ENDOSCOPIC SUBCUTANEOUS NEUROVASCULAR LOWER-EXTREMITY MYOFASCIAL FLAPHARVESTING FOR GENITOURINARY RECONSTRUCTION

Neurovascular myofascial flaps have been widely utilized when healthy tissues outside the anatomic confines of the pelvis are necessary for complex genitourinary reconstructions. Myofascial flaps have great pot ential in providing support and tone to the bladder neck in a model of total urinary incontinence. Two muscles were evaluated for minimally invasive harvesting utilizing an adult rabbit and human cadaveric mode l: the gracilis, because of its neurovascular supply and length, and t he sartorius, because of its location, Three adult New Zealand White r abbits were prepared and draped in sterile fashion after general anest hesia. Bilateral 2-cm incisions were made over the origins of the grac ilis and sartorius muscles. Dissection times were entered in a databas e on a personal computer for paired Student t-tests, Special technique s for dissection included utilization of a 5-mm subcutaneous dissector /retractor and reticulated scissors and dissector, Once the tissues we re harvested, rotational angles of the functional arcs around the orig ins of the gracilis and sartorius flaps were measured, as were the len gths of the muscular flaps from the proximal pedicle to the free dista l end. Initial positioning of the myofascial flap at the bladder neck was investigated in this nonsurvival study. Blood loss was estimated b efore the animals were humanely sacrificed. The possibilities of minim ally invasive genitourinary reconstruction are numerous. Both flaps ca n be dissected endoscopically and have rotational angles allowing tran sfer to more cephalad positions in the groin or intra-abdominally, Fur ther studies are needed to establish the efficacy of the myofascial gr aft for minimally invasive genitourinary reconstructions.