Malikov S, Rolland P H, Magnan P E, Bartoli M, Champsaur P, Branchereau A
Department of Vascular Surgery, School of Medicine, Mediterranean Sea University, La Timone Hospital, Marseilles, France.
Eur J Vasc Endovasc Surg. 2009 Jan;37(1):77-84. doi: 10.1016/j.ejvs.2008.09.006. Epub 2008 Oct 14.
The haemodynamic effects of revascularisation with combined bypass and free-muscle flap remain controversial. In a porcine experimental model, we investigated the transplantation-induced changes in the haemodynamics of a Y-shaped combined arterial autograft bypass-muscle flap (AABF).
Anatomy of AABF was identified in eight dissections in four porcine cadavers. In five animals, AABF served as a superficial femoral artery (SFA) defect replacement. Modelled, triggered pulsatile pressure (P) and flow (Q) waves delivered mean haemodynamics and PQ hysteresis loops before and after transplantation at days 0 and 10.
Anatomically, AABF combined subscapular and circumflex-scapular arteries, and thoracodorsal artery as latissimus dorsi flap pedicle. Surgical feasibility and AABF patency were confirmed in each case. At day 0, the proximal flow was increased in the grafted Y-shaped AABF, which also adopted the specific SFA pulsatile haemodynamics. Regulatory mechanisms of AABF vasomotricity were preserved and AABF-flow-dependence amplified the flow in the distal segment, which otherwise preserved its own flow dependence. At 10 days, the AABF flow was unchanged in the distal segment, and remained elevated in the proximal and pedicle segments.
Combined AABF, as a single one-piece arterial autograft, was shown highly adaptive to the receiving arteries. The transplantation-induced changes in AABF pulsatile flow profile and vascular reactivity improve the overall graft flow, and strongly advocate for beneficial effects on the blood propelling capacity of the grafted circulation.
联合搭桥和游离肌皮瓣血运重建的血流动力学效应仍存在争议。在一个猪实验模型中，我们研究了Y形联合动脉自体移植搭桥-肌皮瓣（AABF）移植引起的血流动力学变化。
在4头猪尸体的8次解剖中确定了AABF的解剖结构。在5只动物中，AABF用于替代股浅动脉（SFA）缺损。在第0天和第10天移植前后，模拟触发的脉动压力（P）和流量（Q）波提供了平均血流动力学和PQ滞后环。
从解剖学上看，AABF联合了肩胛下动脉和旋肩胛动脉，以及作为背阔肌皮瓣蒂的胸背动脉。每例均证实了手术可行性和AABF通畅性。在第0天，移植的Y形AABF近端血流增加，其也采用了特定的SFA脉动血流动力学。AABF血管舒缩性的调节机制得以保留，AABF血流依赖性增强了远端节段的血流，否则远端节段保留其自身的血流依赖性。在第10天，AABF远端节段血流未变，近端和蒂部节段血流仍升高。
联合AABF作为单个一体式动脉自体移植物，显示出对受体动脉的高度适应性。移植引起的AABF脉动血流分布和血管反应性变化改善了总体移植物血流，并有力地支持了其对移植循环血液推进能力的有益作用。
