The Mesenteric Vascular Pedicle

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SEGMENTS of small intestine have been used in humans for reconstruction or replacement of other organs both intra- and extra-abdominal in location. This paper presents a résumé of the various ways in which such segments have been employed and reports our own experimental use of them in dogs.

Bowel Segment as a Pedicled Graft

The mesenteric vascular pedicle has been used intraabdominally in the urologic, the gastrointestinal, the gynecologic, and the plastic branches of surgery. Von Mikulicz, in 1898, used a segment of intestine to enlarge the urinary bladder, and in 1909 Shoemaker reported the use of an ileal pouch as a substitute for a tuberculous bladder.1 Intestinal segments have been used to enlarge a contracted bladder such as Scheele’s loop anastomosis (1922) and Tasker’s patch (1953).1 This type of procedure was termed ileocystoplasty. Replacement of a ureter by an ileal segment was reported by Longuet2 in 1948. Bricker3 in 1950 reported the satisfactory use of the ileal segment as a total substitute for the bladder, implanting ureters as an end-to-side procedure with the open end of the ileum as an abdominal cutaneous ileostomy. Bricker3 refined the technics conceived and carried out by Verhoogen in 1908.

As a replacement for the stomach after total gastrectomy Lee4 interposed terminal ileum and a segment of the right colon on its vascular pedicle between the distal portion of the esophagus and the duodenum. The ileocecal valve served as a replacement of the esophagogastric sphincter.

An ileal segment within the abdomen has been used. . .



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