union. A chimeric partial scapula and Latissimus Dorsi Muscle flap and short perforator-based skin flap may be used for the reconstruction of combined bony and soft tissue defects of the midfoot and to promote bone healing. © 2016 Wiley Periodicals, Inc. Microsurgery 36:598–603, 2016.
Georg Bartsch - One of the best experts on this subject based on the ideXlab platform.
-
free neurovascular transfer of Latissimus Dorsi Muscle for the treatment of bladder acontractility ii clinical results
2003Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Anton H. Schwabegger, Georg Bartsch, R ProsserAbstract:ABSTRACTPurpose: Until now patients with bladder acontractility were destined to lifelong clean intermittent catheterization with all of its inherent risks. Previous experimental studies demonstrated that voluntary voiding can be restored by microneurovascular free transfer of a carefully selected Muscle flap. We present the selection criteria, modifications in technique, followup schedule and long-term results in 20 patients treated with transplantation of Latissimus Dorsi Muscle to the bladder.Materials and Methods: In 20 patients with bladder acontractility requiring intermittent catheterization for at least 2 years we performed Latissimus Dorsi detrusor myoplasty. Preoperative evaluation included urodynamic assessment, cystoscopy, upper tract imaging and electromyography of the rectus Muscle. The procedure involves transfer of a free neurovascular Latissimus Dorsi Muscle flap to the pelvis where it is anastomosed to the lowest motor branches of the intercostal nerve and deep inferior epigastric vessel...
-
functional urinary bladder wall substitute using a free innervated Latissimus Dorsi Muscle flap
1997Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Michael W. Hess, Anton H. Schwabegger, K. Colleselli, Georg Bartsch, H Feichtinger, Hans AnderlAbstract:This study was designed to investigate the ability of the Latissimus Dorsi Muscle in situ to evacuate a bladder reservoir and to study the functional anatomic, and histopathologic results of partial or subtotal bladder reconstruction with an innervated free Latissimus Dorsi Muscle in mongrel dogs. In group I (four dogs), the Latissimus Dorsi Muscle was dissected and tailored in situ. Then the so-formed pedicled Latissimus Dorsi Muscle flap was wrapped around tissue expanders of varying sizes (volumes of 50, 100, and 150 cc, respectively) to form a bladder-like reservoir. Electromyography and intraluminal pressure measurements were done at the time of surgery and 6 months thereafter using a standard electromyograph and a Dantec urodynamic unit. In group II (four dogs), the dome of the bladder wall was removed, with up to 50 percent of the mucosal layer being left intact. The resulting muscular defect was repaired with a free innervated Latissimus Dorsi Muscle flap. The transformed Latissimus Dorsi Muscle was shaped and wrapped around the bladder in a spiral form, with particular attention to the resting tension. The thoracodorsal vessels were anastomosed to the pelvic branches of the hypogastric vessels, and the thoracodorsal nerve was coapted to a pelvic motor nerve that was selected by use of nerve stimulator. Cystography and urodynamic studies were performed after 3, 6, and 9 months. Electromyography was done after 9 months, before sacrifice of the animals, which was followed by regular histologic and electron microscopic examinations. Stimulation of the thoracodorsal nerve of the reconfigured Latissimus Dorsi Muscle reservoirs in situ after 6 months yielded average intraluminal pressures of 190 cmH 2 O at maximum capacity and 35 cmH 2 O at a minimum capacity of 10 to 15 cc. Stimulation of the Latissimus Dorsi muslce transferred to the bladder resulted in a visible and measurable contraction of the transplanted Muscle after 9 months. Urodynamic values preoperatively and postoperatively were basically unchanged. During cystography, the bladder outline was smooth during both filling and voiding. Light and electron microscopic examinations confirmed viable, reinnervated Muscle. The reconfigured pedicled Latissimus Dorsi Muscle has the ability to evacuate a bladder-like reservoir after nerve stimulation. A detrusor function of the bladder can be induced through the contractility of a reinnervated free Latissimus Dorsi Muscle that was wrapped around the bladder. An innervated free Latissimus Dorsi Muscle flap does not undergo severe Muscle fibrosis, contracture, and atrophy such as occur after transfer of completely or partially denervated, pedicled Muscle. This means that a functional bladder reconstruction/augmentation can be achieved by microneurovascular transfer of a Latissimus Dorsi Muscle flap.
-
Free Neurovascular Transfer of Latissimus Dorsi Muscle to the Bladder. I. Experimental Studies
1997Co-Authors: Arnulf Stenzl, Milomir Ninkovic, Johann Willeit, Michael W. Hess, Hans Feichtinger, Anton H. Schwabegger, K. Colleselli, Margit Pavelka, Hans Anderl, Georg BartschAbstract:ABSTRACTObjectives: Experimental studies were undertaken to investigate the practicability of a microneurovascular transfer of Latissimus Dorsi Muscle to the bladder, and to look for possible techniques enhancing evacuation of a reservoir such as the bladder by striated Muscle.Materials and Methods: Twelve dogs were used for the studies. They were divided into 3 groups. Group I: Evacuation proficiency of a re-configured Latissimus Dorsi under tension was hydrodynamically tested after 6 months. Group II: Microneurovascular Latissimus Dorsi transposition anastomosing thoracodorsal vessels and nerve to circumflexa ilium profunda vessels and a lumbar plexus motor nerve, respectively, was performed to cover the bladder devoid of up to 50% of the detrusor Muscle. Group III: Microneurovascular Latissimus Dorsi transposition was used to reconstruct the bladder after supratrigonal cystectomy. Urodynamic and radiographic in vivo studies were done after 6 and 9 months.Results: Stimulation of the thoracodorsal nerve ...
Arnulf Stenzl - One of the best experts on this subject based on the ideXlab platform.
-
free neurovascular transfer of Latissimus Dorsi Muscle for the treatment of bladder acontractility ii clinical results
2003Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Anton H. Schwabegger, Georg Bartsch, R ProsserAbstract:ABSTRACTPurpose: Until now patients with bladder acontractility were destined to lifelong clean intermittent catheterization with all of its inherent risks. Previous experimental studies demonstrated that voluntary voiding can be restored by microneurovascular free transfer of a carefully selected Muscle flap. We present the selection criteria, modifications in technique, followup schedule and long-term results in 20 patients treated with transplantation of Latissimus Dorsi Muscle to the bladder.Materials and Methods: In 20 patients with bladder acontractility requiring intermittent catheterization for at least 2 years we performed Latissimus Dorsi detrusor myoplasty. Preoperative evaluation included urodynamic assessment, cystoscopy, upper tract imaging and electromyography of the rectus Muscle. The procedure involves transfer of a free neurovascular Latissimus Dorsi Muscle flap to the pelvis where it is anastomosed to the lowest motor branches of the intercostal nerve and deep inferior epigastric vessel...
-
functional urinary bladder wall substitute using a free innervated Latissimus Dorsi Muscle flap
1997Co-Authors: Milomir Ninkovic, Arnulf Stenzl, Michael W. Hess, Anton H. Schwabegger, K. Colleselli, Georg Bartsch, H Feichtinger, Hans AnderlAbstract:This study was designed to investigate the ability of the Latissimus Dorsi Muscle in situ to evacuate a bladder reservoir and to study the functional anatomic, and histopathologic results of partial or subtotal bladder reconstruction with an innervated free Latissimus Dorsi Muscle in mongrel dogs. In group I (four dogs), the Latissimus Dorsi Muscle was dissected and tailored in situ. Then the so-formed pedicled Latissimus Dorsi Muscle flap was wrapped around tissue expanders of varying sizes (volumes of 50, 100, and 150 cc, respectively) to form a bladder-like reservoir. Electromyography and intraluminal pressure measurements were done at the time of surgery and 6 months thereafter using a standard electromyograph and a Dantec urodynamic unit. In group II (four dogs), the dome of the bladder wall was removed, with up to 50 percent of the mucosal layer being left intact. The resulting muscular defect was repaired with a free innervated Latissimus Dorsi Muscle flap. The transformed Latissimus Dorsi Muscle was shaped and wrapped around the bladder in a spiral form, with particular attention to the resting tension. The thoracodorsal vessels were anastomosed to the pelvic branches of the hypogastric vessels, and the thoracodorsal nerve was coapted to a pelvic motor nerve that was selected by use of nerve stimulator. Cystography and urodynamic studies were performed after 3, 6, and 9 months. Electromyography was done after 9 months, before sacrifice of the animals, which was followed by regular histologic and electron microscopic examinations. Stimulation of the thoracodorsal nerve of the reconfigured Latissimus Dorsi Muscle reservoirs in situ after 6 months yielded average intraluminal pressures of 190 cmH 2 O at maximum capacity and 35 cmH 2 O at a minimum capacity of 10 to 15 cc. Stimulation of the Latissimus Dorsi muslce transferred to the bladder resulted in a visible and measurable contraction of the transplanted Muscle after 9 months. Urodynamic values preoperatively and postoperatively were basically unchanged. During cystography, the bladder outline was smooth during both filling and voiding. Light and electron microscopic examinations confirmed viable, reinnervated Muscle. The reconfigured pedicled Latissimus Dorsi Muscle has the ability to evacuate a bladder-like reservoir after nerve stimulation. A detrusor function of the bladder can be induced through the contractility of a reinnervated free Latissimus Dorsi Muscle that was wrapped around the bladder. An innervated free Latissimus Dorsi Muscle flap does not undergo severe Muscle fibrosis, contracture, and atrophy such as occur after transfer of completely or partially denervated, pedicled Muscle. This means that a functional bladder reconstruction/augmentation can be achieved by microneurovascular transfer of a Latissimus Dorsi Muscle flap.
-
Free Neurovascular Transfer of Latissimus Dorsi Muscle to the Bladder. I. Experimental Studies
1997Co-Authors: Arnulf Stenzl, Milomir Ninkovic, Johann Willeit, Michael W. Hess, Hans Feichtinger, Anton H. Schwabegger, K. Colleselli, Margit Pavelka, Hans Anderl, Georg BartschAbstract:ABSTRACTObjectives: Experimental studies were undertaken to investigate the practicability of a microneurovascular transfer of Latissimus Dorsi Muscle to the bladder, and to look for possible techniques enhancing evacuation of a reservoir such as the bladder by striated Muscle.Materials and Methods: Twelve dogs were used for the studies. They were divided into 3 groups. Group I: Evacuation proficiency of a re-configured Latissimus Dorsi under tension was hydrodynamically tested after 6 months. Group II: Microneurovascular Latissimus Dorsi transposition anastomosing thoracodorsal vessels and nerve to circumflexa ilium profunda vessels and a lumbar plexus motor nerve, respectively, was performed to cover the bladder devoid of up to 50% of the detrusor Muscle. Group III: Microneurovascular Latissimus Dorsi transposition was used to reconstruct the bladder after supratrigonal cystectomy. Urodynamic and radiographic in vivo studies were done after 6 and 9 months.Results: Stimulation of the thoracodorsal nerve ...
