title: Effect of surgical traumas on microcirculation.
abstract: BACKGROUND
  Adequate microcirculation in different tissues maintains the physiological function and heals surgical wounds. In any surgical procedure, the commonly used instruments are cautery, tissue forceps, and clamps. The fact that their inappropriate use produces an adverse effect on microcirculation is often not realized. By this study, we could demonstrate live, the effect of these surgical traumas.
  
  
  METHODS
  The study was conducted on the inferiorly based fasciocutaneous flap with a fascial extension in patients with a distal leg defect. The extended fascial flap was mounted on a glass slide and observed for live microcirculation under x160 magnification. Three methods were used: (a) cautery in low power, (b) microcrushing forceps to crush the vessels, and (c) noncrushing clamps at the base of the fascial flap.
  
  
  RESULTS
  It was observed that the vessels are well protected within the deep fascia. Once the fascia was pierced the current damaged the vessel wall. As the wattage was increased, it caused charring of the tissue and multiple vessels ultimately leading to cessation of blood flow. Once the vessel wall was crushed by forceps, blood extravasated in a variable intensity depending upon the size of the vessel. Clamping led to gradual slowing of blood flow with microclot formation. In certain vessels, there was discontinuity in the blood column and ultimately the blood flow stopped.
  
  
  CONCLUSIONS
  This study showed live demonstration of the effect of surgical traumas on microcirculation. It should guide the surgeons to select the use of appropriate instruments which will cause minimal damage to vascularity and thereby lead to a better surgical outcome.
authors.affiliation: Department of Plastic Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh-221005, India.
authors.forename: Visweswar
authors.initials: V
authors.lastname: Bhattacharya
authors.forename: Biswajit
authors.initials: B
authors.lastname: Mishra
authors.forename: Binayak
authors.initials: B
authors.lastname: Mishra
authors.forename: Umesh
authors.initials: U
authors.lastname: Kumar
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Bhattacharya