Monitoring of microcirculation in free transferred musculocutaneous latissimus dorsi flaps by confocal laser scanning microscopy – a promising non-invasive methodical approach

• Published in: Journal of plastic, reconstructive & aesthetic surgery reconstructive & aesthetic surgery, 2010-01, Vol.63 (1), p.111-117
• Main Authors: Altintas, M.A, Altintas, A.A, Guggenheim, M, Knobloch, K, Niederbichler, A.D, Vogt, P.M
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Confocal laser scanning microscopy; Female; Flap surgery; Flap surveillance; Graft Survival; Histomorphology; Humans; Male; Medical sciences; Microcirculation; Microscopy, Confocal; Monitoring, Physiologic - methods; Non-invasive monitoring; Plastic Surgery; Statistics, Nonparametric; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgical Flaps - blood supply
• ISSN: 1748-6815; 1878-0539
• DOI: 10.1016/j.bjps.2008.08.034

Summary Introduction For the survival of a microvascular tissue transfer, early detection of vascular complications is crucial. In vivo confocal laser scanning microscopy allows real-time, non-invasive evaluation of tissue microcirculation with a high cellular resolution. The aim of this study was to evaluate confocal laser scanning microscopy for early recognition of flap failure. Methods Fourteen patients (ages: 40.2 ± 12.4 years) were monitored postoperatively for a period of 24 h following free microvascular M. latissimus dorsi transfer to the lower extremity using confocal laser scanning microscopy (Vivascope1500; Rochester; New York; USA). The following parameters were evaluated: quantitative blood-cell flow, diameter of capillary loops and minimal thickness of the epidermis. Results Venous congestion was characterised by a decrease in blood-cell flow of up to 41%, accompanied by an increase of the diameter of capillary loops of up to 22% and the minimal thickness of the epidermis up to 32%. By contrast, arterial occlusion was clearly verified by a decrease in blood flow of up to 90%, accompanied by an insignificant change of both capillary loop size and epidermal thickness. Conclusion Confocal laser scanning microscopy appears to be a useful non-invasive tool for early recognition of flap failure during the monitoring of microsurgical tissue transfer prior to its clinical manifestation.