Microcirculation Research for Microsurgeons: Basic Concepts and Potential Applications

Abstract

The primary purpose of this review is to introduce the techniques of modern microcirculation research to reconstructive microsurgeons and trauma surgeons. When applied to clinically relevant situations, these techniques are powerful tools to elucidate the mechanisms regulating success or failure of a reconstructive procedure. Several phenomena at the microcirculatory level can have significant influence on the outcome of free flaps or replants. Most importantly these are ischemia/reperfusion injury, problems with wound healing and failure of downstream microcirculation due to thrombosis at the vascular anastomosis. Traditional research methods to assess free flap or replant failure utilize patency of the repaired vessel as the principal parameter. This all-or-nothing measurement provides little information about the dynamic mechanisms regulating thrombosis and microcirculation in general. Modern microcirculation research techniques, in contrast, permit direct visualization with qualitative and quantitative analysis of microcirculation in vivo. Applying these modern research techniques in model systems that simulate clinical reconstructive microsurgery has the potential to expand our understanding of the relevance of blood flow and its alterations to clinicals outcomes. To enable such an understanding, this review focuses on elucidating the basic nomenclature used in microcirculation research in context of microvascular problems clinically encountered by reconstructive and trauma surgeons.