Erection of a reconstructed penis by increased blood flow due to arteriovenous fistula peripheral to the free tube flap

为了重建勃起的阴茎，用带血管蒂的游离组织瓣将周围的动脉和静脉与重建的阴茎吻合，形成动静脉瘘，通过压迫重建阴茎的根部引起充血来实现勃起。在游离皮瓣远端制作房室瘘时，血偷现象会降低皮瓣组织的血流量，导致皮瓣坏死。因此，必须首先澄清安全问题。由于移植游离皮瓣需要缝合微血管，有可能形成吻合口血栓，但房室瘘增加了吻合区血流量，因此可以防止吻合口血栓形成。本研究的目的就是调查这些问题。这项研究是用成年狗进行的。以股下端隐动脉、静脉为血管蒂，取岛状皮瓣，观察皮瓣充血情况，测量皮瓣内股动脉静脉压、血流量及皮瓣血流量，比较有无房室瘘。作为皮瓣供血血管的股动脉在皮瓣解除后血流量明显减少。宏观上，动脉搏动和血管壁张力降低。当在皮瓣周围建立房室瘘时，血流量增加了约45倍，并且在术后第二周内股动脉血流量仍保持较高水平。此外，股房内瘘导致皮瓣组织的血流量减少了约50%，但在第二周恢复到术前水平，未见皮瓣坏死。这些结果表明，流向皮肤的血流量减少约50%不会导致皮瓣坏死，并支持移植带有房室瘘的皮瓣的安全性。由于吻合区血流明显增加，用游离皮瓣制作的房瘘在防止吻合口血栓形成方面非常有用。未来，我们计划阐明该房瘘模型的长期病理变化和静脉通畅情况，并阐明挤压皮瓣基底导致充血对皮瓣组织的损伤。少

To reconstruct an erectile penis, an arteriovenous(AV) fistula was formed by anastomosing an artery and vein peripheral to a penis reconstructed using a free tissue flap with a vascular pedicle, so that erection could be achieved by compressing the root of the reconstructed penis to induce congestion.When making an AV fistula distal to a free flap, the blood steal phenomenon can lower blood flow to the flap tissue, resulting in flap necrosis. Safety therefore had to be clarified first. As grafting a free flap requires microvessel suturing, anastomotic thrombosis is likely, but AV fistula increases blood flow in the anastomotic region, so anastomotic thrombosis may be prevented. The purposes of the present study was to investigate these points.The study was conducted using adult dogs. Flap congestion was observed and venous pressure and blood flow in the femoral artery in the flap and flap blood flow were measured and compared with or without AV fistula after lifting an island flap with … More the saphenous artery and vein of the lower thigh as vascular pedicles.Blood flow of the femoral artery, which served as the feeding vessel of the flap, decreased significantly after lifting the flap. Macroscopically, arterial pulsation and vascular wall tension decreased. When an AV fistula was made peripheral to the flap, blood flow increased by about 45-fold, and the increased blood flow of the femoral artery remained high during the second week postoperatively. Furthermore, blood flow to the flap tissue decreased by about 50% with the femoral AV fistula, but returned to preoperative levels by the second week, and no flap necrosis was seen.These findings show that a decrease of about 50% in blood flow to the skin does not cause flap necrosis and supports the safety of grafting a flap with an AV fistula. AV fistula made with a free flap is extremely useful in preventing anastomotic thrombosis due to the marked increase in blood flow in the anastomotic region.In future, we plan to clarify the long-term pathological changes and patency of veins in this AV fistula model and clarify damage to flap tissue caused by compressing the flap base to induce congestion. Less