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阴茎周围的动静脉与重建的阴茎吻合形成动静脉瘘，通过压迫重建的阴茎根部诱导充血来实现勃起。当在游离皮瓣远端制造动静脉瘘时，血液窃取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微血管缝合，很可能会发生吻合口血栓，但动静脉瘘会增加吻合口的血流量，因此可以预防吻合口血栓形成。本研究的目的是调查这些点。这项研究是在成年狗身上进行的。观察…掀起岛状皮瓣后，皮瓣充血的情况，测量皮瓣内股动脉的静脉压、血流量和血流量，比较有无房室瘘的情况多以股隐动、静脉为蒂，作为皮瓣供血血管的股动脉，其血流量在皮瓣解除后明显减少。宏观上，动脉搏动和血管壁张力降低。当在皮瓣周围制作动静脉瘘时，血流量增加了约45倍，在术后第二周，股动脉的血流量仍然很高。此外，发生股动静脉瘘时，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，皮瓣血流量减少约50%不会导致皮瓣坏死，这支持了有动静脉瘘的皮瓣移植的安全性。用游离皮瓣制作动静脉瘘在预防吻合口血栓形成方面是非常有用的，因为吻合口血流量显著增加。在未来，我们计划在这个动静脉瘘模型中阐明静脉的长期病理变化和通畅性，并阐明压迫皮瓣底部导致充血对皮瓣组织的损害。较少

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