Ghalia Qayyum
Comparison Of Perfused And Non Perfused Jejunal Auto Transplants For Reconstruction Of Massive Abdominal - 1997
Surgeons occasionally see patients who have malignant soft tissue tumors, loss of a part due to trauma or excessive debridement of the abdominal wall. Regardless of the etiology they represent challenging anatomical problems, both with respect to resection and especially to reconstruction. Many defects are unsightly and difficult to appose by the surrounding tissue. SuIeons in medical field as well as veterinarians have tried and reported many surgical corrections to these conditions.
Twenty clinically healthy mongrel dogs of either sex were used for the experimental translocation of jejurial auto-grafts for the resurfacing of massive abdominal wall defects. The dogs were randomly divided into two groups of 10 animals each. Laparotomy was carried out by a vertical incision in right lateral recumbency. A portion of jejunum 12 cm long was selected and isolated from rest of the intestinal tract with its mesenteric blood supply intact. The continuity of the small bowel was restored by end-to-end anastomosis.
The isolated segment of jejunum was then processed and cut open longitudinally along the antimesenteric border. After wards the open patch was cut into two equal pieces, perpendicular to the long axis and then sutured together parallel, so as to have even bigger surface area of the graft to cover a defect which was wider in width and could be repaired by single width of the intestine. In group I, both the parts of intestine sutured together retained their blood supply intact. In group II, one half of the transplant was rendered avascular. Using the previous incision site, a full thickness 6x6 cm, square shape defect was created in the abdominal wall. The jejunal patch was placed over the defect in the abdominal wall, with its mucosal surface apposing the external fascia. Simple interrupted sutures using chrornic cat gut No.2 were used to tailor the patch in such a way that normal contours of abdominal wall were reconstituted. A drain was placed at the site of operation and the subcutaneous tissue and skin were closed in a routine manner.
In group-I there was no mortality and no herniation of the bowel occurred through the operative site. The graft was well tolerated by the animals as it was homologous. In group-TI the nonvascularised portion of the graft did not develop its new blood supply leading to its death and sloughing. Eventration took place on 6th day and the animals died, except one dog. It was concluded on the basis of this study that:
1. In group-I perfused pedicle grafts provided 100% resurfacing to the abdominal wall defects.
2. The mucosa of the bowel transplant under went degeneration.
3. The junctional histology of the graft revealed a thick layer of fibrous tissue indicating perfect union between the two portions of the graft.
4. A marked inflammatory reaction was also evident.
5. There was clear cut histological evidence of failure with loss of cellular integrity and no production of collagen fibers in the non perfused group.
In a nut shell the chosen method of reconstruction was consistent with the hierarchy of treatment priorities, which makes survival paramount, followed by function, freedom from pain and acceptable appearances. Thus when there is no other way of saving the animals life other than surgical intervention, the satisfaction derived from such a successful, last resort operation is indeed a valuable encouragement to a young veterinary surgeon.
Department of Clinical Medicine & Surgery
0527,T
Comparison Of Perfused And Non Perfused Jejunal Auto Transplants For Reconstruction Of Massive Abdominal - 1997
Surgeons occasionally see patients who have malignant soft tissue tumors, loss of a part due to trauma or excessive debridement of the abdominal wall. Regardless of the etiology they represent challenging anatomical problems, both with respect to resection and especially to reconstruction. Many defects are unsightly and difficult to appose by the surrounding tissue. SuIeons in medical field as well as veterinarians have tried and reported many surgical corrections to these conditions.
Twenty clinically healthy mongrel dogs of either sex were used for the experimental translocation of jejurial auto-grafts for the resurfacing of massive abdominal wall defects. The dogs were randomly divided into two groups of 10 animals each. Laparotomy was carried out by a vertical incision in right lateral recumbency. A portion of jejunum 12 cm long was selected and isolated from rest of the intestinal tract with its mesenteric blood supply intact. The continuity of the small bowel was restored by end-to-end anastomosis.
The isolated segment of jejunum was then processed and cut open longitudinally along the antimesenteric border. After wards the open patch was cut into two equal pieces, perpendicular to the long axis and then sutured together parallel, so as to have even bigger surface area of the graft to cover a defect which was wider in width and could be repaired by single width of the intestine. In group I, both the parts of intestine sutured together retained their blood supply intact. In group II, one half of the transplant was rendered avascular. Using the previous incision site, a full thickness 6x6 cm, square shape defect was created in the abdominal wall. The jejunal patch was placed over the defect in the abdominal wall, with its mucosal surface apposing the external fascia. Simple interrupted sutures using chrornic cat gut No.2 were used to tailor the patch in such a way that normal contours of abdominal wall were reconstituted. A drain was placed at the site of operation and the subcutaneous tissue and skin were closed in a routine manner.
In group-I there was no mortality and no herniation of the bowel occurred through the operative site. The graft was well tolerated by the animals as it was homologous. In group-TI the nonvascularised portion of the graft did not develop its new blood supply leading to its death and sloughing. Eventration took place on 6th day and the animals died, except one dog. It was concluded on the basis of this study that:
1. In group-I perfused pedicle grafts provided 100% resurfacing to the abdominal wall defects.
2. The mucosa of the bowel transplant under went degeneration.
3. The junctional histology of the graft revealed a thick layer of fibrous tissue indicating perfect union between the two portions of the graft.
4. A marked inflammatory reaction was also evident.
5. There was clear cut histological evidence of failure with loss of cellular integrity and no production of collagen fibers in the non perfused group.
In a nut shell the chosen method of reconstruction was consistent with the hierarchy of treatment priorities, which makes survival paramount, followed by function, freedom from pain and acceptable appearances. Thus when there is no other way of saving the animals life other than surgical intervention, the satisfaction derived from such a successful, last resort operation is indeed a valuable encouragement to a young veterinary surgeon.
Department of Clinical Medicine & Surgery
0527,T