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ObjectiveTo describe and evaluate an ultrasound-guided modified subcostal approach for the transversus abdominis plane (TAP) block in horse cadavers in lateral or dorsal recumbency.Study designProspective, experimental cadaveric study.AnimalsStudy of one preserved foal and eight fresh adult horse cadavers.MethodsThe lateral and ventral abdominal wall of a preserved cadaver was dissected to identify the muscles and nerves. A unilateral standard TAP block technique was performed (60 mL of methylene blue dye–bupivacaine) on a fresh cadaver in right lateral recumbency. A modified subcostal technique was performed on the opposite side using a linear ultrasound transducer and in-plane approach. Injection points (two 30 mL dye) were at the level of the TAP (between the rectus abdominis and transversus abdominis muscles and ventral to the cutaneous trunci muscle) perpendicular to: 1) the mid-point between the xiphoid cartilage and umbilical scar; and 2) at a point between the caudal and middle thirds of the abdomen measured from the first injection point to the umbilical scar. The modified subcostal approach was performed in seven additional cadavers in both hemiabdomens, with three cadavers in lateral and four cadavers in dorsal recumbency. Ultrasound guidance was used with all injections.ResultsThe standard approach stained the sixteenth to eighteenth thoracic nerves (T16–T18). The modified subcostal approach performed in lateral recumbency provided greater spread (T9–T17) than dorsal recumbency (T12–T18) (p = 0.016).Conclusions and clinical relevanceThe modified subcostal TAP approach resulted in extensive staining exceeding the standard approach. The nerves stained are consistent with production of ventral abdominal wall anesthesia in horses. Clinical studies are needed to verify these findings.  相似文献   

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Objective

This study evaluated the spread of a two-point transversus abdominis plane (TAP) injection in canine cadavers. Compared with previous techniques, the two-point TAP injection was developed to increase the consistency of local anaesthetic spread to the nerve segments T11, T12, L1, L2 and L3.

Study design

Prospective experimental trial.

Animals

Five fresh canine cadavers.

Methods

Two-point TAP injections were performed under ultrasound guidance by a single trained individual in canine cadavers (15.7–43.0 kg). Each hemi-abdomen was infiltrated and evaluated independently for a total of 10 evaluations of the technique. The first injection was performed at the level of the costo-chondral junction of the thirteenth rib, and the second injection was performed cranial to the tuber coxae. Each injection comprised 0.3 mL kg–1 methylene blue solution (0.0015 mg mL–1). Ten minutes after the injections, abdominal wall dissection was performed, and any nerves stained for a minimum of 10 mm along their long axis were identified and recorded.

Results

During all injections, separation of the internal oblique and transversus abdominis muscles was observed on ultrasound. On dissection, branches of T12, T13, L1, L2 and L3 were adequately stained in 30%, 100%, 100%, 90% and 90% of injections, respectively. No staining of branches of T11 occurred in any of the cadavers. In one hemi-abdomen, branches of L1 and L3, but not L2, were stained.

Conclusions and clinical relevance

This study indicates that the two-point TAP injection delivers consistent dye dispersion to adequately stain branches of T13, L1, L2 and L3, with no coverage of T11 and poor coverage of T12, in fresh canine cadavers. An in vivo study using local anaesthetic should be performed to evaluate the analgesic efficacy of this technique in mid to caudal abdominal surgeries.  相似文献   

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ObjectiveTo compare the dye distribution following either two lateral abdominal or one lateral abdominal and one subcostal ultrasound-guided transversus abdominis plane (TAP) injections of a clinically relevant volume of dye solution in dogs.Study designRandomized cadaveric study.AnimalsA total of eight canine cadavers.MethodsOn one side of each cadaver, two TAP injections were performed on the lateral aspect of the abdomen (approach LL), caudal to the last rib and cranial to the iliac crest. On the contralateral hemiabdomen, one subcostal (caudal to the costal arch) and one lateral abdominal injection (between last rib and iliac crest), were performed (approach SL). Side allocation was randomly determined. A spinal needle was introduced in-plane to the transducer for each injection of methylene blue (0.25 mL kg?1). All cadavers were dissected to assess dye distribution and number of stained target nerves.ResultsAll injections were performed in the TAP. The proportion of target nerve staining was 53.5% versus 80.4% with approaches LL and SL, respectively (p = 0.005). Approach LL stained the first lumbar (L1) spinal nerve in 100% of injections and ninth thoracic (T9), T10, T11, T12, T13 and L2 were stained in 0%, 0%, 37.5%, 62.5%, 87.5% and 87.5% of injections, respectively. Approach SL stained T11, L1 and L2 in 100% of injections and T9, T10, T12 and T13 were stained in 37.5%, 87.5%, 75% and 62.5% of injections, respectively. Approach SL resulted in greater staining of nerves cranial to T12 compared with approach LL. The two approaches were equivalent in staining nerves caudal to T12.Conclusions and clinical relevanceApproach SL provided a broader distribution of the injected solution than approach LL, which may result in a larger blocked area in live animals undergoing celiotomy.  相似文献   

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ObjectiveTo determine whether the addition of bupivacaine or contrast medium to methylene blue dye would affect dye distribution following ultrasound (US)-guided transversus abdominis plane (TAP) injections.Study designProspective, randomized, blinded cadaveric study.AnimalsA total of 29 fresh Beagle dog cadavers.MethodsEach hemiabdomen (n = 58) was randomized into one of three groups: group M, 1% methylene blue; group MB, 50:50 mixture of 1% methylene blue and 0.5% bupivacaine; group MC, 25:75 mixture of 1% methylene blue and contrast agent (iohexol). TAP injections (0.5 mL kg–1) were performed bilaterally by a trained individual followed by dissection of the abdominal walls. Craniocaudal and dorsoventral spread along tissue planes was measured. Staining of branches of the thoracic and lumbar spinal nerves was considered successful when dye on the nerve was >10 mm. One-way anova with post hoc Tukey test was used to compare craniocaudal and dorsoventral spread and Kruskal–Wallis test to compare incidence of nerve staining among groups.ResultsTAP injections were successful in 52 out of 58 hemiabdomens. Dorsoventral spread was greater for group M (60 ± 10 mm) compared with MC (49 ± 9 mm; p = 0.01) but not MB (52 ± 9 mm; p = 0.09). No difference was found in craniocaudal spread or number of nerves stained among groups.Conclusion and clinical relevanceThe significant difference found in spread of tissue staining between methylene blue alone and methylene blue mixed with contrast in the TAP blocks should be kept in mind when interpreting dye-based cadaveric regional anesthesia studies.  相似文献   

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Colic surgery is one of the most painful procedures carried out in horses. Common strategies to alleviate immediate postsurgical abdominal pain include the administration of potent systemic analgesics; however, these may cause unwanted adverse effects such as cardiovascular depression, ileus, and ataxia. The administration of local anesthetics at the incision site in form of an ultrasound-guided subcostal transversus abdominis plane (TAP) block may therefore be preferred to provide adequate analgesia without significant side effects. To date, no technique for a TAP block in horses undergoing median celiotomy has been described. The objective of the study was to develop a TAP block technique, which will lead to the desensitization of the ventrolateral abdominal wall and adjacent skin area of experimental Shetland Ponies using bupivacaine 0.125%. This is a prospective, blinded, self-controlled trial. A cadaver study was performed to determine the ideal injection points and the volume required to stain the nerves responsible for the sensation of the ventrolateral abdominal wall and skin in Shetland pony cadavers (i.e., T9–L 2). Subsequently, using the ideal injectate volume and the landmarks obtained in the first phase of the study, six Shetland ponies received a bilateral TAP injection, either with a local anesthetic solution (bupivacaine 0.125%) or with saline in a randomized, crossover, blinded fashion. Effectiveness was determined over a 4 hour postinjection time, by using a pinprick technique. Significant differences were found to the responses of the pinprick evaluation between the bupivacaine- and saline-treated sides after 30 minutes of TAP block injection. Reported “learned behavior” could have affected the results of the pinprick testing. The TAP block technique reported in this study using bupivacaine 0.125% appeared effective in desensitizing the lower abdomen of ponies for up to 2 hours. Further research is required to apply this technique in horses undergoing celiotomy. Potentially larger volumes and/or higher concentrations of bupivacaine may be necessary to provide longer duration of action of the block.  相似文献   

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Transversus abdominis plane (TAP) is a fascial plane containing the thoracolumbar nerve branches that innervate the abdominal wall. Limited information is available on the anatomical organization of these nerve branches in the dog, which is of great importance for the success of the TAP block anaesthetic technique. The aim of this study was to describe the origin and conformation of thoracolumbar nerves running through the TAP in 20 hemi‐abdominal walls of 10 adult mongrel dog cadavers with an average body weight of 12.6 kg (range: 9.6‐15.6). The abdominal walls were dissected from superficial to deep direction, the skin and both obliquus externus abdominis and obliquus internus abdominis muscles were dissected and reflected dorsally to expose the transversus abdominis muscle and the thoracolumbar nerve branches located in this plane. The anatomical features of ventral nerve branches were described. The thoracic nerve branches: T7–T12 and costoabdominalis; and the lumbar nerve branches: iliohypogastricus cranialis, iliohypogastricus caudalis, ilioinguinalis and cutaneus femoris lateralis were identified in all the cadavers. Anatomical variations related to the presence or absence within the TAP of the T7, T8 and T9 nerve branches were found. These variations should be taken into account when planning the TAP block technique in dogs.  相似文献   

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ObjectivesTo describe the ultrasound-guided rectus sheath block technique and the anatomical spread of two volumes of methylene blue injection in dog cadavers.Study designBlinded, prospective, experimental cadaveric study.AnimalsA total of eight dog cadavers weighing 8.9 ± 1.6 kg.MethodsUltrasound-guided rectus sheath injections were performed bilaterally 1 cm cranial to the umbilicus using 0.25 mL kg–1 (low volume; LV) and 0.50 mL kg–1 (high volume; HV) of 0.5% methylene blue dye. A total of 16 hemiabdomens were injected. The ultrasound image quality of the muscular and fascial plane landmarks and needle visualization were scored using a standardized scale. Cadavers were dissected to determine the distribution of the dye and to assess staining of ventral branches of the spinal nerves.ResultsFewer ventral spinal nerve branches were stained in the LV group than in the HV group, at 2.00 ± 0 and 2.90 ± 0.83, respectively (p < 0.01). Ventral branches of thoracic (T) and lumbar (L) spinal nerves (T10, T11, T12, T13 and L1) were stained 25%, 100%, 75%, 25% and 0% of the time in LV group and 12.5%, 87.5%, 100.0%, 75.0% and 13.0% in HV group. A lesser extent of cranial–caudal dye distribution was observed in the LV group than in the HV group (7.1 ± 1.8 cm and 9.2 ± 1.8 cm, respectively; p = 0.03). There was no significant difference in medial–lateral spread of dye, number of test doses or ultrasound image quality scores between groups.Conclusions and clinical relevanceThe results of this study suggest that, on an anatomical basis, this easily performed block has the potential to provide effective abdominal wall analgesia for the ventral midline. This study supports the potential of the rectus sheath block for abdominal procedures, and further investigations on its clinical efficacy are warranted.  相似文献   

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ObjectiveTo evaluate staining of nerve branches after the injection of different volumes during ultrasound-guided transversus abdominis plane (TAP) block in dog cadavers.Study designProspective randomized study.AnimalsA total of 15 frozen/thawed adult dog cadavers.MethodsHemiabdomens were randomly allocated to one of four groups. In groups G0.3, G0.6 and G1.0, ropivacaine–methylene blue solution (0.3, 0.6 and 1.0 mL kg–1 in seven, eight and eight hemiabdomens, respectively) was injected at the midpoint between the iliac crest and the last rib at the height of the shoulder. In group G0.3×2 (seven hemiabdomens), two injections (0.3 mL kg–1) were performed, caudal to the last rib and cranial to the iliac crest at the same height. Total time for injection was recorded; after 30 minutes, cadavers were dissected and spread of dye was evaluated.ResultsAccuracy of injection site was 80% and injection time was 71 (48–120) seconds for all groups together. Craniocaudal spread was 6.4 ± 1.6, 9.1 ± 2.6, 11.4 ± 2.3 and 11.2 ± 3.8 cm for G0.3, G0.6, G1.0 and G0.3×2, respectively [G0.3 to G0.3×2 (p = 0.044) and G1.0 (p = 0.034)]. There was no difference in dorsoventral spread among groups. Number of ventral nerve branches stained was 3 (2–4), 3 (2–4), 3 (3–4) and 3 (2–4) for G0.3, G0.6, G1.0 and G0.3×2, respectively, including nerve branches from twelfth thoracic to third lumbar (L3) in different proportions among groups.Conclusions and clinical relevanceResults suggest that a single-injection TAP block, using 0.3 mL kg–1, stains comparable number of nerve branches as higher volumes or two-point injection. Despite the volume or technique, consistent staining of the innervation of the caudal abdomen (L1–L3) was observed. Additional cadaveric studies are necessary to identify the optimal technique for complete abdominal wall staining.  相似文献   

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ObjectiveTo describe the sonoanatomy of the abdominal wall in live cats and to compare the distribution pattern of two versus three ultrasound-guided transversus abdominis plane (TAP) injections using clinically applicable volumes of lidocaine–dye solution in cat cadavers.Study designProspective anatomical study.AnimalsA total of eight client-owned healthy cats and eight cat cadavers.MethodsUltrasound anatomy of the abdominal wall, landmarks and sites for needle access were determined in live cats. Ultrasound-guided TAP injections were performed in eight thawed cat cadavers. Volumes of 0.25 or 0.16 mL kg?1 per point of a lidocaine–dye solution were injected using either two [subcostal and preiliac (SP)] or three [subcostal, retrocostal and preiliac (SRP)] injection points, respectively. Each cadaver was then dissected to determine the injectate distribution and the number of thoracolumbar nerves stained with each approach. The target nerves were defined as the ventromedial branches of the thoracic nerves 10 (T10), T11, T12, T13 and lumbar nerves 1 (L1) and L2.ResultsSonoanatomy was consistent with anatomy upon dissection and the TAP was identified in all cadavers. A total of 16 subcostal, 16 preiliac and nine retrocostal TAP injections were performed. The overall staining success rate of the target nerves was 66.7% and 92.6% for the SP and SPR approaches, respectively (p = 0.02). The ventromedial branches of T10, T11, T12, T13, L1 and L2 were stained in 57.1%, 100.0%, 85.7%, 28.6%, 42.9% and 85.7%, and in 66.7%, 100.0%, 100.0%, 100.0%, 88.9% and 100.0% of the cases with the SP and SRP approaches, respectively.Conclusions and clinical relevanceThe SRP approach allowed a broader distribution around the target nerves, whereas a staining gap was observed at T13 and L1 with the SP approach. Further studies are necessary to investigate the analgesic effect of these approaches in a clinical setting.  相似文献   

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ObjectiveTo describe a technique for ultrasound-guided rectus sheath block in pigs and the distribution of two injectate volumes.Study designExperimental study.AnimalsA group of 11 Hanford miniature pig cadavers.MethodsThe lateral border of each rectus abdominis muscle in 10 freshly euthanized pigs was visualized with a 6-15 MHz linear ultrasound probe. A spinal needle was inserted 1 cm cranial to the umbilicus, in-plane and medial to the probe, and advanced dorsal to lateral until the tip was ventral to the internal rectus sheath. Pigs were injected bilaterally with high volume (treatment HV; 0.8 mL kg–1) or low volume (treatment LV; 0.5 mL kg–1) of 1:1 solution of 1% methylene blue and 0.5% bupivacaine (1 mg kg–1) diluted with 0.9% saline. Nerve staining ≥ 1 cm circumferentially was determined by dissection 15 minutes postinjection. The Clopper–Pearson method was used to calculate 95% confidence intervals (CIs) for proportions of stained nerves. In another pig, a 1:1 solution of 1% methylene blue and 74% ioversol contrast was injected, and computed tomography performed at 15 minute intervals after injection.ResultsNerve staining for thoracic (T) spinal nerves T9, T10, T11, T12, T13 and T14 occurred 20%, 60%, 90% 100%, 100% and 50%, and 0%, 20%, 90%, 100%, 100% and 50% of the time in treatments HV and LV, respectively. More nerves were stained in treatment HV in 4/10 animals (40%, 95% CI: 12%–74%) than in treatment LV (0%, 95% CI: 0%–31%). The greatest spread of injectate occurred within the first 15 minutes after injection.Conclusions and clinical relevanceStaining of T11–T14 nerves was the same in both treatments but the higher volume stained more T9–T10 nerves. Based on dye distribution, a rectus sheath block may only provide ventral abdominal analgesia cranial to the umbilicus in pigs.  相似文献   

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Objective To describe an ultrasound‐guided technique and the anatomical basis for three clinically useful nerve blocks in dogs. Study design Prospective experimental trial. Animals Four hound‐cross dogs aged 2 ± 0 years (mean ± SD) weighing 30 ± 5 kg and four Beagles aged 2 ± 0 years and weighing 8.5 ± 0.5 kg. Methods Axillary brachial plexus, femoral, and sciatic combined ultrasound/electrolocation‐guided nerve blocks were performed sequentially and bilaterally using a lidocaine solution mixed with methylene blue. Sciatic nerve blocks were not performed in the hounds. After the blocks, the dogs were euthanatized and each relevant site dissected. Results Axillary brachial plexus block Landmark blood vessels and the roots of the brachial plexus were identified by ultrasound in all eight dogs. Anatomical examination confirmed the relationship between the four ventral nerve roots (C6, C7, C8, and T1) and the axillary vessels. Three roots (C7, C8, and T1) were adequately stained bilaterally in all dogs. Femoral nerve block Landmark blood vessels (femoral artery and femoral vein), the femoral and saphenous nerves and the medial portion of the rectus femoris muscle were identified by ultrasound in all dogs. Anatomical examination confirmed the relationship between the femoral vessels, femoral nerve, and the rectus femoris muscle. The femoral nerves were adequately stained bilaterally in all dogs. Sciatic nerve block. Ultrasound landmarks (semimembranosus muscle, the fascia of the biceps femoris muscle and the sciatic nerve) could be identified in all of the dogs. In the four Beagles, anatomical examination confirmed the relationship between the biceps femoris muscle, the semimembranosus muscle, and the sciatic nerve. In the Beagles, all but one of the sciatic nerves were stained adequately. Conclusions and clinical relevance Ultrasound‐guided needle insertion is an accurate method for depositing local anesthetic for axillary brachial plexus, femoral, and sciatic nerve blocks.  相似文献   

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ObjectiveTo evaluate a direct intra-abdominal approach to injection of the ventral transversus abdominis plane (TAP) and compare the dispersion of two volumes of injectate.Study designProspective anatomic and feasibility study.AnimalsA total of 10 canine cadavers weighing 9 ± 4 kg.MethodsA ventral incision was made extending through the linea alba, from the umbilicus and extending 5 cm caudally. A single injection of an isovolumic mixture of iopamidol and new methylene blue was performed with a hypodermic needle placed within the TAP of each hemiabdomen, alternating between 0.5 mL kg–1 in low-volume group (LV) and 1 mL kg–1 in high-volume group (HV). Surgical staples marked the incision. Computed tomography and three-dimensional reconstruction of the tomographic images evaluated the dimensions, cranial and caudal spread beyond the incision and the total area of the injectate. Dissection determined the extent of nerve staining within the TAP adjacent to the abdominal incision. Wilcoxon signed rank (stain) or paired t test was used to compare variables between groups. Data are reported as mean ± standard deviation or median (range).ResultsInjectate spread was within the ventral TAP. Length of spread was 2.5 ± 1.6 cm greater in group HV than in group LV. There was a strong positive correlation between the surface area (p = 0.02, r = 0.71) and cranial–caudal spread of injectate (p = 0.041, r = 0.65) with volume.All but two LV injections were associated with staining of all nerves adjacent to the incision. Additional nerves caudal to the incision were stained in group HV (p = 0.02).ConclusionsThis approach to the TAP was easily performed, with volume of injectate positively influencing distribution.Clinical relevanceThis technique is easily applied and future prospective studies are warranted to determine its analgesic efficacy.  相似文献   

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HistoryEleven female dogs of different breeds undergoing unilateral radical (n = 7) or regional abdominal mastectomy (n = 4) received an ultrasound guided transverse abdominis plane block (TAP-block).Physical examinationSubjects showed single or multiple mammary tumours. Serum biochemistry, CBC and electrocardiogram were unremarkable. Eight animals were classified as ASA physical status II and 3 as ASA III.ManagementDogs were premedicated with methadone [0.1 or 0.2 mg kg?1 intravenously (IV) or intramuscularly respectively] or fentanyl (2.5 μgkg?1 IV). Anaesthesia was induced with propofol and maintained with isoflurane or sevoflurane. Unilateral ultrasound guided TAP blocks were performed in the caudal and cranial abdomen with bupivacaine 0.25% (0.3 to 0.35 mL kg?1). Intercostal nerve blocks (T4 to T11) with bupivacaine 0.25% (0.013 to 0.04 mL kg?1) completed the blocked area in dogs undergoing radical mastectomy.Follow upThe median (range) of end-expired isoflurane and sevoflurane necessary to maintain anaesthesia was 1.15 (1.07–1.22) and 2.07 (2.05–2.2) vol% respectively. A single administration of fentanyl (2.5 μg kg?1, IV) was administered to control nociception (defined as an increased heart rate or mean arterial blood pressure above 20% of the pre-incisional value) in four of 11 dogs. All dogs received carprofen (2 mg kg?1 subcutaneously) at the end of surgery. Post-operative pain, assessed for 120 minutes using the short form of Glasgow Composite Pain Scale (0–24), was always lower than 3. No rescue analgesia (allowed by the protocol) was required in this time.ConclusionTransverse abdominis plane block combined with intercostal nerve blocks may be useful to produce intraoperative anti-nociception and short term post-operative analgesia in dogs undergoing unilateral mastectomy.  相似文献   

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The purpose of the anatomical study was to identify potential myoperitoneal microvascular free flaps, in dogs, that are based on a single artery and vein. The angiosomes of the right deep circumflex iliac artery and left phrenicoabdominal (cranial abdominal) artery were evaluated in six medium-sized canine cadavers. The right deep circumflex iliac artery and left phrenicoabdominal (cranial abdominal) artery were injected with a mixture of barium and latex (equal parts). The entire right and left transversus abdominis muscles were dissected from the abdominal wall and radiographed. The angiograms of the deep circumflex iliac artery showed poor arborization of the vessels within the transversus abdominis muscle in all six cadavers. The angiograms of the phrenicoabdominal (cranial abdominal) artery showed consistent filling of the vascular bed of the cranial half of the transversus abdominis muscle flap in all six dogs. The vascular pedicle lengths and the diameter of the arteries and veins of both the deep circumflex iliac and phrenicoabdominal (cranial abdominal) myoperitoneal free flaps were found to be acceptable for microvascular anastomosis. The deep circumflex iliac flap was unacceptable because of inadequate vascular perfusion. The cranial abdominal artery had a consistent, large branch that supplied the cranial half of the transversus abdominis muscle, thereby making a myoperitoneal flap supplied by this vessel a potentially useful free flap. An 8-year-old male, neutered, mixed-breed dog was evaluated for possible repair of a large defect of the hard palate. Previous operations, using local tissue flaps, had been unsuccessful. A myoperitoneal free flap, based on the right cranial abdominal artery, and consisting of the cranial portion of the transversus abdominis muscle, was used successfully to reconstruct the hard palate. Migrating epithelium from the edges of the wound covered the myoperitoneal flap by 10 weeks after surgery. Therefore, the cranial abdominal myoperitoneal free flap can be considered for reconstruction of intra-oral defects that cannot be repaired using conventional local flap techniques.  相似文献   

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