Vascular Delay, Angiogenesis and Cardiomyoplasty

Vascular delay is a surgical technique that renders a skin flap sub-lethally ischemic and produces significant alterations in the characteristics of the tissue perfusion. The enhanced perfusion is associated with decreased distal flap necrosis and increased viability. Applying this technique to skeletal muscle flaps produces similar vascular changes and results in enhanced perfusion and contractile function. The changes in vascular architecture and total blood flow for both skin and muscle flaps represent alterations in basic arteriogenic and angiogenic activity. The recruitment of previously collapsed collateral vessels and growth and development of new vessels occurs over a period of days. The optimal period of vascular delay for rat latissimus dorsi muscle (LDM) is 3-14 days and 14 days has been used for human LDM. The mechanism(s) underlying the changes in angiogenic activity are likely to involve vascular growth factors such as basic fibroblast growth factor (b-FGF) and vascular endothelial growth factor (VEGF). The use of such adjuncts have significant potential benefits to the use of the LDM in cardiomyoplasty.