title: Monitoring of microcirculation in free transferred musculocutaneous latissimus dorsi flaps by confocal laser scanning microscopy--a promising non-invasive methodical approach.
abstract: BACKGROUND
  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 24h 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Plastic, Hand and Reconstructive Surgery, Medical School Hannover, 30625 Hannover, Germany. altintas.mehmet@mh-hannover.de
authors.forename: M A
authors.initials: MA
authors.lastname: Altintas
authors.forename: A A
authors.initials: AA
authors.lastname: Altintas
authors.forename: M
authors.initials: M
authors.lastname: Guggenheim
authors.forename: K
authors.initials: K
authors.lastname: Knobloch
authors.forename: A D
authors.initials: AD
authors.lastname: Niederbichler
authors.forename: P M
authors.initials: PM
authors.lastname: Vogt
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008833:Microcirculation; D018613:Microscopy, Confocal; D008991:Monitoring, Physiologic / Q000379:methods*; D018709:Statistics, Nonparametric; D013524:Surgical Flaps / Q000098:blood supply*