Microcirculatory consequences of microvascular surgery

Although free tissue transfer success has been greatly improved by developments in operating microscopes, microsutures, microinstruments, and technique, free flap and replant failure remain a significant problem under certain adverse circumstances. The nature of these failures is often multifactorial and remains poorly understood. A greater understanding of the processes involved would provide the potential for greater pharmacological control of any adverse conditions prevailing and would thus offer the prospect of more effective adjunctive therapy in the presence of such adverse conditions. Research endeavors in this area have been hindered by the absence of good research models. The isolated rat cremaster muscle model is a recently developed model that simulates the conditions of free tissue transfer. Using this model, both thrombus formation and numerous microcirculatory parameters can be measured. The microcirculatory parameters studied to date include the formation of thromboembolism, capillary perfusion, vessel diameters, red blood cell velocity, leukocyte-endothelium interaction, and microvascular leakage. The isolated rat cremaster muscle model addresses many of the shortcomings of earlier research models and offers the promise of answering at least some of the many unanswered questions relating to free flap and replant failure.