Microvasculature of the Unconditioned Latissimus Dorsi Muscle after Vascular Delay and Postmobilization for Cardiomyoplasty

Vascular deafferentation of the Latissimus Dorsi Muscle (LDM) for dynamic cardiomyoplasty is an important cause of ischemia in the distal portion of the muscle with degeneration of muscle fibres and consequent reduction in the effectiveness of the surgery. Experimental studies suggest that a vascular delay procedure and a 10-day delay adaptation significantly improve the distal perfusion and function of the LDM flap for cardiomyoplasty. We here report a comparative histological and ultrastructural study of biopsies from unconditioned LDM flaps of two patients, taken 30 days after vascular deafferentation and dynamic cardiomyoplasty, and 10 days after a vascular delay procedure, respectively. In the first case, in the distal part of LDM we found muscle atrophy and degeneration, necrosis of capillaries, with swelling of endothelial cells and disruption of cytoplasmic organelles, and capillary neoangiogenesis. In the second patient, the distal LDM after vascular delay procedure show minimal muscle fibre degeneration, dilatation of capillaries with endothelial cell preservation, and scarce capillary neoangiogenesis. The present results seem to confirm that a vascular delay procedure on LDM for use with cardiomyoplasty may improve the LDM perfusion and function, inducing moderate morphological changes in muscle fibres and vasculature in comparison to the deafferentated LDM.