Effect of surgical traumas on microcirculation

Area of Science:

• Surgical Techniques
• Microcirculation Research
• Wound Healing Studies

Background:

• Adequate tissue microcirculation is vital for physiological function and surgical wound healing.
• Common surgical instruments (cautery, forceps, clamps) can adversely affect microcirculation, often unrecognized.
• This study visually demonstrates the impact of surgical trauma on microcirculation.

Purpose of the Study:

• To visually demonstrate the real-time effects of common surgical instruments on microcirculation.
• To highlight the potential damage caused by inappropriate instrument use.
• To inform surgical practice regarding instrument selection for preserving vascularity.

Main Methods:

• Utilized an inferiorly based fasciocutaneous flap with a fascial extension in distal leg defect patients.
• Mounted the fascial flap on a glass slide for live observation of microcirculation at 160x magnification.
• Applied three methods: low-power cautery, microcrushing forceps, and noncrushing clamps to fascial flap vessels.

Main Results:

• Cautery, especially at higher wattages, damaged vessel walls, caused tissue charring, and led to blood flow cessation.
• Forceps crushing resulted in variable blood extravasation based on vessel size.
• Clamping induced gradual blood flow reduction, microclot formation, and vessel discontinuity, ultimately stopping blood flow.

Conclusions:

• Live demonstration confirmed surgical traumas significantly impact microcirculation.
• Findings emphasize the need for careful instrument selection to minimize vascular damage.
• Appropriate instrument use is crucial for optimizing surgical outcomes and promoting effective wound healing.