摘要:

Purpose of reviewThe purpose of this review is to summarize the different reconstructive options for urogenital indications. The development of various flap techniques to restore congenital and acquired urogenital defects is presented.Recent findingsVarious reconstructive techniques have been demonstrated recently. On the basis of the reconstructive requirements, two main techniques can be defined: the standard local or regional flap technique (pedicled flap) and the more sophisticated microvascular free flap technique. Free tissue transplantation (transfer) is a procedure that involves microvascular transplantation of a flap (a fasciocutaneous, muscle or composite flap) in one stage from a donor site in the body to a distant recipient site. The viability of the transplanted flap is maintained by microvascular anastomosis between the flap's vessels (at least one artery and one vein) and recipient vessels. Re-innervation and functioning muscle contraction is achieved by suturing the vessels and a motor nerve in the recipient area to a motor nerve of a free transplanted muscle. After regeneration of the nerve and re-innervation of the transplanted muscle, a functioning free transplanted muscle offers enough contractile capacity and strength to replace the function of the missing muscles at the recipient site. The technique of microvascular free tissue transfer necessitates extensive experience in microvascular technique and this approach could be efficiently applied in cooperation with other specialists. Recent studies show the development and clinical application of these new surgical techniques in urology (e.g. in the treatment of bladder acontractility using innervated free latissimus dorsi muscle and in the use of a free microvascular fillet lower leg flap for the reconstruction of a large pelvic-floor defect).SummaryVarious reconstructive requirements define the techniques for reconstruction. The main principle is to obtain optimal anatomical and functional reconstruction with minimal donor site morbidity. Depending on the etiology of the defect, different reconstructive options are available to optimize the reconstructive result. Optimal reconstruction might best be achieved by adopting an interdisciplinary approach in which the primary objective is to provide the best possible outcome for each patient. This review presents the main indications for and principles of flap selection according to the reconstructive requirements.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewReconstructive surgery for patients with genital abnormalities or for patients who require reconstructive efforts is challenging. This review highlights those articles, which are outstanding among all those important papers, which have been published during the last year (2002-2003).Recent findingsA greater understanding of embryonal development improves the success of reconstructive surgery. Other factors, such as the patient's sex, influence the surgical technique used and the degree of invasiveness or complexity. In the adult the pressure to shorten hospital stays has played a big part in the continual modification and enhancement of surgical techniques. In addition to modified techniques, new off-the-shelf materials are introduced to the clinic, which seem to have the potential to improve the surgical outcome and shorten hospital stays.SummaryWith the continued successful basic anatomy and basic research, reconstructive surgery brings higher success rates. Long-term results are still required to validate the reliability of these new surgical techniques and materials.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTo assess the potential role of nerve regeneration in restoring urinary tract function, the rapidly developing and exciting area of central and peripheral nerve repair and regeneration is reviewed, with particular reference to papers in which animal models of nerve damage resulting in urogenital dysfunction have been used. The difficulties and potential of these techniques for therapeutic application to human subjects with functional problems of the urinary tract are discussed.Recent findingsMethods for encouraging regeneration of cut axons and directed growth in the inhibitory environment of the central nervous system are being extensively explored. The recent discovery of the potential of olfactory ensheathing cells has proved a significant advance. Olfactory ensheathing cells are a type of glial cell which can be harvested from the olfactory mucosa. Transplantation of these cells, in conjunction with a biodegradable synthetic nerve guide or conduit, has been shown to restore urinary tract function after spinal cord injury. Artificial, biodegradable conduits have also restored bladder and spermatic duct function after sympathetic nerve damage. Other adjuvants facilitating the process of axonal recovery include the use of neurotrophins to accelerate and guide the formation of new nerve-fibre growth.SummaryThese revolutionary technologies may, in the future, provide a means of treating urinary tract dysfunction with some types of aetiology, including acute spinal cord injury, and injury to nerves following pelvic surgery. It is, however, less likely that these treatments will be used successfully in the near future in patients in which the neural damage is long term, or associated with death of post-ganglionic neurons.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID