An evaluation of fascial staples (a new technique) in wide fascial plication during reconstructive abdominoplasty.

The purpose of this study is to evaluate the fascial stapler (a new technique) in the plication of the musculoaponeurotic fascia abdominoplasty in comparison to conventional (sutured) techniques. Thirty-eight patients underwent abdominoplasty with rectus sheath plication. Patients were randomized into staple and suture groups. Similar degrees of plicationing were performed in both groups (range, 12-20 cm). Fascial repairs were evaluated postoperatively at approximately 1 month and 6 months. A small, but comparable, subclinical fascial separation was demonstrated immediately in both the stapled and sutured groups. No progression of fascial separation was observed in either group at 1 month and 4 months postoperatively. No complications attributable to the fascial closure were noted in either group. Operative time was considerably less with the stapled technique. The results, although early, suggest that the use of fascial staples for plicationing of the musculoaponeurotic fascia during abdominoplasty is comparable to conventional (sutured) techniques regarding complication rate and disruption rate, but appreciably decreases operative time.

Serratus anterior intercostal nerve graft: a new vascularized nerve graft.

We present our investigative and clinical experience with a new vascularized nerve graft: the serratus anterior intercostal nerve graft. The serratus branch of the thoracodorsal arterial system was injected with silicone rubber injection compound in seven fresh cadavers (N = 11 injected specimens) after the composite serratus-intercostal structures were harvested. Microdissection of selected vascular territories was then performed. Our findings reconfirmed the previously described vascular connections between the thoracodorsal system and the intercostal vessels via periosteal vessels. We also newly discovered vascular anastomoses between the serratus anterior muscle and the intercostal artery running within a mesentery. This mesentery is lateral to and distinct from the serratus-periosteal-intercostal network. The nerve graft was applied clinically in the reconstruction of a complex soft-tissue, 13-cm ulnar nerve defect of the volar forearm after an electrical injury. The clinical application was successful with limb salvage and return of protective sensation at 4 months. Our clinical and investigative results support the feasibility of the serratus anterior intercostal nerve graft, a unique and versatile new vascularized nerve graft.