Seromuscular Flap Research Articles

Pedicled jejunal seromuscular flap for bronchocutaneous fistula

We report the successful closure of a complicated bronchocutaneous fistula using a pedicled jejunal flap. The fistula, secondary to tuberculosis and irradiation, previously had been closed with a latissimus dorsi musculocutaneous flap. This initial repair failed. The recurrent fistulas were closed again using a jejunal seromuscular flap, and the chest wall defect was reconstructed with a rectus abdominis musculocutaneous flap.

A free smooth muscle graft for a continent urinary conduit in dogs.

We constructed a continent, catheterizable urinary conduit using a smooth muscle graft in dogs. One end of an isolated vascularized ileal segment was anastomosed to the bladder dome, and the other end was opened in the abdominal wall. The ileal conduit was tightly encircled with a free seromuscular flap of the ileum in 6 dogs and with a similar flap of colon in 6 other dogs. All smooth muscle grafts were alive 6 months after the operation. Pressure study showed that all but one ileal conduit had a pressure of more than 30 cm of water. Two dogs with a free ileal graft leaked urine when the bladder pressure increased, whereas all dogs with a colonic graft never leaked urine from the stoma. This smooth muscle graft will be available to reinforce the continent action of a plicated or narrowed intestinal tube for a urinary reservoir.

Reversed Seromuscular Flaps in the Urinary Tract in Dogs

Reversed seromuscular flaps of ileum and standard bowel replacement procedures were performed in 16 dogs to evaluate their potential to decrease the likelihood of recognized complications in cases of standard bowel replacement. Of 12 dogs augmentation cystoplasty was done in 6 and ureteral replacement was done in 6. In each group 4 procedures were performed using reversed seromuscular flap, while the remaining 2 were done in the conventional manner (controls). All flap animals had partial to full re-epithelialization with transitional cells but they also had gross and microscopic evidence of flap contraction at the end of 6 months. In the flap augmentation group intravesical pressure measured preoperatively at bladder volumes of 30cc and 60cc averaged 25.8 and 45.8mm. Hg compared to sacrifice pressures of 56.7 and 80.8mm. Hg. Monthly serum blood urea nitrogen measurements were lower in reversed seromuscular flap animals compared to controls. An additional 4 dogs were studied to help elucidate the etiology of graft contraction, of which 2 underwent reversed seromuscular flap enterocystoplasty with no mucosal stripping while 2 had a procedure exposing intact intestinal serosa to the lumen of the bladder and urine. All of these animals demonstrated good re-epithelialization of the serosal surface with transitional cells as well as little or no evidence of flap fibrosis or contraction. Our results demonstrate that the use of reversed seromuscular flaps in the urinary tract in dogs results in good re-epithelialization of the serosal surface with transitional cells but also flap contraction. This fibrosis and scarring process is largely due to the trauma of mucosal stripping and not urine contact.

Surgical treatment of the atonic bladder ("vesical cap").

As demonstrated in animal experiments and in five patients with atonic bladders, "vesical cap" surgery causally solves detrusor impairment by functionally reinforcing it with a vital muscle layer from an ileal seromuscular flap. All other genuine components of the bladder are kept intact, which is very beneficial for bladder function.