Microvascular transplantation and replantation of the rabbit submandibulargland

Background: Xerostomia is a devastating complication of radiation therapy. Previous research has demonstrated that submandibular glands may be removed from the neck and transplanted using microvascular techniques, with good g land survival. However, microvascular transplantation and replantation has never been attempted on a composite tissue such as a salivary gland. Objective: To evaluate the ability of a rabbit submandibular gland to under go 2 successive microvascular transplantations. Subjects and Design: Study rabbits underwent a midline neck incision with d issection of a submandibular gland to its arterial and venous pedicle. Micr ovascular techniques were then used to transplant the gland to the femoral system of the right groin. The incisions were reopened later under surgical conditions. The transferred gland was examined for survival and patency of its artery and vein. Healthy glands were dissected and transferred to a su itable artery and vein within the neck, where they were again reanastamosed using microvascular surgical techniques. After additional time, the gland was again examined for survival and pedicle patency, then removed and evalu ated for histopathological evidence of survival. Results: Surgical technique evolved during the course of this work to avoid encountered pitfalls. After refining the technique, we have determined tha t the rabbit submandibular gland is able to mdthstandsuccessivemicrovascula r transplantation and replantation with good likelihood of longterm surviva l, according to histopathological criterial. Conclusions: The rabbit submandibular gland is able to undergo microvascula r transplantation and replantation with evidence of long-term survivability and preserved function. The body's natural response to surgery and tissue transplantation makes replantation a technical challenge; however, methods delineated herein alleviate many of the potential pitfalls. Extending these results to humans, patients who are to undergo radiation therapy could hav e a disease-free gland removed from the neck, transferred outside of the fi eld of radiation, and then returned to the neck at the completion of radiat ion therapy. This may enable them to maintain salivary gland function and m aintain oral cavity function and comfort.