Original communication Society for Vascular Surgery| Volume 37, ISSUE 1, P32-53, January 1955

Revascularization of the heart by pedicled skin flap

An experimental study investigating the functions of extracoronary anastomoses
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      Three experimental methods are described which may be used to study the functions of extracoronary anastomoses produced in the laboratory animal.
      The first is the choice of a pedicled skin flap as the vehicle to bring systemic blood vessels to the surface of the heart. Extracoronary anastomoses formed with the vessels of this tissue are more easily studied than those formed with other tissues, and the procedure is simple to carry out.
      The second is a way to produce slow complete occlusion of a coronary artery without reoperation. This is accomplished by the use of a stainless steel clip which is closed by a spring and is held open by catgut which slowly absorbs after the clip is placed in the tissues.
      The third is a technique for determining the direction of blood flow through extracoronary anastomoses in the living animal, and it consists of a comparison of the times required for blood to reach the coronary sinus by the normal route and by a shorter route through the anastomoses.
      Using these methods we have occluded up to 80 per cent of the coronary arterial supply in animals protected by flaps, and present evidence suggests that the extracoronary source of blood was not responsible for their survival. The findings neither prove nor disprove the value of extracoronary anastomoses, but merely indicate the extent to which the normal heart is capable of protecting its blood supply, following slow occlusion. This method of occlusion requires nearly total coronary artery closure before simulating coronary disease in the human being, and further studies in this direction are being carried out.
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