Frédéric Bodin1, Michele Diana2, Alexandre Koutsomanis3, Emeric Robert3, Jacques Marescaux2, Catherine Bruant-Rodier3. 1. Department of Plastic Surgery, University Hospital of Strasbourg, Strasbourg, France. Electronic address: frederic.bodin@chru-strasbourg.fr. 2. IRCAD, Research Institute Against Cancer of the Digestive Tract, Strasbourg, France; IHU-Strasbourg, Minimally Invasive Image-Guided Surgical Institute, Strasbourg, France. 3. Department of Plastic Surgery, University Hospital of Strasbourg, Strasbourg, France.
Abstract
BACKGROUND: Free-flap breast reconstruction is a challenging surgical procedure with a steep learning curve. A reproducible large animal model could be relevant for free-flap harvesting and microsurgical anastomosis training. The aim of this study was to assess the feasibility of a porcine model for free-flap breast reconstruction. METHODS: Three female pigs were placed under general anesthesia in order to study feasibility and estimate relevance for training. The deep inferior epigastric perforator (DIEP) flap, the transverse musculocutaneous gracilis (TMG) flap, and the superior gluteal artery perforator (SGAP) flap were harvested and anastomosed to the internal thoracic vessels. Differences were noted between pig and human anatomy, and the surgical procedure was adapted to build training models. RESULTS: Under a more prominent anterior thoracic wall, the internal thoracic vessels were slightly deeper and larger than in human anatomy. The DIEP flap was never feasible in the porcine model. However, the superior epigastric artery perforator (SEAP) flap showed anatomical similarity with the human DIEP flap, and it proved to be suitable for an inverted training model. The porcine TMG flap harvesting was close to the human one, reproducing specific dissection and anastomotic difficulties. The SGAP flap was not a muscular perforator flap in pigs but a septocutaneous flap. Because of the thinness of the hypodermal fat, porcine flaps were not considered adequate training models for breast-mound shaping. CONCLUSIONS: Despite any anatomical variations, the pig has proven to be a suitable training model for free-flap harvesting and transfer in the field of breast reconstruction.
BACKGROUND: Free-flap breast reconstruction is a challenging surgical procedure with a steep learning curve. A reproducible large animal model could be relevant for free-flap harvesting and microsurgical anastomosis training. The aim of this study was to assess the feasibility of a porcine model for free-flap breast reconstruction. METHODS: Three female pigs were placed under general anesthesia in order to study feasibility and estimate relevance for training. The deep inferior epigastric perforator (DIEP) flap, the transverse musculocutaneous gracilis (TMG) flap, and the superior gluteal artery perforator (SGAP) flap were harvested and anastomosed to the internal thoracic vessels. Differences were noted between pig and human anatomy, and the surgical procedure was adapted to build training models. RESULTS: Under a more prominent anterior thoracic wall, the internal thoracic vessels were slightly deeper and larger than in human anatomy. The DIEP flap was never feasible in the porcine model. However, the superior epigastric artery perforator (SEAP) flap showed anatomical similarity with the human DIEP flap, and it proved to be suitable for an inverted training model. The porcine TMG flap harvesting was close to the human one, reproducing specific dissection and anastomotic difficulties. The SGAP flap was not a muscular perforator flap in pigs but a septocutaneous flap. Because of the thinness of the hypodermal fat, porcine flaps were not considered adequate training models for breast-mound shaping. CONCLUSIONS: Despite any anatomical variations, the pig has proven to be a suitable training model for free-flap harvesting and transfer in the field of breast reconstruction.
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Authors: Wubin Bai; Hexia Guo; Wei Ouyang; Yang Weng; Changsheng Wu; Yihan Liu; Hao Zang; Lauren Jacobson; Yameng Xu; Di Lu; Ziying Hu; Shuo Li; Hany M Arafa; Quansan Yang; Amanda M Westman; Matthew R MacEwan; John A Rogers; Mitchell A Pet Journal: J Reconstr Microsurg Date: 2021-09-22 Impact factor: 2.329
Authors: Hexia Guo; Wubin Bai; Wei Ouyang; Yihan Liu; Changsheng Wu; Yameng Xu; Yang Weng; Hao Zang; Yiming Liu; Lauren Jacobson; Ziying Hu; Yihang Wang; Hany M Arafa; Quansan Yang; Di Lu; Shuo Li; Lin Zhang; Xun Xiao; Abraham Vázquez-Guardado; Joanna Ciatti; Elizabeth Dempsey; Nayereh Ghoreishi-Haack; Emily A Waters; Chad R Haney; Amanda M Westman; Matthew R MacEwan; Mitchell A Pet; John A Rogers Journal: Nat Commun Date: 2022-05-30 Impact factor: 17.694