Autologous Free Reverse Inlay Vein Graft in the Treatment of Cripple Hypospadias; an experimental rabbit model

Abstract

Objective: The aim of this study is using the autologous reverse inlay jugular vein graft as a substitute for defective urethral plate and the incorporation of the graft to the urethral plate. Cripple hypospadias are the patients who have a history of previous multiple unsuccessful hypospadias surgery and still having anatomical and functional complications. Insufficient local or support tissue for the repair of defective urethral plate is always a problem. Material and Methods: In the study fourteen male 8-10 months old which is weighting four kg, New Zealand type rabbit are divided into two equal groups. Juguler vein graft (1st group) and buccal mucosal graft (2nd group) harvested and transferred to defective area in the urethral plate as a free flap. Results: In the histopatologic examination, epithelization, fibrosis and inflammation degrees were evaluated between the groups and in-groups. In the histopatological examination of the 1st group, uroepithelization is complete or nearly complete, fibrotic activity is (+) and the inflammation was found minimal. In the second group after 21st day, the uroepithelization on the graft is nearly thirty percent, fibrotic activity is (++) and the inflammation is also found minimal. Conclusion: From the results of the study, in the treatment of defective urethra in cripple hypospadias cases, reverse free juguler vein graft can be used as an alternative for buccal mucosa graft as a substitution material which has been used for a long time.

Keywords

• Cripple hypospadias
• urethral reconstruction
• vein graft

Kriple Hipospadias Tedavisinde Otolog Serbest Ters Inlay Ven Greftini; Deneysel Bir Tavşan Modeli

Abstract

Amaç: Çalışmanın amacı hipospadias sakatlı olgularda defektif üretranın yerine juguler venin serbest reverse greft olarak getirilmesi ve bu dokunun üretral plak ile olan uyumunun incelenmesidir. Hipospadias sakatlı olgular, daha önce hipospadias nedeni ile tamir edilmeye çalışılmış, fonksiyonel ve anatomik komplikasyonları devam eden hipospadias grubu olarak tanımlanabilir. Bu hastalarda defektif üretral plak onarımında tübülarize edilecek lokal yada destek dokusunun bulunmayışı hemen daima sorun oluşturmaktadır. Gereç ve Yöntemler: Çalışmada on dört adet genç erişkin, ortalama ağırlığı dört kilo olan, 8-10 aylık, erkek New Zealand cinsi tavşan; yedi tavşandan oluşan iki gruba bölündü. Birinci gruptan juguler ven grefti, ikinci gruptan bukkal mukoza grefti alındı ve alınan greftler üretral plakta oluşturulan defekte serbest flep olarak aktarıldı. Bulgular: Histopatolojik incelemede grup içi ve gruplar arası epitelizasyon, fibrozis ve inflamasyon değerlendirildi. Juguler ven grefti kullanılan grubun (Grup 1) histopatolojik incelemesinde üroepitelizasyonunun tam veya tama yakın olduğu, fibrotik (+) ve inflamasyonun minimal olduğu izlendi. Bukkal mukoza grefti uygulanan grupta (Grup 2) ise üroepitelizasyonun yirmi birinci gün sonunda greft üzerinde yüzde otuz civarında olduğu, fibrotik aktivitenin (++) ve inflamasyonun minimal olduğu izlendi. Sonuç: Çalışmamızın sonucunda hipospadias sakatlı olgularda defektif üretranın onarımında reverse serbest juguler ven greftinin uzun zamandır kullanılagelen bukkal mukozaya alternatif olarak kullanılabileceği sonucuna varılmıştır.

Keywords

• Greft alımı
• Hipospadiyas
• Uretra

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