Preservation of the latissimus dorsi muscle during cardiomyoplasty surgery

Application of Animal Models: Chronic Electrical Stimulation-Induced Contractile Activity

Unilateral, chronic low-frequency electrical stimulation (CLFS) is an experimental model that evokes numerous biochemical and physiological adaptations in skeletal muscle. These occur within a short time frame and are restricted to the stimulated muscle. The humoral effects of whole body exercise are eliminated and the nonstimulated contralaterai limb can often be used as a control muscle, if possible effects on the contralateral side are considered. CLFS induces a fast-to-slow transformation of muscle because of alterations in calcium dynamics and myofibrillar proteins, and a white-to-red transformation because of changes in mitochondrial enzymes, myoglobin, and the induction of angiogenesis. These adaptations occur in a coordinated time-dependent manner and result from altered gene expression, including transcriptional and posttranscriptional processes. CLFS techniques have also been applied to myocytes in cell culture, which provide a greater opportunity for the delivery of pharmacological agents or for the application of gene transfer methodologies. Clinical applications of the CLFS technique have been limited, but they have shown potential therapeutic value in patients in whom voluntary muscle contraction is not possible due to debilitating disease and/or injury. Thus the CLFS technique has great value for studying various aspects of muscle adaptation, and its wider scientific application to a variety of neuromuscular-based disorders in humans appears to be warranted. Key words: skeletal muscle, muscle plasticity, endurance training, mitochondrial biogenesis, fiber types

Analysis of chronic morphologic changes of small bowel in electrically stimulated canine island-flap rectus abdominis muscle stomal sphincters

PURPOSE

Dynamic myoplasty to achieve fecal continence has been used in humans with varying results. A potential complication of the use of dynamic skeletal sphincters to attain fecal continence is the development of ischemic strictures within the bowel encircled by the functional sphincter. This study examines the histologic changes present in the bowel wall used to create a functional dynamic island-flap stomal sphincter in a chronic canine model.

METHODS

The rectus abdominis muscles of canines were used to create island-flap stomal sphincters. Eight dynamic island-flap stomal sphincters were created from the rectus abdominis muscles in mongrel dogs by wrapping them around a blind loop of distal ileum that was no longer in continuity with the terminal small bowel. Temporary pacing electrodes were secured intramuscularly near the intercostal nerve entry point and connected to a subcutaneously placed pulse stimulator. Two different training protocols resulting in different contractile properties were used: Program A (n = 4) and Program B (n = 4). The island-flap sphincters were trained over 3 months to generate stomal intraluminal pressures of more than 60 mmHg in all animals. The intact sphincters, normal bowel, and contralateral stomal bowel were obtained when the animals were killed. Specimens were processed with paraffin embedding, sectioned, and stained with trichrome and hematoxylin-and-eosin stains. Measurements of the different bowel layers were made with a micrometer. The muscular sphincters were biopsied before and after training. Fiber-type histochemistry was performed with a monoclonal antibody to the fast isoforms of myosin. Pretrained and posttrained skeletal muscle specimens were examined histologically.

RESULTS

The bowel wall within the functional dynamic stomal sphincter did not exhibit any significant architectural changes related to ischemic fibrosis or mucosal damage. A significant fiber-type conversion was achieved in both training groups with Programs A and B, with a >50 percent conversion from fatigue-prone (type II) muscle fibers to fatigue-resistant (type I) muscle fibers. Biopsy specimens revealed that fiber-type transformation was uniform throughout the sphincters. Skeletal muscle fibers within both groups demonstrated a reduction in their fiber diameter. There was no evidence of significant fibrosis or deposition of fat within the skeletal muscle of the sphincters.

CONCLUSION

Results of our experiment suggest that our anterior abdominal wall dynamic island-flap stomal sphincter, which generates a contractile force over the bowel wall capable of producing enough stomal pressure to achieve fecal continence, is not intrinsically harmful to the bowel that it encircles. The transformation of skeletal muscle to fatigue-resistant (type I) fibers occurred uniformly throughout the skeletal muscle sphincters without evidence of muscle fiber damage or significant fibrosis.

Cold stress does not induce stress proteins SP 25 and SP 72 in rat skeletal muscle

Cryotherapy is a common treatment for musculoskeletal injuries, yet the mechanism(s) underlying its effects remain unclear. Since cryotherapeutic treatment often involves temperatures that are known to induce the protective stress proteins (SPs), we determined whether SP 25 and SP 72 expression was altered following a 20-min cold stress to the hindlimb muscles of Sprague-Dawley rats. The right hindlimb of anesthetized animals was placed in an ice bath until muscle temperature decreased to either 8.4 +/- 0.4 degrees C or 19.7 +/- 0.3 degrees C for 20 min. After a 24-h recovery, the white and red gastrocnemius, plantaris, soleus, extensor digitorum longus, and tibialis anterior muscles from both legs were removed and rapidly frozen in liquid nitrogen. Portions of the muscles were homogenized and SP 25 and SP 72 content was assessed by SDS-PAGE/Western blot analyses. Quantification of SP 25 and SP 72 by densitometric scanning of blots demonstrated no significant increases in SP 25 or SP 72 content in any of the muscles exposed to either the 8 or the 20 degrees C cold stress compared to muscles from the unstressed contralateral limbs. These results suggest that a 20-min cold stress of 8 degrees C or 20 degrees C does not increase muscle SP 25 or SP 72 content.

Neuromuscular function of the latissimus dorsi muscle in goats after dynamic cardiomyoplasty

Skeletal muscle deterioration is emerging as a limitation to long-term cardiac assist by dynamic cardiomyoplasty. Chronic electrical stimulation of in situ skeletal muscle showed that ischemia, decreased muscle preload, muscle overuse, and chronic electrical stimulation are factors for muscle deterioration. Transposition around the heart has been associated with signs of muscle denervation after chronic electrical stimulation. To evaluate latissimus dorsi muscle neuromuscular function after longterm dynamic cardiomyoplasty, we performed neuromuscular functional analysis and histology on the latissimus dorsi muscle and thoracodorsal nerve of six normal goats and six goats after 6 months of dynamic cardiomyoplasty. Electromyographic analysis showed positive sharp waves and fibrillation potentials in the latissimus dorsi of three goats from the dynamic cardiomyoplasty group. Conduction velocity of the thoracodorsal nerve of goats from the dynamic cardiomyoplasty group (58.32+/-9.80 m/s) was reduced compared to the goats from the control group (71.48+/-5.71 m/s, P = 0.02). Histologic changes in skeletal muscle were compatible with denervation. Loss of myelin sheaths, collapse of endoneurial connective tissue, and solitary foci of axonophagia and myelinophagia further documented severe injury to the thoracodorsal nerve in goats from the dynamic cardiomyoplasty group. The latissimus dorsi muscle wrap was denervated after long-term dynamic cardiomyoplasty. Traction on the neurovascular pedicle at each contraction of the transposed muscle may induce afferent axonal injury of the thoracodorsal nerve resulting in diminished muscular function.

Cardiomyoplasty: the benefits of electrical prestimulation of the latissimus dorsi muscle in situ

BACKGROUND

Ischemic damage in the latissimus dorsi muscle may limit the success of cardiomyoplasty. Electrical prestimulation of the muscle in situ is known to enhance thoracodorsal perfusion to the distal latissimus dorsi muscle immediately after grafting. In this study we asked whether prestimulation was also beneficial under typical postoperative conditions.

METHODS

Ten sheep were randomly assigned to two equal groups. In one group the latissimus dorsi muscle was stimulated continuously in situ at 2 Hz for 2 weeks; in the other group the muscle was not stimulated. Regional blood flows in the muscle were determined sequentially (1) under baseline conditions, (2) immediately after surgical mobilization, handling, and reattachment at 80% of the resting length, and (3) after 5 days.

RESULTS

Manipulation of the unstimulated muscle resulted in an acute global reduction in blood flow with no improvement after 5 days. The distal region was most severely affected (26.2%+/-4.2% of baseline blood flow). Electrical prestimulation significantly reduced regional blood flow under baseline conditions but rendered the whole muscle more resistant to the surgical manipulations; blood flow was significantly better-preserved immediately afterwards, and there was complete recovery to baseline levels after 5 days.

CONCLUSIONS

Electrical prestimulation of the latissimus dorsi muscle in situ reduces the acute distal ischemia caused by surgical manipulations, and promotes subsequent recovery of blood flow to baseline levels after a few days. Use of a prestimulated graft may therefore improve the outcome of skeletal muscle cardiac assistance.