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Abstract

Volume 22, Issue 5 (September 2020) 22, 459–464; 10.4103/aja.aja_133_19

Tissue expander capsule as an induced vascular bed to prefabricate an axial vascularized buccal mucosa-lined flap for tubularized posterior urethral reconstruction: preliminary results in an animal model

Hai-Lin Guo1,2,3,4, Lin Wang1,2,3, Zhi-Ming Jia1, Xing-Qi Bao1, Yi-Chen Huang1, Jun-Mei Zhou5, Hua Xie1, Xiu-Jun Yang6, Fang Chen1,2,3

1 Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
2 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
3 Shanghai Eastern Urological Reconstruction and Repair Institute, Shanghai 200233, China
4 Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
5 Central Laboratory, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China
6 Department of Radiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai 200062, China

Correspondence: Dr. F Chen (doctorchenfang@126.com)

Date of Submission 24-Jul-2019 Date of Acceptance 09-Sep-2019 Date of Web Publication 10-Jan-2020

Abstract

Surgical repair of complex posterior urethral disruptions remains one of the most challenging problems in urology. The efficacy of using a tissue expander capsule as an induced vascular bed to prefabricate axial vascularized buccal mucosa-lined flaps for tubularized posterior urethral reconstruction in a rabbit model was tested. The experiments were performed in three stages. First, silicone tissue expanders were inserted into the groin to induce vascularized capsule pouch formation. Next, buccal mucosa grafts were transplanted into the newly formed capsular tissue supplied by axial vessels for buccal mucosa-lined flap prefabrication. Then, circumferential posterior urethral defects were created and repaired with the buccal mucosa graft (Group 1), the capsule flap (Group 2), and the prefabricated capsule buccal mucosa composite flap (Group 3). After surgery, notable contracture of the tubularized buccal mucosa graft was observed in the neourethra, and none of the rabbits in Group 1 maintained a wide urethral caliber. In Group 2, the retrieved neourethra showed little evidence of epithelial lining during the study period, and the lumen caliber was narrowed at the 3-month evaluation. In Group 3, the buccal mucosa formed the lining in the neourethra and maintained a wide urethral caliber for 3 months. The capsule may serve as an induced vascular bed for buccal mucosa-lined flap prefabrication. The prefabricated buccal mucosa-lined flap may serve as a neourethra flap for posterior urethral replacement.

Keywords: buccal mucosa; flap; prefabrication; urethra; vascularization

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