Anderson W A, Ianuzzo C D, Klabunde R E
Department of Surgery, Deborah Heart and Lung Center, Browns Mills, New Jersey 08015, USA.
J Card Surg. 1996 Jul-Aug;11(4):237-46. doi: 10.1111/j.1540-8191.1996.tb00046.x.
Dynamic cardiomyoplasty has shown promise as a surgical treatment for congestive heart failure, however, skeletal muscle damage has been reported in the latissimus dorsi muscle flap. Possible etiologies for the muscle damage include surgical dissection of the latissimus dorsi muscle with interruption of collateral blood supply, as well as chronic electrical stimulation of the muscle.
To investigate these possible etiologies, we conducted a series of experiments using the goat model, evaluating blood flow and muscle morphology following surgical dissection and chronic stimulation of the latissimus dorsi muscle. Four different conditions were evaluated: (1) latissimus dorsi muscle that was neither dissected nor chronically stimulated; (2) latissimus dorsi muscle that was stimulated, but not dissected; (3) latissimus dorsi muscle that was surgically dissected, but not chronically stimulated; and (4) latissimus dorsi muscle that was both surgically dissected and chronically stimulated.
We concluded that skeletal muscle damage resulted primarily from the surgical dissection, whereby the collateral blood supply to the latissimus dorsi muscle was interrupted and not primarily as a result of chronic electrical stimulation.
动力性心肌成形术已显示出作为充血性心力衰竭外科治疗方法的前景,然而,据报道背阔肌肌瓣存在骨骼肌损伤。肌肉损伤的可能病因包括背阔肌的手术解剖导致侧支血供中断,以及对肌肉的慢性电刺激。
为了研究这些可能的病因,我们使用山羊模型进行了一系列实验,评估背阔肌手术解剖和慢性刺激后的血流和肌肉形态。评估了四种不同情况:(1)既未解剖也未慢性刺激的背阔肌;(2)受到刺激但未解剖的背阔肌;(3)接受手术解剖但未慢性刺激的背阔肌;(4)既接受手术解剖又受到慢性刺激的背阔肌。
我们得出结论,骨骼肌损伤主要是由手术解剖导致的,即背阔肌的侧支血供被中断,而不是主要由慢性电刺激导致的。