Intraoperative Identification of Perforator Spasm and Decreased Pulsation Using Video-capillaroscopy during Free Flap...

Area of Science:

• Vascular Surgery
• Microsurgery
• Medical Imaging

Background:

• Vascular spasm in small perforators is a challenge in microvascular reconstruction.
• Current methods lack reliability for assessing spasm resolution at the periphery of perforators.

Purpose of the Study:

• To evaluate the utility of video-capillaroscopy for assessing perforator vessel spasm after flap elevation.
• To classify the types of perforator spasms observed using this imaging modality.

Main Methods:

• Video-capillaroscopy was used to evaluate seven free flaps between November 2021 and February 2022.
• Twenty-five perforators (diameter <1mm) were assessed for vasospasm and classified into six types based on resolution.
• Treatment interventions included papaverine hydrochloride spraying and hot water treatment (PHS+HWT).

Main Results:

• No type F spasm (no recovery) was observed in any of the evaluated perforators.
• The observed spasms were classified as type A (no spasm/decreased pulsation) to type E (requiring PHS+HWT with recovery within 15 minutes).
• Video-capillaroscopy confirmed blood flow deterioration in areas difficult to assess macroscopically.

Conclusions:

• Video-capillaroscopy is a valuable noninvasive tool for intraoperative evaluation of perforator flow and spasm.
• This modality allows for objective assessment and classification of vasospasm, aiding surgical decision-making.
• It provides a reliable method to determine spasm resolution in microvascular reconstruction.