Plastic Surgery Research Council
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BIOENGINEERED RECONSTRUCTION OF UPPER DIGESTIVE TRACT.
Presenter: Andrew Polyakov, MD
Co-Authors: Reshetov I; Polyakov A; Batukhtina E; Filushin M
P A Herzen Moscow Cancer Research Institute

Introduction: considering anatomic and functional specifics of upper digestive tract surgery of any extent leads to formation of significant functional and cosmetic defects that require performing reconstructive surgery for restoration of organs and tissues, as well as their functions. Purpose: surgical rehabilitation of patients with upper digestive tract defects including tissue restoration according to morpho-functional principle using transposed and free-flaps.

Materials and Methods: Nine patients underwent surgical reconstruction of upper digestive tract with bioengeneered flaps in P. A. Herzen Moscow Cancer Research Institute. All patients underwent surgery forming vast combined tissue defects on different stages of specialized oncological treatment. Primary tumors were found in 33,3 % (3) of cases, 66,7 % (6) of patients had recurrent tumors after previous ineffective oncological treatment. Prefabricated bioengeneered musculo-mucosal flaps were used for reconstruction of upper digestive tract: displaced flaps including musclus pectoralis major in 6 cases, free-flaps including musculus rectus abdomnis in 3 cases. Reconstruction was performed in two stages in 5 patients. First stage included flap prefabrication implantation of autologic mucosa minigrafts on musculus pectoris major. Reconstructive surgery using bioengeneered prefabricated flaps was performed in the second stage. Four patients underwent immediate mucous fragments implantation and organ reconstruction using bioengeneered musculo-mucosal flaps.

Results: the use of bioengineered flaps provide functional rehabilitation in 89 % (8) cases. Morphologically proved adequate epithelial layer of the mucous membrane on muscle fibers was achieved in 67% (6) cases. In 1 patient (11%) postoperative period was complicated by ligature fistula. Complications of donor area w?re not.

Conclusion: the developed method reconstruction of the upper digestive tract with use of bioengineered flaps can improve the results of complex combined defects elimination by imparting the desired properties to the flap, responding to issues of reconstruction.


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