Free neurovascular transfer of latisstmus dorsi muscle for the treatment of bladder acontractility: II. Clinical results.
نویسندگان
چکیده
PURPOSE Until now patients with bladder acontractility were destined to lifelong clean intermittent catheterization with all of its inherent risks. Previous experimental studies demonstrated that voluntary voiding can be restored by microneurovascular free transfer of a carefully selected muscle flap. We present the selection criteria, modifications in technique, followup schedule and long-term results in 20 patients treated with transplantation of latissimus dorsi muscle to the bladder. MATERIALS AND METHODS In 20 patients with bladder acontractility requiring intermittent catheterization for at least 2 years we performed latissimus dorsi detrusor myoplasty. Preoperative evaluation included urodynamic assessment, cystoscopy, upper tract imaging and electromyography of the rectus muscle. The procedure involves transfer of a free neurovascular latissimus dorsi muscle flap to the pelvis where it is anastomosed to the lowest motor branches of the intercostal nerve and deep inferior epigastric vessels. Patients were instructed to attempt voluntary voiding 3 months postoperatively. Followup included urodynamic evaluation, biannual Doppler ultrasonography and annual dynamic computerized tomography. RESULTS Annual dynamic computerized tomography and/or biannual Doppler ultrasonography demonstrated vascularization and contractility of all transplanted muscle flaps. Mean followup is 44 months (range 18 to 74). Of the 20 patients 14 were able to void spontaneously within 4 months postoperatively with post-void residual volumes of less than 100 cc, voluntary voiding was restored by bladder neck incision in 4 and 2 (10%) still require self-catheterization. Postoperative detrusor pressures ranged from 5 to 218 cm. H2O (mean 72, median 55). None of the patients had morphological and functional changes of the upper tract, or de novo incontinence postoperatively. CONCLUSIONS Functioning free muscle transplantation was able to restore voluntary voiding in patients who had previously been dependent on long-term catheterization. Voluntary voiding has been maintained several years postoperatively without deterioration of upper tract function.
منابع مشابه
Free Neurovascular Latissimus Dorsi Muscle Transplantation for Reconstruction of Hip Abductors
Resection of tumors affecting the hip abductors can cause significant decrease in muscle strength and may lead to abnormal gait and poor function. We present a case report showing full functional recovery after resection of a synovial sarcoma affecting the right gluteus medius and minimus muscles with reconstruction free neurovascular latissimus dorsi muscle transplantation. The latissimus dors...
متن کاملRepair of Minor Tissue Defect in Hand by Transfer of Free Tissue Flap from the Toe
Background: To introduce our experience of using the free neurovascular flap from great and second toe. Methods: Thirteen patients (fifteen fingers) sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. I...
متن کاملCASE REPORT Repair of a wide lower extremity defect with cross-leg free transfer of latissimus dorsi and serratus anterior combined flap: a case report
Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would n...
متن کاملRepair of a wide lower extremity defect with cross-leg free transfer of latissimus dorsi and serratus anterior combined flap: a case report
Composite tissue loss in extremities involving neurovascular structures has been a major challenge for reconstructive surgeons. Reconstruction of large defects can only be achieved with microsurgical procedures. The success of free flap operations depends on the presence of healthy recipient vessels. In cases with no suitable donor artery and vein or in which even the use of vein grafts would n...
متن کاملCompartmentalization of the Latissimus Dorsi Muscle
This anatomical study provides a detailed description of the thoraco-dorsal artery, vein and nerve systems within the latissimus dorsi muscle. The nerve and vascular relationships in ten fresh cadaveric latissimus dorsi muscle specimens, were analysed. Radio-opaque material was injected into the thoraco-dorsal artery, while the thoraco-dorsal nerve and its main branches were dissected and label...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- International braz j urol : official journal of the Brazilian Society of Urology
دوره 29 2 شماره
صفحات -
تاریخ انتشار 2003