Porcine model for free-flap breast reconstruction training

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• 作者：Fré ; dé ; ric Bodin^a ; ^{frederic.bodin@chru-strasbourg.fr" class="auth_mail" title="E-mail the corresponding author} ; Michele Diana^b ; ^c ; Alexandre Koutsomanis^a ; Emeric Robert^a ; Jacques Marescaux^b ; ^c ; Catherine Bruant-Rodier^a
• 关键词：Breast reconstruction ; Free flap ; Microsurgery ; Surgical training models ; Porcine model ; Learning curve
• 刊名：Journal of Plastic, Reconstructive & Aesthetic Surgery
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：68
• 期：10
• 页码：1402-1409
• 全文大小：2460 K

文摘

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.