Monitoring of microcirculation in free transferred musculocutaneous latissimus dorsi flaps by confocal laser scanning microscopy--a promising non-invasive methodical approach.
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.
Altintas
M A
MA
Department of Plastic, Hand and Reconstructive Surgery, Medical School Hannover, 30625 Hannover, Germany. altintas.mehmet@mh-hannover.de
Altintas
A A
AA
Guggenheim
M
M
Knobloch
K
K
Niederbichler
A D
AD
Vogt
P M
PM
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*