Long-term morphometric and immunohistochemical findings in human free microvascular muscle flaps

Reinnervation, muscle regeneration, density of microvessels, and muscle‐type specific atrophy were studied 3–4 years after surgery in surgically nonreinnervated free microvascular muscle flaps to 13 patients transplanted to the upper or lower extremities. Routine histology and immunohistochemistry f...

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Bibliographic Details
Published in:Microsurgery 2004, Vol.24 (1), p.30-38
Main Authors: Kauhanen, M. Susanna C., Lorenzetti, Fulvio, Leivo, Ilmo V.V., Tukiainen, Erkki, Asko-Seljavaara, Sirpa L.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Cell Division
Combined surgery. Multiple transplantations
Female
Humans
Immunohistochemistry
Male
Medical sciences
Muscle Fibers, Skeletal - physiology
Muscle, Skeletal - physiology
Muscle, Skeletal - surgery
Muscular Atrophy - pathology
Regeneration
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgical Flaps - blood supply
Surgical Flaps - innervation
Surgical Flaps - physiology
Time Factors
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Summary:Reinnervation, muscle regeneration, density of microvessels, and muscle‐type specific atrophy were studied 3–4 years after surgery in surgically nonreinnervated free microvascular muscle flaps to 13 patients transplanted to the upper or lower extremities. Routine histology and immunohistochemistry for PGP 9.5 and S‐100 (neuronal markers), Ki‐67 (cell proliferation), myosin (muscle fiber types), and CD‐31 (endothelium) were carried out, and results were analyzed morphometrically. Three to 4 years after surgery, severe atrophy of predominantly slow‐type fibers was seen in 9 cases. In 4 cases, muscle‐fiber diameter and fiber‐type distribution were close to normal. Long intraoperative muscle ischemia and postoperative immobilization were associated with poor muscle bulk in flaps. The density of microvessels in flaps did not differ from control muscles. PGP 9.5 and S‐100 immunopositive nerve fibers were detected in 7 patients. Reinnervation was associated with good muscle bulk. In 4 patients, activation of satellite cells was evident. The results suggest that in some cases, spontaneous reinnervation may occur in free muscle flaps, and that several years after microvascular free flap transfer, the muscle still attempts to regenerate. © 2004 Wiley‐Liss, Inc.
ISSN:0738-1085
1098-2752
DOI:10.1002/micr.10189