Reconstructive Surgery & Anaplastology

ISSN - 2161-1173


Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels

Ricardo A Yañez1 *, Jose R Rodriguez1 , Ignacio J Cifuentes1 , Bruno L Dagnino1 , Sebastian A Sepulveda2 , Arturo A Meissner4 , Rodrigo A Menchaca4 and Glenn W Hernandez3

A timely diagnosis of vascular compromise improves free flap survival. The aim of this study was to determine the feasibility of monitoring flap vascular patency through noninvasive microcirculation monitoring using SDF. An experimental study was performed in five volunteers. A radial forearm flap was simulated in both upper extremities and cutaneous microcirculation assessment devices were used (SDF and NIRS), and compared with clinical and doppler evaluation. Conditions of venous occlusion (VO) and total vascular occlusion (TVO) were mimicked by using a cuff. The results of the Microscan SDF monitoring during VO and TVO showed a reduced microcirculatory flow at 16.5 (6-30) and 6 (2-11) seconds respectively. Both NIRS and clinical evaluation were slower than SDF at identifying vascular compromise. During VO the Doppler signal does not disappear; while in TVO the signal disappeared at 1.8 (1-5) seconds. This study shows that evaluation of microcirculation with Microscan SDF is a viable alternative that may allow detection of flap venous and total vascular occlusion earlier than Doppler, NIRS and clinical evaluation