Autoplasty

AUTOPLASTY (from Greek autos-self and plassein-to mold), plastic operations in which the material used is the patient's own tissues (of a human or an animal). In plastic operations the goal is usually achieved by moving tissues taken either in immediate proximity to the field of operation or at a distance from it. In the first case the parts to be moved are not completely detached, but are made more mobile by means of various auxiliary incisions. Sometimes small auxiliary incisions are sufficient to make the moving part sufficiently mobile; sometimes, however, it is necessary to cut out so-called flaps that remain connected to their bed by a pedicle. Through this pedicle the flap is nourished during the time necessary for its engraftment at the new place. After this (usually after 12-15 days) the pedicle, if it interferes, may be severed, and the flap will be nourished through newly formed vessels at the site of engraftment. In the second case, i.e., when transplanting flaps from distant parts of the body, they can be taken either also in the form of flaps on a pedicle or in the form of completely detached ("free") flaps. The transfer of a flap on a pedicle from a distant part of the body is effected either by bringing these parts of the body closer together or by so-called migration of flaps. The bringing together is achieved by various methods: either the part of the body with the cut-out flap is brought close to the field of operation, for example, a hand with a skin flap for rhinoplasty is bandaged to the head (the "Italian method"), or, conversely, the part of the body being operated upon is brought close to the flap; for example, to close a skin defect on the hand a skin flap can be cut out on the abdomen and the hand bandaged to this place. Migration of flaps is performed as follows: a long skin flap on a pedicle is cut out so that the pedicle is located closer to the defect to be closed. The flap is turned over towards the defect and its free end is sutured to the skin incision made for this purpose. When this end has engrafted (after 10-15 days) the pedicle is severed, the site of engraftment itself becomes the pedicle, and the flap is turned over again towards the defect. A skin incision is made again, and the end of the flap is sutured, and after 10-15 days the next stage. Thus, the flap seems to step towards the defect at intervals of 10-15 days until it approaches the site of the defect. When cutting out a flap on a pedicle it is necessary to remember that almost all soft tissues are in a state of greater or lesser stretching and contract upon detachment; for example, skin flaps (on a pedicle or free) contract almost to one-third of their size after being cut out. When placing them in position one should not stretch them to their former size, as this always has a bad effect on their nourishment and, consequently, on their engraftment; they should be fixed at the new place without any tension; therefore they must be cut out with an appropriate reserve. Since the nourishment of the flap on a pedicle in the first days occurs through the vessels of the pedicle, it is important to cut them out so that significant vessels pass through the pedicle. A sign of good blood supply of the flap immediately after its cutting out and detachment is the color of the flap: if the flap retains approximately a normal color and its edges bleed at least a little, this is a good sign speaking for the viability of the flap; a bluish-pale, non-bleeding flap causes concern about its fate, although it must be noted that the vessels of the pedicle may adapt, and insufficient nourishment in the first hours may be restored after some time. It is much simpler and sooner when cutting out flaps from distant parts of the body to use completely detached ("free") flaps. The possibility of engraftment of these flaps at the new place is based on the fact that our tissues do not die immediately upon detachment from the organism, but remain alive for some time, and if during this time the transplanted flap manages to grow new vessels from the side of the bed to which the transplantation was made and, thus, receives its blood supply and, consequently, nourishment, then its further fate is already more or less secured. Different tissues do not preserve their viability for the same length of time after detachment, therefore their ability to engraft is not the same. Generally, epithelium and connective tissue are capable of free transplants, muscular and nervous tissue are not capable; therefore, in autoplasty operations on muscles and nerves one has to use exclusively flaps on a pedicle. Transplantations of tissues and organs are performed not only in plastic operations, but also for other purposes, for example, transplantation of internal secretion organs in case of prolapse or decrease in function of the corresponding gland. If the organ to be transplanted is taken from the patient himself, such transplants are also called autoplasties, although these operations, strictly speaking, do not belong to plastic ones, and it would be more correct to speak of autotransplantations. Autoplasty operations are performed on skin, mucous membranes, muscles, tendons, fasciae and aponeuroses, peripheral nerves, bones, and organs of the digestive tract (see also Homoplasty and Heteroplasty).

V. Pokotilo.