title: Direct microvascular monitoring of a free autologous jejunal flap using microendoscopy: a case report.
abstract: BACKGROUND
  Early identification of flap failure is an indispensable prerequisite for flap salvage. Although many technical developments of free flap monitoring have now reached clinical application, very few are considered to be reliable and non-invasive for early recognition of flap failure.
  
  
  METHODS
  We used microendoscopic technique for microvascular monitoring of free autologous jejunal flap by the direct visualisation of the flow of erythrocytes through the capillary vasculature on both the mucosal and serosal surfaces. Blood flow was seen to be pulsatile, with individual erythrocytes visible in the capillaries. The best view was obtained when the scope was focussed directly on the capillary rather than the graft surface. The view of the unstained mucosal surface was bland apart from the fine capillary loops which were seen to fill with each pulsatile event. The microendoscopic examination of the serosal surface revealed much larger calibre vessels with obvious blood flow.
  
  
  CONCLUSIONS
  The microendoscopic monitoring technique is simple and safe with direct visualisation of blood flow. The technique may also be useful for the monitoring of other free bowel transplants.
authors.affiliation: Head & Neck Unit, University College London Hospitals, UK. mrtupile@yahoo.com
authors.forename: Tahwinder
authors.initials: T
authors.lastname: Upile
authors.forename: Waseem
authors.initials: W
authors.lastname: Jerjes
authors.forename: Mohammed
authors.initials: M
authors.lastname: El Maaytah
authors.forename: Colin
authors.initials: C
authors.lastname: Hopper
authors.forename: Adam
authors.initials: A
authors.lastname: Searle
authors.forename: Anthony
authors.initials: A
authors.lastname: Wright