Combination of preconditioning and delayed flap elevation: evidence for improved perfusion and oxygenation of the latissimus dorsi muscle for cardiomyoplasty

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Combination of preconditioning and delayed flap elevation: evidence for improved perfusion and oxygenation of the latissimus dorsi muscle for cardiomyoplasty David J Barron, Phillip J Etherington, BSc, C.Peter Winlove, DPhil, Jonathon C Jarvis, PhD, Stanley Salmons, PhD, John R Pepper The Annals of Thoracic Surgery Volume 71, Issue 3, Pages 852-861 (March 2001) DOI: 10.1016/S0003-4975(00)02445-0

Fig 1 Photograph of the implantable stimulator and electrodes used in this study, with centimeter scale. The device can be switched on or off while implanted by means of flashes of light through the overlying tissues. (Such devices and similar, more versatile programmable devices are available for experimental work from the University of Liverpool.) The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 2 Experimental groups. The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 3 Muscle loading apparatus for electrical stimulation and fatigue testing of the latissimus dorsi muscle. The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 4 Fiber-type composition of the control and conditioned latissimus dorsi muscles. Group A received in situ preconditioning, group B underwent combined preconditioning and delayed elevation, and group C underwent complete elevation followed by conditioning. Results are the mean values from each group (n = 8). Error bars represent standard error of the mean. The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 5 Mean pressure curves. Values show the mean pressure developed by control and conditioned muscles during a fatigue test of repeated tetanic contractions for a period of 10 minutes. Pressures were expressed as a percentage of the initial pressure generated. The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 6 Photomicrographs of muscle biopsies taken from the distal region of the latissimus dorsi muscle. Hematoxylin-eosin stain, ×250 magnification. (A) Group B muscle showing maintenance of normal muscle architecture. (B) Group C muscle, which had undergone complete elevation 2 weeks earlier and subsequent conditioning. There is a dense inflammatory cell infiltrate, extensive muscle fiber necrosis, and vacuolation with loss of the muscle architecture. The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 7 Computer-enhanced images of capillary fluorescence in 20-μm muscle sections from control (A), group A (B), group B (C), and group C (D) muscles. Capillaries are visualized by fluorescence of Evan’s Blue–labeled albumin viewed under a mercury light. (magnification ×150.) The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 8 Muscle perfusion recorded in the proximal (A and C) and distal (B and D) regions of the latissimus dorsi muscle. (A and B) Effect of complete flap elevation on muscle perfusion. (C and D) Effect of repeated tetanic contraction on muscle perfusion. Differences from the control value are marked (∗p < 0.05). The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)

Fig 9 Tissue oxygenation of the proximal (A and B) and distal (C and D) regions of the latissimus dorsi muscle. (A and C) Effect of complete flap elevation on the mean tissue Po2. (B and D) Effect of repeated tetanic contraction on the mean tissue Po2. Significant differences from the control value are marked (∗p < 0.05). The Annals of Thoracic Surgery 2001 71, 852-861DOI: (10.1016/S0003-4975(00)02445-0)