Cystoplasty Combined Autologous Peritoneum with Ileal Seromuscular segment: a new model study

BackgroundAfter enterocystoplasty, some serious complications are presented, which are resulted from the chronic interaction between urine and intestinal epithelium. Composite cystoplasty is recommended as a method of surmounting these complications by replacing intestinal epithelium with autologous peritoneum.To develop a feasible surgical procedure for composite cystoplasty which can reduce serious complications postoperatively, keep sterility by excluding the possibility of contamination from the ileal contents, and provide a basis for the further clinical application of reconstruction bladder.MethodsSix female Chinese minipigs (CMP) were randomly chosen, weighted 28–33 kg. By intravenous anesthesia, bladder augmentation was carried out (implanting autologus peritoneum vascularized and, de-epithelialised ileal- seromuscular flaps. The composite cystoplasty used these flaps to mend and reconstruct bladders). Upon release of catheters and balloon at the fifth day, by monitoring the voiding behaviors of the pigs, routine pathology and immunohistochemistry were done by euthanizing the pigs at the 12th week.ResultsSix pigs experienced reconstruction, without complications. Ileum was 10 cm long, and the area of substitute peritoneum was 7 × 4 cm2. Voiding behavior was normal, and urine was clear in all animals after the catheter was taken out. Autopsy indicated that the fixed, bladder was in good condition, covered by continuous urothelium while the peritoneum disappeared, without regeneration of calculi, mucus, fibrosis, or ileal mucosa. Pathological examination demonstrated the success of the technique in developing the seromuscular flap without epithelial remnant. Bladders augmented with autologous peritoneum had fewer lymphocytes infiltration, indicating more effective urinary barrier function.Conclusion In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular segment is an ideal approach since it can prevent regrowth of ileal epithelial cells and avoid the complications of conventional enterocystoplasty. The potential functions of the peritoneum are both protection and transitional support. This animal study provides a basis for further clinical application of the new enterocysplasty.

Seromuscular Colonic Flap for Intrapelvic Soft-Tissue Coverage: A Reconstructive Option for Plastic Surgeons When Traditionally Used Flaps Are Not Available

Background. Reconstruction of intrapelvic defects can be a challenging problem in patients with limited regional muscle flap options and previously resected omentum. In such situations, alternative methods of mobilizing vascularized tissue may be required.Methods. A case of a patient that underwent pelvic extirpation for recurrent rectal cancer who had limited donor sites for flap reconstruction is presented. The mucosa was removed from a blind loop of colon, and a pedicled seromuscular flap based on the colonic mesentery was placed into the pelvis for vascularized soft-tissue coverage and elimination of dead space.Results. The postoperative course was only complicated by a small subcutaneous fluid collection beneath the sacrectomy skin incision, which was drained with radiological assistance. The patient recovered without any major postoperative complications.Conclusion. Seromuscular colonic flap is a useful option for soft-tissue coverage after pelvic extirpation and should be considered by plastic surgeons when other reconstruction options are not available.

Mesoplasty with Pedanculated Seromuscular Flap in Type IIIb Jejuno-ileal Atresia

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