Name: porcine as a training module for head and neck microvascular reconstruction
Uploaded: 2018-09-29T13:00:00
Description: Watch this Scientific Journal Video about Porcine As a Training Module for Head and Neck Microvascular Reconstruction at JoVE.com

这项工作由科学、信息和通信技术和未来规划部 (2015R1C1A1A01051907) 资助的韩国国家研究基金会 (NRF) 资助和支持。这项工作还得到了科学、信息和通信技术 & 未来规划 (NRF-2016M3A9E9941746) 资助的韩国国家研究基金会 (NRF) 的基础科学研究项目的支持。

这项研究由实验动物资源部指导和批准, Yonsei 生物医学研究所, Yonsei 大学医学院, 由实验室动物护理评估和认可协会认证国际。本研究遵循了实验室动物资源委员会生命科学研究所国家研究委员会实验室动物护理和使用指南。在手术前, 所有的猪都经过了一周的驯化。
1. 准备
<ol><li>在全身麻醉之前, 不要让猪吃超过12小时的食物, 免费获得水。 注: 六只女约克郡猪被使用称25...

<ol>
	<li>Chen, C. L., Zenga, J., Roland, L. T., Pipkorn, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complications+of+double+free+flap+and+free+flap+combined+with+locoregional+flap+in+head+and+neck+reconstruction:+A+systematic+review.">Complications of double free flap and free flap combined with locoregional flap in head and neck reconstruction: A systematic review.</a> Head &amp; Neck journal of the Science and Specialties of the Head and Neck. 40 (3), 632-646 (2018).</li><li>Smith, R. K., Wykes, J., Martin, D. T., Niles, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Perforator+variability+in+the+anterolateral+thigh+free+flap:+a+systematic+review.">Perforator variability in the anterolateral thigh free flap: a systematic review.</a> Surgical and Radiologic Anatomy. 39 (7), 779-789 (2017).</li><li>Bauer, F., Koerdt, S., H&#246;lzle, F., Mitchell, D. A., Wolff, K. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Eight+free+flaps+in+24+hours:+a+training+concept+for+postgraduate+teaching+of+how+to+raise+microvascular+free+flaps.">Eight free flaps in 24 hours: a training concept for postgraduate teaching of how to raise microvascular free flaps.</a> British Journal of Oral and Maxillofacial. 54 (1), 35-39 (2016).</li><li>Schoeff, S., Hernandez, B., Robinson, D. J., Jameson, M. J., Shonka, D. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microvascular+Anastomosis+Simulation+Using+a+Chicken+Thigh+Model:+Interval+Versus+Massed+Training.">Microvascular Anastomosis Simulation Using a Chicken Thigh Model: Interval Versus Massed Training.</a> The Laryngoscope. 127 (11), 2490-2494 (2017).</li><li>Bodin, F., Diana, M., Koutsomanis, A., Robert, E., Marescaux, J., Bruant-Rodier, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Porcine+model+for+free-flap+breast+reconstruction+training.">Porcine model for free-flap breast reconstruction training.</a> Plastic and Reconstructive Surgery Journal. 68 (10), 1402-1409 (2015).</li><li>Rodriguez, J. R., Ya&#241;ez, R., Cifuentes, I., Varas, J., Dagnino, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Microsurgery+Workout:+A+Novel+Simulation+Training+Curriculum+Based+on+Nonliving+Models.">Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models.</a> Plastic and Reconstructive Surgery Journal. 138 (4), 739e-747e (2016).</li><li>Carey, J. N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simulation+of+plastic+surgery+and+microvascular+procedures+using+perfused+fresh+human+cadavers.">Simulation of plastic surgery and microvascular procedures using perfused fresh human cadavers.</a> Plastic and Reconstructive Surgery journal. 67 (2), e42-e48 (2014).</li><li>Chan, W., Niranjan, N., Ramakrishnan, V. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Structured+assessment+of+microsurgery+skills+in+the+clinical+setting.">Structured assessment of microsurgery skills in the clinical setting.</a> Plastic and Reconstructive Surgery Journal. 63 (8), 1329-1334 (2010).</li><li>Matsumura, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+newly+designed+training+tool+for+microvascular+anastomosis+techniques:+Microvascular+Practice+Card.">A newly designed training tool for microvascular anastomosis techniques: Microvascular Practice Card.</a> Surgical Neurology Journal. 71 (5), 616-620 (2010).</li><li>Kim, W. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracheal+reconstruction+with+a+free+vascularized+myofascial+flap:+preclinical+investigation+in+a+porcine+model+to+human+clinical+application.">Tracheal reconstruction with a free vascularized myofascial flap: preclinical investigation in a porcine model to human clinical application.</a> Scientific Reports. 7 (1), 10022 (2017).</li></ol>

头颈部恶性肿瘤患者在手术治疗中可能出现严重的发病率和缺陷。在大多数情况下, 微血管游离组织移植已成为重建的基础。皮瓣的可行性是一个关键问题, 需要稳定, 精确处理椎弓根, 触觉感觉, 空间能力, 和优秀的手术流程从外科医生8。要发展这些技能, 你需要广泛的实践与训练模型3,4,5,<sup class="xref...

头颈部恶性肿瘤术后重建是一项与重大发病率相关的困难手术。微血管游离皮瓣重建已被公认为标准方法重建20年1,2,3。游离皮瓣转移在改善癌症患者头颈部管理和创伤后损伤中起着重要作用, 从而推动疾病外科切除术的边界超越以往的技术, 从而导致更大的患者生活质量和更长的生存率1,2,3。用于重建的各种皮瓣包括旋转、接枝和游离襟翼。
游离皮瓣在头颈部重建中的作用已经扩大。这是最困难的皮瓣工作, 需要熟练和微妙的处理。皮瓣衰竭是一项灾难性事件, 发病率4,5。因此, 需要相当长的训练时间来为成功的手术结果3、4、5、6、7、8, 制定必要的精确度, 9。与这种手术相关的陡峭的学习曲线可以影响患者的预后, 影响治疗管理3,4,5,6,7, 8,9。为了减少新外科医生的训练时间和学习曲线, 需要一个模拟人类生物学的训练模型, 并提供类似的手术现场条件8。
本研究的目的是表明猪的可见性, 作为一个良好的训练模块的头部和颈部微血管重建类似的人的情况下, 提高技能的积极的方式。
本研究采用猪模型训练新的同事在头颈部微血管重建中进行游离皮瓣转移, 为临床现场训练提供成本效益和较少压力的补充, 可靠地类似自由襟翼程序的功能。猪被用于许多研究和作为教学模型为各种各样的外科重建,例如,乳房重建;5然而, 猪从来没有被用于头颈部重建, 除了在我们的研究, 气管重建由于气管狭窄10。
这个想法是在弗雷德里克布丹7之后开始的, 他描述了乳房重建的类似皮瓣。研究其他微血管训练模块的主要优点是主动点缀模块, 其结果是程序的实时性。

<table>
	<tbody>
		<tr>
			<td>Pigs XP Bio, Seoul, South Korea</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Surgical Hair Removal shaver</td>
			<td>3M</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>22 gage catheter</td>
			<td>B.BRAUN</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>syring with needle size 18</td>
			<td>Jung Rim Medical</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Intramuscular alfaxan</td>
			<td>Careside</td>
			<td></td>
			<td>10ml/VAL</td>
		</tr>
		<tr>
			<td>Intramuscularxylazine</td>
			<td>Bayer</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Intramuscular azaperone</td>
			<td>Sigma-aldrich</td>
			<td></td>
			<td>34223</td>
		</tr>
		<tr>
			<td>Intramuscular atropine</td>
			<td>Daewon</td>
			<td></td>
			<td>0.5mg/A</td>
		</tr>
		<tr>
			<td>Intramuscular cefazolin</td>
			<td>Yuhan</td>
			<td></td>
			<td>1g</td>
		</tr>
		<tr>
			<td>intravenous Ketorolac</td>
			<td>Hana Pharm</td>
			<td></td>
			<td>30mg</td>
		</tr>
		<tr>
			<td>Swine ansthesia mask</td>
			<td>DRE</td>
			<td></td>
			<td>1392</td>
		</tr>
		<tr>
			<td>endotracheal cuff tube 6.5 mm</td>
			<td>SMITH medical</td>
			<td></td>
			<td>100/150/065</td>
		</tr>
		<tr>
			<td>ansthesia Machine</td>
			<td>Dr&#228;ger</td>
			<td></td>
			<td>PRIMUS IE</td>
		</tr>
		<tr>
			<td>2% lidocaine topical solution</td>
			<td>Taejoon</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>vet ointment</td>
			<td>Pfizer</td>
			<td></td>
			<td>terramycin<img alt="Misc" src="/files/ftp_upload/58104/58104misc1.jpg" /></td>
		</tr>
		<tr>
			<td>eye cover patch</td>
			<td>Innomed</td>
			<td></td>
			<td>S-universal010S</td>
		</tr>
		<tr>
			<td>betadine solution 1%.</td>
			<td>Korea Pharma</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>gauze 4*4</td>
			<td>First Medical</td>
			<td></td>
			<td>22*30CM 320S</td>
		</tr>
		<tr>
			<td>blade No. 23</td>
			<td>Paragon</td>
			<td></td>
			<td>23</td>
		</tr>
		<tr>
			<td>lahey retractor</td>
			<td>V.Mueller</td>
			<td></td>
			<td>SU3960</td>
		</tr>
		<tr>
			<td>kelly tissue scissors</td>
			<td>SOLCO</td>
			<td></td>
			<td>05-1990</td>
		</tr>
		<tr>
			<td>blade No. 11</td>
			<td>Paragon</td>
			<td></td>
			<td>11</td>
		</tr>
		<tr>
			<td>surgical marking pen</td>
			<td>Aspen Surgical</td>
			<td></td>
			<td>Regular #2750</td>
		</tr>
		<tr>
			<td>allis</td>
			<td>V.Mueller</td>
			<td></td>
			<td>SU4055</td>
		</tr>
		<tr>
			<td>tie suture</td>
			<td>Covidein</td>
			<td></td>
			<td>non-needle</td>
		</tr>
		<tr>
			<td>3.5&#215; surgical loupe</td>
			<td>zeiss</td>
			<td></td>
			<td>eyemag smart</td>
		</tr>
		<tr>
			<td>double clamp without frame</td>
			<td>V.Mueller</td>
			<td></td>
			<td>CH7155</td>
		</tr>
		<tr>
			<td>microscissors</td>
			<td>AESCULAP</td>
			<td></td>
			<td>FD038R</td>
		</tr>
		<tr>
			<td>Ringer&#39;s lactate</td>
			<td>Daehan</td>
			<td></td>
			<td>500ml/1bag</td>
		</tr>
		<tr>
			<td>amoxicillin&#8211;clavulanate</td>
			<td>Ilsung</td>
			<td></td>
			<td>0.6g/V</td>
		</tr>
		<tr>
			<td>Meloxicam</td>
			<td>Samil</td>
			<td></td>
			<td>7.5mg</td>
		</tr>
		<tr>
			<td>propofol</td>
			<td>Dong Kook</td>
			<td></td>
			<td>120mg/V</td>
		</tr>
		<tr>
			<td>intravenous KCl solution</td>
			<td>Daehan</td>
			<td></td>
			<td>20ml/50P</td>
		</tr>
		<tr>
			<td>mosquito curved</td>
			<td>SOLCO</td>
			<td></td>
			<td>013-0111</td>
		</tr>
		<tr>
			<td>mosquito straight</td>
			<td>SOLCO</td>
			<td></td>
			<td>05-1050</td>
		</tr>
		<tr>
			<td>ethilone 10-0 suture</td>
			<td>ethicone</td>
			<td></td>
			<td>10/0W1756</td>
		</tr>
		<tr>
			<td>Vicryl 3-0.</td>
			<td>ethicone</td>
			<td></td>
			<td>3/0W9890</td>
		</tr>
		<tr>
			<td>buprenorphine</td>
			<td>Hanlim</td>
			<td></td>
			<td>0.3mg</td>
		</tr>
	</tbody>
</table>

porcine as a training module for head and neck microvascular reconstruction

在训练游离皮瓣采集和吻合术时, 需要有类似人类手术条件的活模型。用于训练的动物模型在许多外科领域已有多年可用。我们使用的女性 (因为他们是容易处理的程序) 约克郡猪的头部和颈部的重建通过收割深下腹动脉穿孔或上腹部动脉穿孔的皮瓣。通过颈总动脉和颈内静脉解剖, 制备吻合部位 (颈部皮肤缺损或气管壁缺损), 在实际生活中使用3.5×放大镜放大术进行吻合。这个过程演示了一种新的训练方法, 使用可靠的学习模式, 并提供一个详细的解剖学在现场场景。重点研究缺血时间、收获、血管吻合、皮瓣的设计, 以适应缺损部位。这种模式改善组织处理和使用适当的仪器可以重复多次, 使外科医生是完全有信心, 然后开始对人类的手术。

我们对六只猪进行了手术: 两只猪颈部皮肤缺损的重建, 两只猪的气管再造, 以及两只猪的血管吻合器的游离皮瓣试验。这些猪被监测了3月, 没有神经系统缺损的临床症状。
平均缺血时间为50分钟 (范围35-80 分钟);时间随着程序的重复而减少。六只猪平均收获时间为55分钟。在我们的模块的捐赠者站点没有发生发病率。皮瓣的平均...

Watch this Scientific Journal Video about Porcine As a Training Module for Head and Neck Microvascular Reconstruction at JoVE.com

Porcine As a Training Module for Head and Neck Microvascular Reconstruction

猪作为头颈部微血管重建训练模块

在这里, 我们提出了一个使用猪上腹动脉穿皮瓣作为一个学习模块的头部和颈部微血管重建的协议。

Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes ...

该方法有助于回答如何建立微血管头颈部重建生命训练模块的关键问题。这项技术的主要优点是，它有利于为初学者外科医生提供微血管重建手术技能。首先使用喉镜通过一只25至30克雌性约克郡猪的嘴露出声带，并喷洒两个泡芙2%利多卡因局部溶液的声带，以防止插管诱导的幼虫。用 6.5 毫米管进行插管。并使用注射器将管袖口充气三到五毫升空气。在确保气管处于适当位置后，在动物的眼睛上涂抹软膏。用盖片保护眼睛接下来，使用1%碘基磨砂溶液对颈部和腹壁进行消毒。并使用 23 号刀片将垂直中线前颈部切口切到胸骨。剖析带状肌肉。并使用凯利组织剪刀和Lahey缩回器横向拉回肌肉，将气管从第一环暴露在胸腔。暴露动脉瘤内血管中常见的胡萝卜动脉，并使用11号刀片在第二或第三个软骨中创建一厘米的窗口。然后通过气管缺陷寻找气管管，并确认通过管存在连续通气。要执行优越的胃动脉穿孔瓣收获，使用手术标记笔在上腹部设计皮瓣，并使用数字23手术刀创建一个四到三厘米的椭圆形皮肤切口，通过腹壁前护套在皮瓣的中侧。在握住 Allis 的筋膜时，从直肠的阿卜多米尼肌护套中提升皮瓣，以找到去皮肤皮瓣的穿孔器。模糊解剖暴露的肌肉组织。并跟随穿孔器到优越的表皮血管。使用数字23手术刀在皮瓣中做一个侧皮切口。并优越地夹紧优越的二胃血管和维纳科坦特与海莫斯特。然后使用凯利组织剪刀切到海莫萨特上方，用三欧缝合线将海莫卡特下面的容器夹上，以便去除海莫萨特。对于血管的异位化，使用手术的胸膜夹住两个相距一到两厘米的胡萝卜动脉。使用微分体切入海莫斯特之间。用双缝合线将容器的上级部分系上，防止泄漏。使用没有卡罗蒂德和皮瓣动脉之间的框架的双夹，使用10-oh简单的全厚度解释缝合线，将前两个停留缝合线围绕容器的周长相距约120度，并在停留缝合线之间缝两到三针。松开夹具并检查有无泄漏。如果没有从静脉体体回流，创建另一个动脉瘤的内部血管和静脉共生体，刚才证明。使用装有 18 量针的注射器，刺破皮肤以确认皮瓣的生存能力。如果出现一滴血，使用三欧缝合线关闭气管窗与优越的胃动脉穿孔瓣的肌肉筋膜。然后外化和缝合皮瓣的皮肤面板到宫颈中线皮肤切口，并关闭腹部皮肤切口。在手术结束时，将猪返回到容易的位置，并允许动物在没有其他动物的情况下恢复。以每小时150毫升的速度提供林格的乳酸，直到动物完全康复，并施用0.3毫克丁丙诺啡进行镇痛。当动物卧躺在开始肌肉内阿莫西林克拉夫拉酸和旋律一个星期，检查捐赠地点和皮瓣在重建现场每天愈合进展。在这些代表性研究中，平均缺血时间是50分钟，随着模型的重复，手术时间会减少。六头猪平均收获时间是55分钟，本单元的捐赠地点未观察到任何发病情况。皮瓣的尺寸平均为10厘米，与在人头和颈部观察到的相似。平均动脉直径为4.4毫米，平均虚值直径为5.75毫米，均大于两个血管的两毫米人类平均值，同时仍能够模拟人体解剖。皮肤桨尺寸从25厘米到40厘米平方，对皮瓣故障没有显著影响。在尝试此过程时，必须记住小心地接近穿孔器，并确保良好的静脉回流。开发后，这项技术为气管重建领域的研究人员探索气管缺陷的筋膜应用，以及确定适当的安全皮瓣尺寸而不使气道崩溃铺平了道路。不要忘记，进行气管重建可能是极其危险的，预防措施，如确保气道是专利和完好无损，应始终采取，而执行这个程序。

Research

JoVE Journal

Medicine

RNAscope for In situ Detection of Transcriptionally Active Human Papillomavirus in Head and Neck Squamous Cell Carcinoma

RNAscope for In situ Detection of Transcriptionally Active Human Papillomavirus in Head and Neck Squamous Cell Carcinoma

RNAscope的<em&gt;原位</em&gt;检测转录活性的人类乳头状瘤病毒在头颈部鳞状细胞癌

The &#39;gold standard&#39; for oncogenic HPV detection is the demonstration of transcriptionally active high-risk HPV in tumor tissue. However, detection ...

科研

医学

The Mouse Round-window Approach for Ototoxic Agent Delivery: A Rapid and Reliable Technique for Inducing Cochlear Cell Degeneration

老鼠圆窗途径耳毒性剂递送：一个快速和可靠的技术诱导耳蜗细胞变性

Investigators have utilized a wide array of animal models and investigative techniques to study the mammalian auditory system. Much of the basic research ...

Isolation and Characterization of a Head and Neck Squamous Cell Carcinoma Subpopulation Having Stem Cell Characteristics

分离和表征头颈部鳞状细胞癌亚群具有干细胞特性

Despite advances in the understanding of head and neck squamous cell carcinomas (HNSCC) progression, the five-year survival rate remains low due to local ...

Surgical Angiogenesis in Porcine Tibial Allotransplantation: A New Large Animal Bone Vascularized Composite Allotransplantation Model

猪胫骨移植术后血管生成的动物模型

Segmental bone loss resulting from trauma, infection malignancy and congenital anomaly remains a major reconstructive challenge. Current therapeutic ...

Discovering Middle Ear Anatomy by Transcanal Endoscopic Ear Surgery: A Dissection Manual

Transcanal 内窥镜下耳部手术发现中耳解剖: 解剖手册

The middle ear is located in the center of the temporal bone and bears a highly complex anatomy. The recently introduced exclusively endoscopic transcanal ...

Posterior Semicircular Canal Approach for Inner Ear Gene Delivery in Neonatal Mouse

后半圆管法在新生小鼠内耳基因传递中的研究

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of ...

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in Meni&#232;re's Disease Ears and Normal Hearing Ears

In Vivo Morphometric Analysis of Human Cranial Nerves Using Magnetic Resonance Imaging in MeniÃƒÆ’Ã†'Ãƒâ€šÃ‚Â¨re's Disease Ears and Normal Hearing Ears

体内Menière 病耳和正常听觉的磁共振成像对人颅神经的形态学分析

Analysis of neural structures in Meni&#232;re's Disease (MD) is of importance, since a loss of such structures has previously been proposed for this ...

Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation

内镜下鼻中隔成形术有限双线切除: 间隔偏差微创手术

Endoscopic septoplasty is a surgical procedure in otolaryngology that is commonly performed to treat nasal airway obstruction caused by nasal septal ...

Surgical Labyrinthectomy of the Rat to Study the Vestibular System

大鼠前庭系统的外科迷路切除术研究

To study the vestibular system or the vestibular compensation process, a number of methods have been developed to cause vestibular damage, including ...

A Training and Testing System for Performing Vascular Reconstruction In Vitro

在体外进行血管重建的训练和测试系统

Manual vascular reconstruction training is essential for a beginner surgeon. However, an optimal training system for vascular reconstruction in vitro has ...