Choice of the Method of Collecting and Preparing a Skin "Sentinel" Flap on a Vascular Pedicle to Optimize the Kidney Transplantation Technology in Patients with High Immunological Risk from the Deceased Donors
Purpose. To study the properties of a «sentinel» skin flap on a vascular pedicle from donors with the brain death using morphological studies after its static cold storage. Materials and methods. Two square and fusiform skin flaps were taken simultaneously with organ explantation in donors with the brain death. During transportation and in the period before organ explantation, the flaps were in bags with a preserving solution in the thermal container with the temperature from 0 to +4 °C. After 9 hours of cold storage of skin grafts, their morphological examination was carried out on the base of the City Clinical Pathology Bureau in Minsk. Dissection, macro- and microscopic evaluation of the surgical material were carried out by a pathologist. The skin flap was examined with transverse serial sections with the interval of 0.5 cm through the entire thickness of the specimen. The following morphological parameters were evaluated: the size of the flap (length, width and thickness of the specimen), size of the vessels, appearance of the skin and hypodermis, resection margins, tissue appearance in the section, presence of hemorrhages and other focal changes and their location, patency of the main vascular bundle on extent. Results. The absence of significant morphological changes in both flaps after 9 hours of cold storage was revealed. The skin and subcutaneous fat structure were close to normal. The lumen of the artery and veins of the vascular bundle was empty on a greater extent, with single mixed venous thrombi observed along with fibrin deposits and some neutrophils at the resection margin of one of the specimens. Conclusion. When taking kidneys from the deceased donor, the skin flaps were obtained with appropriate macro- and microscopic evaluation for further transplantation of kidney to the recipient with high immunological risk.