Jurnalul de Chirurgie
 Jurnalul de chirurgie
Aparitie trimestriala in a doua luna a trimestrului
Published quarterly in the second month of the quarter
ISSN: 1584 - 9341 Vol.10 Nr.3 - Iulie-Septembrie 2014 | luni, 22 aprilie 2019
ISSN: 1584 - 9341 Vol.10 No.3 - July-September 2014
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ENDOSCOPIC-ASSISTED HARVEST OF GRACILIS MUSCLE IN PIGS. A MODEL TO LEARN AND PRACTICE ENDOSCOPIC TECHNIQUES
N. Gheţu (1), Venera Mihaela Iliescu (2), Daniela-Emanuela Gheţu (1), V.I. Ilie (1),
V.G. Ilie (1), M. Ionac (2), G. Mihalache (1), D. Pieptu (1)
(1) “Gr. T. Popa” University of Medicine and Pharmacy,
Center for Simulation and Training in Surgery, Iasi, Romania
(2) “Victor Babes” University of Medicine and Pharmacy,
”P. Brânzeu” Center for Laparoscopic Surgery and Microsurgery, Timisoara, Romania
Jurnalul de chirurgie 2010; 6 (4): 456-466
Full text:
Format PDF (Engleză/English)

Abstract:

Background: gracilis muscle is a versatile choice for soft tissue coverage and for functional reconstruction in brachial or facial palsy and in fecal or urinary incontinence. Traditional harvest with large incisions results in increased donor-site morbidity with pejorative effect on overall outcome. Endoscopic-assisted gracilis harvest decreases the associated morbidity and increases patients’ satisfaction. Endoscopic plastic surgery has specific technical prerequisites. Achieving proficiency requires learning and practicing on a proper model. The aim of this study is to evaluate the swine gracilis muscle as a model for learning and practicing the endoscopic techniques. Material and methods: twenty-six gracilis muscle flaps (20 bilateral and 6 unilateral) were endoscopic-assisted harvested in 16 pigs, using single incision for each muscle. Operating time, accidents and complications were recorded. Muscle survival was evaluated half hour after operation and after one week (for eight muscles). Results: mean operating time was 118 minutes (range 75-210 minutes) and pedicle endoscopic-dissection time decreased from 45 to 10-15 minutes. The learning curve of operating time versus cases revealed fast initial improvement that gradually reached a “plateau”, with increased practice. Initial longer operating times decreased to almost one third over the last cases. Retrospectively, overall operating times between endoscopic (“plateau” phase) and classic muscle harvest are similar. Injury of one vena comitans occurred in first 4 cases with no effect on muscle survival. Eight muscles were viable at one-week follow-up. Muscles, pedicles, and nerves lengths ranged from 14/9 cm to 18/13 cm, 2.5 to 5 cm and 4 to 7 cm, respectively. Four seromas developed in the absence of drainage, but postoperative course was uneventful with quick recovery. Conclusions: Endoscopic-assisted harvesting of the swine gracilis muscle is a safe, reliable and cost-effective technique, comparable to classical harvesting method. It is a complex learning experience that combines rapid progress in skill with constant refinements. Therefore, endoscopic-assisted harvesting of the swine gracilis muscle it is an excellent model to learn and practice the endoscopic techniques.

KEY WORDS: ENDOSCOPY, GRACILIS, FLAP HARVESTING, RECONSTRUCTIVE SURGERY, TRAINING MODEL

Correspondence to: Associate Professor Dragoş Pieptu, MD, PhD, “Gr. T. Popa” University of Medicine and Pharmacy, Center for Simulation and Training in Surgery, Iasi, Romania, str. Universităţii, nr. 16, email: .



: Creative Commons License
Jurnalul de chirurgie [Journal of Surgery] by Editorial Board, Department of Surgery University of Medicine and Pharmacy Iasi, E. Tarcoveanu, R. Moldovanu is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
Based on a work at www.jurnaluldechirurgie.ro.