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Direct microvascular monitoring of a free autologous jejunal flap using microendoscopy: a case report.

Upile T, Jerjes W, El Maaytah M, Hopper C, Searle A, Wright A - BMC Ear Nose Throat Disord (2006)

Bottom Line: The best view was obtained when the scope was focussed directly on the capillary rather than the graft surface.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Head & Neck Unit, University College London Hospitals, UK. mrtupile@yahoo.com

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.

Case presentation: 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.

Conclusion: 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.

No MeSH data available.


Microendoscopic view ×150 showing serosal surface and underlying capillary network. No methylene blue stain was used. The larger calibre serosal capillaries are easier to visualise, in real time actual cells and flow is visible within the lumen of the vessels. The procedure may be undertaken intraoperatively (during graft setting and before tissue coverage) and on sentinel graft islands postoperatively to assess perfusion. Again time gated image analysis can be performed to provide quantifiable data on blood flow and perfusion with colorimetric analysis possible to assess state of oxygen saturation.
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Figure 5: Microendoscopic view ×150 showing serosal surface and underlying capillary network. No methylene blue stain was used. The larger calibre serosal capillaries are easier to visualise, in real time actual cells and flow is visible within the lumen of the vessels. The procedure may be undertaken intraoperatively (during graft setting and before tissue coverage) and on sentinel graft islands postoperatively to assess perfusion. Again time gated image analysis can be performed to provide quantifiable data on blood flow and perfusion with colorimetric analysis possible to assess state of oxygen saturation.

Mentions: Using this method we were able to directly visualise the flow of blood through the sub-mucosal capillary networks of the transferred free jejunal graft (Figures 3 and 4). This was further confirmed by direct intra-operative visualisation of the blood flow through the vasculature of the graft's serosal surface (Figure 5). This method was used successfully to assess the viability of the flap.


Direct microvascular monitoring of a free autologous jejunal flap using microendoscopy: a case report.

Upile T, Jerjes W, El Maaytah M, Hopper C, Searle A, Wright A - BMC Ear Nose Throat Disord (2006)

Microendoscopic view ×150 showing serosal surface and underlying capillary network. No methylene blue stain was used. The larger calibre serosal capillaries are easier to visualise, in real time actual cells and flow is visible within the lumen of the vessels. The procedure may be undertaken intraoperatively (during graft setting and before tissue coverage) and on sentinel graft islands postoperatively to assess perfusion. Again time gated image analysis can be performed to provide quantifiable data on blood flow and perfusion with colorimetric analysis possible to assess state of oxygen saturation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC1590045&req=5

Figure 5: Microendoscopic view ×150 showing serosal surface and underlying capillary network. No methylene blue stain was used. The larger calibre serosal capillaries are easier to visualise, in real time actual cells and flow is visible within the lumen of the vessels. The procedure may be undertaken intraoperatively (during graft setting and before tissue coverage) and on sentinel graft islands postoperatively to assess perfusion. Again time gated image analysis can be performed to provide quantifiable data on blood flow and perfusion with colorimetric analysis possible to assess state of oxygen saturation.
Mentions: Using this method we were able to directly visualise the flow of blood through the sub-mucosal capillary networks of the transferred free jejunal graft (Figures 3 and 4). This was further confirmed by direct intra-operative visualisation of the blood flow through the vasculature of the graft's serosal surface (Figure 5). This method was used successfully to assess the viability of the flap.

Bottom Line: The best view was obtained when the scope was focussed directly on the capillary rather than the graft surface.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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Head & Neck Unit, University College London Hospitals, UK. mrtupile@yahoo.com

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.

Case presentation: 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.

Conclusion: 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.

No MeSH data available.