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Functional urinary bladder wall substitute using a free innervated latissimus dorsi muscle flap
1Department of Plastic Surgery, University of Innsbruck, Austria.
Plastic and Reconstructive Surgery
|August 1, 1997
Summary
The latissimus dorsi muscle can create a functional bladder reservoir and induce detrusor function after nerve stimulation. This study shows potential for latissimus dorsi muscle flaps in bladder reconstruction, avoiding muscle degeneration.
Area of Science:
- Urology
- Surgical Innovation
- Muscle Physiology
Background:
- Bladder reconstruction presents challenges in restoring native function.
- The latissimus dorsi muscle is a potential candidate for functional tissue transfer due to its size and vascularity.
- Previous attempts with denervated muscle flaps have shown limitations like fibrosis and atrophy.
Purpose of the Study:
- To investigate the capacity of the latissimus dorsi muscle in situ to evacuate a bladder reservoir.
- To assess functional, anatomic, and histopathologic outcomes of bladder reconstruction using an innervated free latissimus dorsi muscle flap.
- To evaluate the potential of reinnervated latissimus dorsi muscle to induce detrusor function.
Main Methods:
- Two groups of mongrel dogs underwent different latissimus dorsi muscle procedures: in situ reservoir formation (Group I) and free flap bladder reconstruction (Group II).
- Procedures involved dissection, tailoring, and wrapping of the latissimus dorsi muscle, with nerve coaptation in Group II.
- Functional assessment included electromyography, intraluminal pressure measurements, cystography, and urodynamic studies over 9 months.
Main Results:
- Nerve stimulation of reconfigured latissimus dorsi muscle reservoirs yielded significant intraluminal pressures (190 cmH2O max).
- Transferred latissimus dorsi muscle flaps showed visible, measurable contraction after 9 months, indicating successful reinnervation.
- Histological examination confirmed viable, reinnervated muscle without significant fibrosis or atrophy, and urodynamic parameters remained stable post-surgery.
Conclusions:
- The reconfigured pedicled latissimus dorsi muscle can effectively evacuate a bladder-like reservoir upon nerve stimulation.
- An innervated free latissimus dorsi muscle flap can induce detrusor function, offering a viable option for bladder reconstruction.
- Microneurovascular transfer of innervated latissimus dorsi muscle flaps provides a promising method for functional bladder augmentation, avoiding complications seen with denervated flaps.