| Purpose:Perforator flaps have proven to be one of the most invaluable options in reconstructive surgery. It plays a crucial role in the soft-tissue defect reconstruction with functional and aesthetic outcomes in the recipient site and minimal morbidities in the donor site. However, the small-sized caliber and thinness of these perforating vessels impose great challenge to the surgeons.In such cases, it is most desirable to have a non-invasive measurement that could effectively guide microsurgical anastomosis and then evaluate the quality of the anastomosis through a visualized system. In this study, we utilized the 3D Spectral Domain Optical Coherence Tomography (3D SD-OCT) to evaluate the quality of the microsurgical anastomosis and thrombosis induced in the murine’s femoral artery. The feasibility and accuracy of this novel method are also investigated.Method:1. To establish an animal model for exploring the ultrastructure of small vessels of mice in vivo using 3D SD-OCT. OCT was used to scan the femoral arteries of mice and the coronal-, sagittal-, and cross-sections of these vessels were obtained in a non-contact manner before micro vascular anastomosis. The scanned images were then imported into a computer and converted into visualized image data. The three-dimensional ultrastructural images of the small vessels were obtained through 3D reconstruction of the image data. During the process of microvascular anastomosis, OCT was used to monitor the procedure on a synchronous and real-time basis. The role of the OCT in monitoring and guiding the microvascular anastomosis is then investigated.2. To evaluate the accuracy of using the OCT to detect a thrombosis in vivo. The thrombosis animal model was established by intravascular administration of the ferric chloride into the femoral arteries of the mice. At 1 minute and 1 hour after administration, OCT was used to scan the femoral arteries of mice. Then heparin was applied to dissolve the thrombosis followed by OCT scanning at 4-hour,18-hour and 24-hour. The coronal-, sagittal-, and cross-sections of these vessels were obtained in a non-contact manner. The scanned images were imported into the Matlab software to obtain the image data.3. Investigation of the efficacy of OCT in monitoring thrombosis induced by incorrect surgical performance. Subjects are randomly divided into 2 groups:normal anastomosis and poor anastomosis. The OCT scanning was performed 1 hour before and after anastomosis. The scanned vessel section was evaluated by H&E staining to confirm the results of OCT scanning.Results:1. The reconstructed images of the 3D SD-OCT presented clearly the ultrastructure of the femoral artery in the cross, coronal and sagittal planes and the three dimensional view of the vessel. During the anastomosis, the OCT scanning can provide real-time information of the locations where the suture went through. By such way, the incorrect performance of suturing to the opposite wall can be accurately diagnosed.2. The thrombosis can be accurately detected by the 3D SD-OCT scanning. The pathophysiological cascade of thrombogenesis and the effect of an anticoagulation treatment can also be showed by the 3D SD-OCT scanning.3.3D SD-OCT accurately captured the potential risks of thrombegenesis by surgical errors, and the results were confirmed by the histopathological analysis.Conclusion:1.3D SD-OCT can provide real-time information. It is a non-invasive, objective, quantifiable, precise, contact-free and replicable measure to monitor the vessel with high resolution.2.3D SD-OCT can present three-dimensional ultrastructural images of small vessels.3.3D SD-OCT can visualize the blood vessel during the process of anastomosis and guide the anastomosis procedure.4.3D SD-OCT can detect arterial thrombosis and show the pathophysiological cascade of thrombogenesis. |
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