Upile Tahwinder, Jerjes Waseem, El Maaytah Mohammed, Hopper Colin, Searle Adam, Wright Anthony
Head & Neck Unit, University College London Hospitals, UK.
BMC Ear Nose Throat Disord. 2006 Sep 29;6:14. doi: 10.1186/1472-6815-6-14.
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.
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.
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.
早期识别皮瓣失败是皮瓣挽救不可或缺的前提条件。尽管目前许多游离皮瓣监测的技术进展已应用于临床，但很少有技术被认为对早期识别皮瓣失败可靠且无创。
我们使用显微内镜技术对游离自体空肠皮瓣进行微血管监测，通过直接观察红细胞在黏膜和浆膜表面毛细血管系统中的流动情况。可见血流呈搏动性，毛细血管中可看到单个红细胞。当内镜直接聚焦于毛细血管而非移植物表面时，可获得最佳视野。除了在每次搏动时可见充满血液的细小毛细血管袢外，未染色的黏膜表面视野平淡。浆膜表面的显微内镜检查显示血管口径大得多，血流明显。
显微内镜监测技术简单安全，可直接观察血流。该技术可能对监测其他游离肠移植也有用。
