Name: The Superficial Inferior Epigastric Artery Fascia Flap for Nerve Reconstruction in Rabbits (Video) | JoVE Journal
Uploaded: 2025-06-13T14:50:00.000+00:00
Duration: 12 min 1 s
Description: Learn to harvest the superficial inferior epigastric artery fascia flap for nerve reconstruction in rabbits. This surgical protocol enhances vascularization and improves regeneration outcomes in peroneal nerve defects.

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5 minutes

The authors would like to thank Joanne Pedersen and Lisa Yngsdal for their expertise and assistance in the surgeries. The authors would like to thank Kevin Ness for recording the surgery footage. We would like to acknowledge Jim Postier for the illustrations in Figures 1, 4, 7, and 9-12. The research detailed in this publication received funding from the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number RO1 NS 102360. The content is the sole responsibility of the authors and does not necessarily reflect the official views of the National Institutes of Health.

All animal procedures were performed with approval of the Institutional Animal Care and Use Committee (IACUC A0000519020). The technique was performed in 36 New Zealand White rabbits to assess feasibility and long-term viability.
1. Animal Subjects
<ol>
	<li>Use male New Zealand white rabbits weighing between 3 and 3.2 kg. 
	NOTE: Anesthesia protocols and flap dimensions may need to be adjusted for other rabbit strains and species with varying weights.</li>
</ol>
2. Nerve graft preparation
<ol>
	<li>Select a nerve graft or conduit of choice to bridge the nerve defect. 
	NOTE: In this study, Dutch Belted rabbits served as donors for the nerve allografts to obtain a major histocompatibility complex mismatch with the recipients49. The donor animal was anesthetized using 35 mg/kg ketamine and 5 mg/kg xylazine intramuscularly in the lumbar region. After, the donor is sacrificed with an overdose of intravenous pentobarbital. The 40 mm peroneal nerve segment was harvested, cleaned of external debris, and processed to become a nerve allograft according to the previously described five-day decellularization protocol using chondroitinase and elastase. After decellularization, the nerve graft was sterilized using &#947;-irradiation and stored in phosphate-buffered saline (PBS) at 4 &#176;C until use9.</li>
</ol>
3. Surgical preparation
<ol>
	<li>Ensure all required surgical instruments are prepared before the surgery (see the Table of Materials).</li>
	<li>Determine the appropriate dosage of anesthesia based on the animal&#39;s weight.</li>
	<li>Induce anesthesia by intramuscular administration of ketamine (35 mg/kg) and xylazine (5 mg/kg).</li>
	<li>Inject 60 mL of warmed Lactated Ringers subcutaneously into the loose skin over the back of the rabbit to maintain proper hydration levels throughout the procedure.</li>
	<li>Subcutaneously administer 5 mg/kg enrofloxacin to prevent postoperative infections, 4 mg/kg carprofen to reduce inflammation and manage pain, and 0.18 mg/kg buprenorphine SR for additional pain management.</li>
	<li>Using electrical clippers, carefully shave the abdomen; in width starting 2 cm paramedian on the contralateral side of the procedure, ranging to the flank on the ipsilateral side; in length, starting under the xyphoid, ranging as distally as possible towards the groin. Shave the hindlimb on the ipsilateral side, ranging from the hip until as distal as possible towards the ankle.</li>
	<li>Intubate the rabbit and ventilate with 1 to 2% isoflurane using a Bain ventilation system. Monitor the vital parameters during surgery.</li>
	<li>Apply ophthalmic ointment to the eyes to protect the cornea during surgery.</li>
	<li>Position the rabbit on a heating pad in a prone position to ensure a body temperature of 37 &#176;C is maintained. Monitor the body temperature with a rectal thermometer probe.</li>
	<li>Mark the surgical sites.</li>
	<li>Test the surgical plane of anesthesia by firmly pinching the foot or gently touching the eye. A withdrawal of the foot or a blink, respectively, indicates inadequate anesthesia. If a positive response is observed, increase the anesthetic dosage to deepen anesthesia accordingly. Monitor the rabbit throughout the surgery and periodically test the reflexes to confirm the surgical plane of anesthesia.</li>
	<li>Prepare the skin with Betadine at the surgical field. The procedure will be performed in a sterile fashion. Ensure the hindlimb can be repositioned during surgery. Use surgical loupes and a surgical microscope to ensure clear visualization of the surgical field.</li>
</ol>
4. Surgical approach to the peroneal nerve reconstruction site
<ol>
	<li>Position the rabbit in right or left lateral recumbent position, based on the side selected for nerve reconstruction (Figure 2).</li>
	<li>Create a 10 cm incision in the skin of the posterolateral aspect of the thigh, parallel to the femur, starting at the greater trochanter using a scalpel with a surgical no. 15 blade.</li>
	<li>Ensure the plane between the biceps femoris muscle and the gluteus maximus and vastus lateralis muscles is correctly identified. Employ a retractor for visualization and use tenotomy scissors to perform a blunt dissection, separating these muscles to expose the underlying sciatic nerve. 
	NOTE: Ensure the fascia is released over the entire length of the nerve to create enough room for the flap.</li>
	<li>Reposition the retractor to maximize access to the nerve when needed.</li>
	<li>To locate the peroneal nerve, first identify the trifurcation of the sciatic nerve. The sciatic nerve divides into three branches, which include the common peroneal nerve, the tibial nerve, and the sural nerve. Reposition the retractor as needed to maximize visibility.</li>
	<li>Carefully separate the nerve from the surrounding connective tissue using curved microsurgical forceps. Ligate and cut the caudal femoral artery and vein for better mobility of the nerve.</li>
	<li>If necessary, place a microsurgery background sheath under the nerve for better visibility.</li>
	<li>Carefully isolate the common peroneal nerve branch of the sciatic nerve. This is usually the most ventral branch. If necessary, further isolate the branch under the surgical microscope (Figure 3).</li>
	<li>The nerve site is prepared for reconstruction after raising the adipofascial flap. Flush the site with 0.9% sodium chloride (NaCl) and temporarily approximate the skin with skin staples.</li>
</ol>
5. Surgical approach to the adipofascial flap
<ol>
	<li>Place the rabbit in a supine position.</li>
	<li>Starting under the xyphoid and medial to the nipple line, create a 10 to 14 cm superficial paramedian incision in the abdominal skin using a scalpel with a surgical no. 15 blade, on the ipsilateral side of the procedure (Figure 4).</li>
	<li>Bluntly dissect the fascia from the skin and release the incision step by step to avoid harming the fascia (Figure 5). Identify the femoral artery in the groin. Ligate small epidermal perforating branches as needed.</li>
	<li>Place single 4-0 nylon sutures in the epidermis along each side of the incision with mosquito forceps on each suture to delicately maneuver the skin whilst separating the skin from the subcutaneous tissues (Figure 6).</li>
	<li>Separate the skin from the fascia using tenotomy scissors, taking care to avoid damage to the SIE vessels, and ensure plenty of room to dissect the 14 x 10 cm flap in the ventral abdomen. Bipolar cauterize small epidermal perforating branches as needed. Take care to avoid damage to the pedicle while separating the skin from the fascia. If needed, further retract the skin using a retractor with four prongs to maximize visibility.</li>
	<li>Dissect the flap starting on the medial side, lateral from the linea alba, in a cephalad direction. Elevate the fascia whilst dissecting to avoid harming the abdominal muscles (Figure 7, Figure 8).</li>
	<li>As the flap is dissected further, separate the superficial- and deep membranous layers of subcutaneous tissue from the abdominal muscle layer, taking care not to damage the fascia. Bipolar cauterize small vessel branches as needed to prevent postoperative hematomas. 
	NOTE: The epigastric nerve will be encountered consistently running in conjunction with the SIE vessels and should be transected.</li>
	<li>Continue the dissection on the transverse side. Further separate skin from the fascia where needed to create more room for the dissection. Bipolar cauterize the SIE pedicle as cranial as possible to complete the transverse dissection. Further separate the superficial- and deep membranous layers of subcutaneous tissue between the abdominal muscles and the fascia as the flap is raised, taking care not to damage the fascia.</li>
	<li>Complete the dissection with the lateral dissection in the cephalad direction to elevate the flap.</li>
	<li>Raise the flap towards the level of the bifurcation of the femoral artery in both plains, taking care not to damage the SIE vessels (Figure 9). Further separate the superficial- and deep membranous layers of subcutaneous tissue between the abdominal muscles and the fascia to completely raise the flap prior to tunneling. 
	NOTE: Keep the flap moist using 0.9% NaCl during the entire flap dissection.</li>
</ol>
6. Tunneling of the flap towards the nerve reconstruction site
<ol>
	<li>Expose the peroneal nerve reconstruction site.</li>
	<li>Bluntly dissect a wide subcutaneous tunnel into the inguinal region above the fascia layer. Widen the tunnel from both sides to ensure the flap will not be constricted.</li>
	<li>Using a hemostat, pass the flap through the tunnel such that the flap is rotated approximately 100&#176; clockwise about its axis, and the vessels are kept ventrally (Figure 10). Ensure there is no pedicle torsion or compression in the subcutaneous tunnel with full mobility of the leg (Figure 11, Figure 12A).</li>
	<li>Keep the flap moist in wet gauze until it can be repositioned around the nerve bundle.</li>
	<li>Ensure all bleeders are bipolar cauterized and flush out the abdominal site.</li>
	<li>Approximate the abdominal incision in layers. Place single 4-0 absorbable sutures to approximate the deep subcutaneous tissue. Approximate the epidermis with a continuous 5-0 absorbable intracutaneous suture.</li>
</ol>
7. Repositioning of the SIEF flap under the nerve
<ol>
	<li>Re-expose the peroneal nerve reconstruction site using a retractor.</li>
	<li>Reposition the flap around the retractor and ensure there is no compression of the flap.</li>
	<li>Ensure the nerve bundle is mobile over the entire length so the flap can be repositioned around it.</li>
	<li>Elevate the nerve using a vessel loop to reposition the flap under the nerve using forceps.</li>
	<li>Ensure there is enough length of the flap to cover both anastomoses without compressing the nerve or the pedicle, with the full mobility of the leg (Figure 12B).</li>
</ol>
8. Nerve reconstruction
<ol>
	<li>Place a microsurgery background sheath under the common peroneal nerve branch of the sciatic nerve (Figure 13).</li>
	<li>Further separate the common peroneal nerve branch from the sciatic nerve bundle under the surgical microscope to ensure enough mobility and length for the reconstruction.</li>
	<li>cm distal to the border of the external obturator muscle, excise a 25-mm segment of the peroneal nerve with microsurgical scissors (Figure 14).</li>
	<li>Reconstruct the nerve defect with a 30 mm nerve allograft using 10-0 nylon epineural sutures on either side of anastomosis (Figure 15).</li>
	<li>Remove microsurgery background sheath.</li>
</ol>
9. Securing flap around the nerve
<ol>
	<li>Loosely wrap the pre-positioned SIEF flap around the nerve with the SIE vessels in line with the nerve, covering the proximal and distal anastomoses (Figure 16). 
	NOTE: Ensure there is no tension on the nerve anastomoses while repositioning the flap.</li>
	<li>Trim the flap edges as needed to fit the defect using tenotomy scissors (Figure 12C, Figure 18).</li>
	<li>Loosely place two 4-0 absorbable sutures through the edges of the flap to secure it around the anastomoses (Figure 12D, Figure 17).</li>
	<li>Approximate the hindlimb incision in layers. Place single 4-0 absorbable sutures to approximate the deep subcutaneous tissue. Approximate the epidermis with a continuous 5-0 absorbable intracutaneous suture.</li>
</ol>
10. Postoperative management
<ol>
	<li>Immediately postoperatively, an additional 60 mL of warmed Lactated Ringers SC will be administered.</li>
	<li>Place an Elizabethan collar on the rabbits for at least two weeks and until wounds are adequately healed.</li>
	<li>Subcutaneously administer 5 mg/kg enrofloxacin to prevent postoperative infections, 4 mg/kg carprofen to reduce inflammation and manage pain, once daily for 5 days postoperatively, of which the first dose is administered preoperatively. Additionally, administer 0.18 mg/kg buprenorphine SR for additional pain management can be subcutaneously administered every 72 hours as needed.</li>
	<li>Inspect the rabbits twice daily for the first five days, daily for the rest of the first month, and then once a week until sacrifice. Rabbits may bear weight and mobilize on the affected limb as tolerated.</li>
	<li>Monitor for postoperative complications, including wound infection, wound dehiscence and necrosis, reduced limb sensation with potential auto-mutilation, lameness, or seroma of the flap harvest area. 
	NOTE: The presence of auto-mutilation of the foot suggests inadequately managed pain and necessitates additional analgesia. If severe and persistent auto-mutilation occurs and remains unresponsive to enhanced pain management, consider humane euthanasia prior to the planned study endpoint.</li>
</ol>

The authors have no disclosures, and no commercial or financial affiliations that could be perceived as a potential conflict of interest.

This protocol details the harvest technique for a pedicled adipofascial flap model in the rabbit to provide a vascular bed for peroneal nerve reconstruction with long-term viability evaluation. The use of the SIEF flap to revascularize nerve grafts has previously been verified in rats37 but has not been detailed prior in larger animal models. This flap was harvested with minimal complexity, as it did not require intramuscular dissection and demonstrated consistent anatomical features. Its suitabil...

Traumatic nerve injuries commonly result in lifelong disabilities and diminished motor function, with an associated significant impact on the quality of life and socioeconomic status of patients1,2,3,4. When tension-free end-to-end epineural repair is not feasible, autograft interposition is the gold standard to maximize nerve regeneration. However, this requires harvesting a functional autologous nerve, involving associated donor site morbidity and limited availability5,6,7. Processed nerve allografts or conduits have been widely investigated as alternatives due to their ready and unlimited availability8,9. The application of allografts remains limited since the functional motor outcomes of nerve autografts, the current gold standard, remain superior9,10.
Revascularization of nerve grafts after peripheral nerve reconstruction continues to be one of the most significant challenges, resulting in limited nerve graft survival, function, and regeneration, particularly in nerve autograft substitutes that lack cellular materials and vascular supply, including acellular nerve allografts or conduits11,12,13. The incidence of central necrosis and diminished cellular survival after reconstruction increases with the length and diameter of a nerve graft, emphasizing the importance of a vascularized bed11,12,13. Surgical angiogenesis, the surgical addition of vascularization, is thought to minimize the duration of ischemia and diminish fibrosis and central necrosis by ensuring blood supply, resulting in enhanced axonal regeneration and faster reinnervation14,15. Moreover, wrapping a vascularized adipofascial flap around the reconstructed nerve graft is thought to enhance results in a significantly scarred tissue bed16,17,18,19,20,21.
Previous studies detailing the application of pedicled fascial flaps in basic science studies are sparse. Strauch and Murray first described the free superficial inferior epigastric artery (SIEA) flap in rats22. This technique has been used in various investigational and training models, including distal flap necrosis23,24,25,26,27, ischemia-reperfusion injury28,29,30,31, and microvascular training32. However, few studies have investigated the effect of adipofascial flaps wrapped around nerve grafts to enhance regeneration33,34,35.
In previous studies, we validated the surgical approach for the pedicled superficial inferior epigastric artery fascial (SIEF) flap in Lewis rats, aimed at increasing vascularization in the sciatic nerve bed, and demonstrated its effectiveness in improving motor function outcomes, nerve revascularization patterns, immunohistochemistry, systemic immune response, gene expression36,37,38,39,40. The flap was found to be technically easy to harvest, and appropriate for revascularization procedures of various tissues in the lower abdomen, genital area, thigh, or upper limb with evaluated long-term survivability in rats37. All flaps were found to be viable and patent at sacrifice, with no flap-related complications37. Adipofascial flaps wrapped around reconstructed nerve defects need to be evaluated in larger animals prior to clinical translation to accurately interpret the effect. In humans, nerves must regenerate across larger distances with a lower regeneration rate, progressively causing distal nerve and target organ deterioration41,42. In rats, the superlative neuroregenerative capacity, small nerve gap, and short regeneration distance may result in enhancement of nerve regeneration, which could fail to translate to larger animal models41,43,44,45,46,47. In rabbits, the SIEF flap has shown strong angiogenetic, pliability, and stability characteristics for the revascularization of bone grafts35. However, fascial flaps have not previously been described for revascularization of nerve grafts in rabbits37.
The SIEF flap is a pedicled flap that is vascularized by the superficial inferior epigastric (SIE) vessels, comprising both arteries and their accompanying venae commitantes37,48. The vessels arise from the femoral vessels in proximity to branches of the popliteal and saphenous vessels37,48, 12-18 mm distal from the inguinal ligament, depending on the weight of the rabbit35. The SIE vessels pass through the inguinal ligament fascia into the highly vascularized inguinal fat pad, wherein the superficial circumflex iliac artery (SCIA) and a single vein branch in a lateral direction35. The SIE vessels are direct cutaneous artery and vein branches. The main trunk of the SIE vessels bifurcates into two branches. The lateral trunk enters the abdominal wall skin, and the smaller medial branch joins the internal mammary vessel as it extends towards the medial abdominal skin (Figure 1)37,48. SIEF flaps are ideal for revascularization, considering the minimal thickness, allowing for a large contact area between the flap and graft35.
This article details a comprehensive step-by-step protocol of the surgical technique to harvest a pedicled SIEF flap in the rabbit, meet the requirements for a tunneled adipofascial flap, and vascularize the peroneal nerve reconstruction site to enhance peripheral nerve regeneration after reconstruction. Additionally, this protocol may be adapted for revascularization of reconstructed nerves in the lower abdomen, genital area, thigh, or upper limb in rabbits.

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Mueller, Vernon Hills, IL, USA</td><td>OP2720</td><td>Metric Ruler, 6in, 15.2cm</td></tr><tr><td>Microsurgery background sheath</td><td>Merican Surgical Supply Co Limited, Topaz Way, Bromsgrove, United Kingdom.&amp;nbsp;</td><td>VB3</td><td>Merican Visibility Background Material&amp;nbsp;</td></tr><tr><td>Microsurgical curved forceps</td><td>ASSI, Westbury, NY, USA</td><td>JFA-5B</td><td>Forceps Cobalt Non Glare 11cm Flat Handle 9mm wide 45 Angle, tip 0.3mm diameter</td></tr><tr><td>Microsurgical scissors</td><td>ASSI, Westbury, NY, USA</td><td>SAS-15R-8-18</td><td>Adventitia Scissors, 15cm long Round Handle 8mm diameter, Straight Blade, 18mm long</td></tr><tr><td>Microsurgical straight forceps</td><td>ASSI, Westbury, NY, USA</td><td>JF-5</td><td>Forceps, 11cm long, Flat Handle 9mm Wide, Straight Tip 0.3mm diameter</td></tr><tr><td>Needleholder</td><td>Capital Medical Resources, Powell, OH, USA</td><td>#CN061</td><td>Codman 36-2000 Classic Plus Crile Wood Needleholder</td></tr><tr><td>Pentobarbital&amp;nbsp;</td><td>Vortech Pharmaceuticals, Dearborn, Mitch.</td><td></td><td>Fatal Plus</td></tr><tr><td>Phosphate-buffered saline</td><td>Thermo Fisher Scientific, MA, USA</td><td>10010 023</td><td>PBS, pH 7.4</td></tr><tr><td>Rectal thermometer</td><td></td><td></td><td></td></tr><tr><td>Retractor, 4 prongs, blunt</td><td>Miltex</td><td>CESS-720448-00001</td><td>Miltex 11-572 Murphy Retractor, 7&amp;frac12;&quot;, 4 Prongs, Blunt</td></tr><tr><td>Right angle forceps</td><td>V. Mueller, Vernon Hills, IL, USA</td><td>SU10496</td><td>Forceps Micro-Line Mixter 5 Inch Length Surgical Grade Stainless Steel NonSterile Ratchet Lock Finger Ring Handle Angled 90&amp;deg; Delicate, Serrated Jaws</td></tr><tr><td>Scalpel Blade No. 15</td><td>Bard-Parker, Aspen Surgical, Caledonia, MI, USA</td><td>371115</td><td>Surgical Blade Bard-ParkerRib-BackCarbon Steel No. 15 Sterile Disposable Individually Wrapped 371115 Box/50</td></tr><tr><td>Scalpel holder</td><td>Electron Microscopy Sciences, Hatfield, PA, USA</td><td>50-949-167</td><td>Feather Scalpel Handle #3</td></tr><tr><td>Self-retaining clip retractor</td><td>ASSI, Westbury, NY, USA</td><td>AG-124426</td><td>Heiss Self Retaining Skin Retractor, 4 Blt. Prongs, 8mm W X 5mm D, 10cm long Blunt</td></tr><tr><td>Self-retaining retractor, large</td><td>ASSI, Westbury, NY, USA</td><td>MTK8572620</td><td>Weitlaner Retractor with ratchet, 20cm 8&quot;, 3x4 Sharp teeth</td></tr><tr><td>Self-retaining retractor, medium</td><td>ASSI, Westbury, NY, USA</td><td>MTK8732616</td><td>Weitlaner Retractor, with Ratchet, 16.5cm 3x4 Sharp Teeth</td></tr><tr><td>Self-retaining retractor, small</td><td>Millenium Surgical, Bala Cynwyd, PA, USA</td><td>1-609</td><td>Weitlaner retractor, 4&quot;, Blunt</td></tr><tr><td>Sharp tipped tenotomy scissors</td><td>Aesculap, Center Valley, PA, USA</td><td>Aesculap BC177R</td><td>Aesculap BC177R - SCISSOR JAMESON SS CURVED</td></tr><tr><td>Sharp tipped tenotomy scissors</td><td>ASSI, Westbury, NY, USA</td><td>ASIM-187</td><td>Tenotomy Scissors, Curved, 14cm, Tungsten Carbide Jaw</td></tr><tr><td>Sharp tipped tenotomy scissors</td><td>Fehling Surgical Instruments, Inc., Kennesaw, GA, USA</td><td>BOS-7</td><td>CERAMO TC STEVENS, Curved, 125 mm</td></tr><tr><td>Silicone rubber injection compound</td><td>Flow tech INC., Boulder, CO, USA</td><td>MV-122</td><td>MICROFIL Silicone Rubber Injection Compound, yellow, Kit B 1 lb</td></tr><tr><td>Skin stapler</td><td>Covidien, Mansfield, MA, USA</td><td>8886803512</td><td>Covidien Appose ULC AutoSuture Slim Body Skin Stapler 35 W</td></tr><tr><td>Stockinette</td><td>Cardinal Health, Dublin, OH, USA</td><td>23650-020</td><td>Stockinette, Tubular, Cotton, Non-Sterile, width 2&quot;</td></tr><tr><td>Surgical gloves</td><td>Cardinal Health, Dublin, OH, USA</td><td>2D73PM--</td><td>Protexis PI Micro Surgical Gloves&lt;br/&gt; Depending on size surgeon</td></tr><tr><td>Surgical gown</td><td>Halyard, Alpharetta, GA, USA</td><td>44672</td><td>Aero Chrome Breathable Performance Surgical Gown&lt;br/&gt; Depending on size surgeon</td></tr><tr><td>Surgical loupes</td><td>Zeiss, Oberkochen, Jena, Germany&amp;nbsp;</td><td></td><td>Head-worn Loupes EyeMag Pro F, 4.3 magnification&lt;br/&gt; Depending on size surgeon</td></tr><tr><td>Surgical Mask</td><td>Halyard, Alpharetta, GA, USA</td><td>49235</td><td>Anti-Fog Surgical Mask</td></tr><tr><td>Surgical microscope</td><td>Med Link USA Inc, Des Moines, IA, USA</td><td>151418</td><td>Z880 Reconstructive Surgical Microscope</td></tr><tr><td>Surgical towels</td><td>Medline, Northfield, IL, USA</td><td>MDT2168286Z&amp;nbsp;</td><td>Sterile Disposable Surgical Towels, Blue&amp;nbsp;</td></tr><tr><td>Vessel loop</td><td>Cardinal Health, Dublin, OH, USA</td><td>24000-01B</td><td>&lt;br/&gt; DEVON Silicone Vessel Loops</td></tr><tr><td>Xylazine</td><td>Bimeda MTC Animal Health, Cambridge, Canada</td><td>1XYL002</td><td>&amp;nbsp;XYLAMED- xylazine injection, solution</td></tr></tbody></table>

the superficial inferior epigastric artery fascia flap for nerve reconstruction in rabbits

The Superficial Inferior Epigastric Artery Fascia Flap for Nerve Reconstruction in Rabbits

The addition of surgical angiogenesis to reconstructed peripheral nerves is argued to improve nerve regeneration. Surgical angiogenesis can be performed by wrapping a vascularized flap around the nerve graft, which is believed to enhance nerve regeneration following reconstruction. The protocol aimed to outline the surgical procedure and report long-term viability and patency for the superficial inferior epigastric artery fascia (SIEF) flap in a rabbit peroneal nerve defect model to add vascularization and enhance nerve regeneration. In this article, step-by-step instructions on the harvest and application of the pedicled adipofascial flap to add vascularization to the peroneal nerve reconstruction site are described. The technique was performed on 36 New Zealand White rabbits to assess feasibility and long-term viability. To harvest a 14 x 10 cm flap, a 14 cm paramedian abdominal incision on the ipsilateral side of the nerve reconstruction was made. After identifying the superficial inferior epigastric (SIE) vessels, the flap was dissected mediodistally, elevated toward the proximal branch of the SIE vessels, and guided through a subcutaneous inguinal tunnel to the previously exposed peroneal nerve reconstruction site, ensuring the pedicle remained free of torsion. The peroneal nerve defect was reconstructed, after which it was loosely wrapped with the harvested flap. The flap was secured, covering both anastomoses, without observed tension and compression on the flap or the reconstructed nerve. At 16 and 24 weeks postoperatively, flap viability was assessed using the milking patency test, along with an evaluation of flap color and the presence of active bleeding at its edges. At sacrifice, all SIEF flaps remained viable, with patent vessels and no flap-related complications. This flap was harvested with minimal complexity and demonstrated consistent anatomical features. Its suitability for revascularization procedures in the lower abdomen, genital area, and thigh in rabbits suggests potential translation to larger animal models.

The surgical technique can be assessed for success using various parameters, including post-operative complications, viability of the flap at sacrifice, immunohistochemistry to confirm the presence of fibrosis and neovascularization, and microcomputed tomography (micro-CT) scanning to visualize neovascularization patterns. 36 rabbits underwent the surgical technique, for survival periods of 16 or 24 weeks (N=18 per timepoint). During the survival period, no infections, hematomas, seromas, or lymphedemas were observed at ...

This protocol presents a step-by-step instruction for harvesting the superficial inferior epigastric artery fascia (SIEF) flap and wrapping it around the reconstructed peroneal nerve defect in rabbits. This surgical addition of vascularization to the tissue bed of nerve grafts is used to improve regeneration outcomes.

The addition of surgical angiogenesis to reconstructed peripheral nerves is argued to improve nerve regeneration. Surgical angiogenesis can be performed ...

the-superficial-inferior-epigastric-artery-fascia-flap-for-nerve

Research

JoVE Journal

Neuroscience

An optimized technique for the microsurgical creation of arterial bifurcation aneurysms mimicking bifurcation human cerebral aneurysms is described. A venous pouch is sutured into an artificially created true bifurcation of both common carotid arteries. Facilitated microsurgical techniques and aggressive postoperative anticoagulation and analgesia lead to minimized morbidity rates and high aneurysm patency rates.

Microsurgical Venous Pouch Arterial-Bifurcation Aneurysms in the Rabbit Model: Technical Aspects

Free tissue transfer is widely employed in reconstructive surgery to restore form and function following oncological resection and trauma. Preconditioning this tissue prior to surgery may improve outcome. This article describes an in situ transverse rectus abdominis myocutaneous flap (TRAM) in rats as a means for testing preconditioning strategies.

In situ Transverse Rectus Abdominis Myocutaneous Flap: A Rat Model of Myocutaneous Ischemia Reperfusion Injury

To date, thick tissue defects are typically reconstructed by applying autologous tissue flaps or engineered tissues. In this protocol, we present a new method for engineering vascularized tissue flap bearing an autologous pedicle, to serve as a substitute to autologous flaps.

Engineered Vascularized Muscle Flap

This paper describes the steps required to raise a fasciocutaneous epigastric free flap and transfer it to the neck in the rat.

A Model of Free Tissue Transfer: The Rat Epigastric Free Flap

Developing and testing endovascular devices for intracranial aneurysm treatment is still of great importance. Most aneurysm models used today miss either the important characteristics of an arterial degenerated wall or the hemodynamics of a true bifurcation. Therefore, we aimed to design a novel arterial pouch bifurcation model in rabbits.

Arterial Pouch Microsurgical Bifurcation Aneurysm Model in the Rabbit

The present protocol describes the porcine fascio-cutaneous flap model and its potential use in vascularized composite tissue research.

A Reliable Porcine Fascio-Cutaneous Flap Model for Vascularized Composite Allografts Bioengineering Studies

This protocol describes harvesting, suturing, and monitoring fasciocutaneous flaps in rats that allow for good visualization and manipulation of blood flow through the superficial inferior epigastric vessels by means of clamping and ligating the femoral vessels. This is critical for studies involving ischemic preconditioning.

The Superficial Inferior Epigastric Artery Axial Flap to Study Ischemic Preconditioning Effects in a Rat Model

This protocol describes a step-by-step procedure for harvesting a vascularized and reinnervated abdominal wall allograft, detailing its anatomic landmarks, technical requirements, and future potential clinical applications.

Procurement for a Vascularized and Reinnervated Abdominal Wall Allotransplantation

Optic Nerve transection is a widely used model of adult CNS injury. This model is ideal for performing a number of experimental manipulations that target the retina globally or directly target the injured neuronal population of retinal ganglion cells.

Methods for Experimental Manipulations after Optic Nerve Transection in the Mammalian CNS

Cochlear implants (CIs) enable hearing by direct electrical stimulation of the auditory nerve. However, poor frequency and intensity resolution limits the quality of hearing with CIs. Here we describe optogenetic stimulation of the auditory nerve in mice as an alternative strategy for auditory research and developing future CIs.

Optogenetic Stimulation of the Auditory Nerve

Learn to harvest the superficial inferior epigastric artery fascia flap for nerve reconstruction in rabbits. This surgical protocol enhances vascularization and improves regeneration outcomes in peroneal nerve defects.

The Superficial Inferior Epigastric Artery Fascia Flap for Nerve Reconstruction in Rabbits

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