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In Vivo Real-time Ultra-fast 3D Fourier Domain Optical Coherence Tomography Imaging of Anastomoses For Super-microsurgical Research
Shan Zhu, MD1, Dedi Tong, MD1, Yong Huang, Phd2, Lehao Wu, MD1, Zuhaib Ibrahim, MD1, Qi Mao, MD1, John Pang, MD1, Damon S. Cooney, MD1, W.P. Andrew Lee, MD1, Gerald Brandacher, MD1.
1Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, Baltimore, MD, USA, 2Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD, Baltimore, MD, USA.
PURPOSE: The emergence of supermicrosurgery has enabled reconstructive surgery to enter into a new era by advancing a series of novel techniques including lymphaticovenous anastomosis, fingertip replantation, and perforator flap surgery. Nonetheless, super-microsurgery techniques impose great technical challenges. The instant monitoring and evaluation of the patency of the anastomosis, in particular of intraluminal structure, is critical to be able to predict the necessity of early re-intervention and thus reduce/avoid complications and improve surgical success rates. Real-time 3D fourier-domain optical coherence tomography (3D FD-OCT) is a powerful imaging system, which uniquely provides noninvasive, in vivo real-time images on a micrometer-scale, allowing intra-operative assessment of dynamic tissue microstructure of vessels at depths beyond those of standard microscopy. In this study, we evaluated 3D FD-OCT as an effective method for in vivo monitoring of various super-microsurgical anastomosis techniques.
METHODS: 40 C57BL/6 mice underwent end-to-end femoral artery anastomosis and in vivo monitoring by the 3D FD-OCT at various time points (pre-anastomosis, right before release of vessel clamp, and 60-minutes post anastomosis). 3D FD-OCT was running at 70,000 A-scans per second with lateral resolution of 12 µm and axial resolution of 3.6 µm was used for intravital imaging. In addition, all results from 3D FD-OCT imaging were correlated and confirmed by H&E histology.
RESULTS: Within the 40 femoral arteries (diameters averaged slightly less than 0.4 millimeter), 38 of them gained immediate patency after removing the clamp and had stable blood flow 1 hour after anastomosis. Two anastomoses were not patent because of suturing the back wall of the vessel and entangled adventitia respectively. In those cases, OCT images successfully exhibited the structures of all layers of the vessel wall, the vessel patency and continuity shown by tomographic section, 3D anatomic reconstruction and Doppler image, and blood flow. In the 2 instances with anastomotic complications, thrombus formation and progression could be clearly visualized. Furthermore, OCT imaging was able to detect impaired endothelium continuity, evidence of technical error and compromised blood flow. Histology confirmed the respective OCT outcomes.
CONCLUSION: 3DFD-OCT is a valid method to evaluate vessel patency, hemodynamics and the structural changes of the anastomosed artery, as well as potential technical glitches during anastomosis. This real-time non-invasive method has tremendous potential for clinical applications and to improve outcomes of super-microsurgical procedures.
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