Monitoring free flaps using the laser Doppler flowmeter: five-year experience

Over a 5-year period, 232 microvascular composite-tissue transfers to the head and neck, trunk, and extremities were monitored using the laser Doppler flowmeter. Thirteen free flaps (5.6 percent) developed vascular complications, all within 4 days after surgery. The laser Doppler flowmeter detected vascular compromise in all cases with no false positives or negatives. Failure to monitor the flap according to protocol by nursing staff occurred in one patient, which led to a delay in detection of venous compromise and subsequent flap loss. The salvage rate was 69.2 percent, leading to an overall flap viability of 98.3 percent. Our series of free-flap monitoring using the laser Doppler flowmeter is the largest reported to date. Review of the English literature shows consistent support by numerous clinical series for the use of the laser Doppler as a valuable postoperative monitor after free-flap transfers.     

Tachykinin-induced vasodilatation in rat skin measured with a laser-Doppler flowmeter: evidence for receptor-mediated effects

Vasodilatation was induced by perfusion of the tachykinins substance P (SP), neurokinin A and neurokinin B and the analogues [Glp6, D-Pro9]SP-(6-11) and [Glp6, L-Pro9]SP-(6-11) over the base of vacuum-induced blisters on the rat footpad. Vasodilatation was measured as change in blood flow using a laser-Doppler flowmeter. The tachykinins induced vasodilatation in a dose-response manner with a threshold of approximately 3 pmol and pD2's of 6.48, 6.13 and 6.21 for SP, neurokinin A and neurokinin B respectively. The D- and L-Pro analogues of [Glp6, Pro9]SP-(6-11) also induced vasodilatation in a dose-dependent manner. The L-Pro analogue was more potent than the D-Pro analogue (D/L ratio of the EC50's = 21) which suggests the involvement of an NK-1 type receptor in the mediation of small vessel vasodilatation. The vasodilatation to SP was reduced by 64% and 59% in capsaicin- and antihistamine-pretreated animals respectively, demonstrating the involvement of capsaicin-sensitive primary afferent nerves and mast cells in the vasodilatation component of the neurogenic inflammatory response.     

The muscular blood flow in rats in ontogenesis as measured by the needle probe laser Doppler flowmeter "LAKK-01"

In anesthetized Wistar rats of the age of 4, 13, 30 and 90 days, blood flow in m. gracilis was measured with the aid of laser-Doppler flowmeter "LAKK-01" with a needle probe. The sharpest postnatal falling of a muscular blood flow was revealed in the first month of life. Features of measurement of the blood flow and biological background by a needle probe in skeletal muscles of rats of various age described.     

Automated computation of relative flow resistance using a pulsed Doppler flowmeter

Use of a pulsed Doppler flowmeter to assess changes in blood flow resistance often requires a laborious series of calculations, and full characterization of resistance changes frequently necessitates replotting of calculated data. To facilitate the interpretation of pulsed Doppler flowmetry data, a simple, inexpensive device was constructed that computes the signal ratio of mean arterial pressure (MAP) to directional pulsed Doppler outputs. With this device, relative flow resistance can be recorded and quantitatively assessed at a glance in three vascular beds in real time. This computer-like device was designed around the Burr-Brown DIV100HP integrated circuit. C741G OpAmps provide input buffering, zeroing, and ranging adjustments enabling the user to accurately follow resistance over a very broad range of changes without exceeding the device's operating limits. A LM339 quad comparator monitors the input of each DIV100 and indicates when operating limits are exceeded via a channel-specific LED indicator and an audible alarm. No significant attenuation of the input signals occurs over the range of direct current to 50 kHz, and the output is without significant phase shift. Comparisons with calculated changes in resistance derived from the MAP and pulsed Doppler flowmetry in unanesthetized, unrestrained rats confirmed that resistance changes can be measured with precision and accuracy.     

Neurogenic vasodilation and release of calcitonin gene-related peptide (CGRP) from perivascular nerves in the rat mesenteric artery

The effect of perivascular nerve stimulation (PNS) on the release of calcitonin gene-related peptide (CGRP) was examined by radioimmunoassay (RIA) in isolated, perfused rat mesenteric arteries. The released CGRP-like immunoreactivity (CGRP-LI) was identified to be CGRP itself and its oxidized form by combined analysis with RIA and high performance liquid chromatography. CGRP-LI was localized in the perivascular nerves of the large mesenteric artery and its branches. In the preparation precontracted by methoxamine, and perfused with a solution containing guanethidine, an adrenergic neuron blocker, PNS induced vasodilator responses and an increase of CGRP-LI in the perfusate in a frequency-dependent manner. Both the responses were attenuated by tetrodotoxin (10(-6) M), suggesting that they were neurogenic in origin. Removal of Ca2+ from the perfusing solution also abolished the PNS-induced release of CGRP-LI. These findings suggest that CGRP plays a transmitter role in the neurogenic vasodilation in the rat mesenteric vascular bed.     

Influence of nitric oxide-mediated vasodilation on the blood pressure measured with the tail-cuff method in the rat

Systolic blood pressure (SBP) is frequently measured in rats by the tail cuff method, which usually comprises pulse/flow disappearance and reappearance during cuff inflation (Inf) and deflation (Def), separated by an interval between cycles (IBC). Although Def values are habitually used to estimate SBP, in 58 Wistar rats we found (Def–Inf) to be −6 ± 1 mmHg, indicating that Def  < Inf in most cases. When the IBC was lengthened to 2 min, (Def–Inf) was increased to −17 ± 2 mmHg, indicating the probable accumulation of a vasodilating metabolite. This increase of (Def–Inf) was prevented by papaverine, indicating its relation to smooth muscle contractility. Adrenergic blockade did not prevent the increase of (Def–Inf), but pretreatment with L-NAME decreased it to −5 ± 2 mmHg (p < 0.05). Simultaneous measurement of SBP by tail-cuff method and carotid cannulation revealed that the Inf value was the most accurate estimation of intravascular SBP. We conclude that: (1) the Inf value should be taken as representative of SBP, since depending on the duration of suprasystolic compression the Def value can underestimate it, and (2) nitric oxide accumulation due to flow deprivation was the main cause of SBP underestimation by Def values. Mariana Fritz—Recipient of a Fellowship from the Agencia Nacional de Promoción Científica y Tecnológica (ANPCYT), República Argentina. Gustavo Rinaldi—Established Investigator of the Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), República Argentina.     

High quality photoplethysmograph signals from a laser Doppler flowmeter: preliminary studies of two simultaneous outputs from the finger

An improvement in the quality of a photoplethysmograph signal derived from a laser Doppler flowmeter probe has been achieved by incorporating an auxiliary fibre in the probe head. This fibre is positioned at an optimum distance from the laser light transmitting fibre and overcomes the problem of high frequency signals which mask the detailed features of the photoplethysmograph pulse when a small fibre separation is used. These two signals may be recorded simultaneously from the same site and a correlation between the Doppler output and the photoplethysmograph amplitude has been demonstrated in the finger. The amplitude is shown to be affected by the relative position of the point of measurement with respect to the heart, a factor which does not appear to influence significantly the Doppler output.     

Postnatal development of autonomic and sensory innervation of thoracic hairy skin in the rat

Summary Histochemical, immunocytochemical, and radioenzymatic techniques were used to examine the neurotransmitter-related properties of the innervation of thoracic hairy skin in rats during adulthood and postnatal development. In the adult, catecholamine-containing fibers were associated with blood vessels and piloerector muscles, and ran in nerve bundles throughout the dermis. The distribution of tyrosine hydroxylase (TH)-immunoreactive (IR) fibers was identical. Neuronal fibers displaying neuropeptide Y (NPY) immunoreactivity were seen in association with blood vessels. Double-labeling studies suggested that most, if not all, NPY-IR fibers were also TH-IR and likewise most, if not all, vessel-associated TH-IR fibers were also NPY-IR. Calcitonin gene-related peptide (CGRP)-IR fibers were observed near and penetrating into the epidermis, in close association with hair follicles and blood vessels, and in nerve bundles. A similar distribution of substance P (SP)-IR fibers was evident. In adult animals treated as neonates with the sympathetic neurotoxin 6-hydroxydopamine, a virtual absence of TH-IR and NPY-IR fibers was observed, whereas the distribution of CGRP-IR and SP-IR fibers appeared unaltered. During postnatal development, a generalized increase in the number, fluorescence intensity, and varicose morphology of neuronal fibers displaying catecholamine fluorescence, NPY-IR, CGRP-IR, and SP-IR was observed. By postnatal day 21, the distribution of the above fibers had reached essentially adult levels, although the density of epidermal-associated CGRP-IR and SP-IR fibers was significantly greater than in the adult. The following were not evident in thoracic hairy skin at any timepoint examined: choline acetyltransferase activity, acetylcholinesterase histochemical staining or immunoreactivity, fibers displaying immunoreactivity to vasoactive intestinal peptide, cholecystokinin, or leucine-enkephalin. The present study demonstrates that the thoracic hairy skin in developing and adult rats receives an abundant sympathetic catecholaminergic and sensory innervation, but not a cholinergic innervation.     

A laser Doppler scanner for imaging blood flow in skin

This paper describes a novel medical instrument that produces an image of blood flow in the capillaries under the skin surface. A laser beam is used to detect blood cell motion from the Doppler broadening of the laser light scattered from the skin. The image is generated by scanning the laser beam in a raster. The design of a practical clinical instrument is outlined and some preliminary results are presented.     

Changes in fibre populations of the rat hairy skin following selective chemodenervation by capsaicin

Perineural application of capsaicin results in a selective and permanent reduction in the sensitivity to noxious chemical and heat stimuli and elimination of the neurogenic inflammatory response. The present quantitative immunohistochemical study has been undertaken to reveal the populations of cutaneous afferent nerves that are affected by perineural capsaicin treatment. Areas of intact and chemodenervated skin were determined with the aid of the vascular labelling technique. In sections taken from intact skin areas, staining with antibodies against protein gene product 9.5 revealed a rich epidermal innervation. Fibres immunoreactive for growth-associated protein 43 were also abundant; nerve fibres immunoreactive for substance P and calcitonin gene-related peptide were less numerous. Somatostatin- and RT97-immunoreactive fibres were seen only in the subepidermal layer. In sections taken from skin areas supplied by the sciatic nerve treated with capsaicin 3 days previously, the number of epidermal nerve fibres immunoreactive to protein gene product 9.5, growth-associated protein 43, substance P and calcitonin gene-related peptide was reduced by 90%, 95%, 97% and 66%, respectively. These changes persisted for at least 42 days. The findings reveal that the majority of epidermal axons are capsaicin-sensitive and comprise a chemically heterogeneous population. Reductions in cutaneous fibre populations following perineural capsaicin treatment may result from both the degeneration of sensory axons and the depletion of neuron-specific macromolecules. In addition, most cutaneous nociceptive axons may not use the major sensory neuropeptides substance P and calcitonin gene-related peptide as afferent neurotransmitters.     

Regional variations of laser Doppler blood flow in ischemic skin flaps

An island skin flap was designed on the left inferior epigastric neurovascular bundle of anesthetized male rats. Blood flow was measured in situ with a laser Doppler flowmeter at 20 discrete points on a grid system (5 points in each quadrant of the flap) before and after surgery, or before vascular occlusion, during reperfusion, and 48 to 72 hours later. Two series of experiments were performed. In the first series, the raised flap was placed in a bath containing heated Ringer's solution and the left pedicle was cross-clamped. After 30 minutes, adenosine at a concentration that produced supramaximal vasodilatation, or its vehicle, was added to the bath. After 1 hour total occlusion time, the vascular clamp was released and adenosine treatment was continued for the first 30 minutes of reperfusion. In the second series, the protocol was similar except that adenosine, or its vehicle, was infused into the ischemic flap by means of the distal stump of the right inferior epigastric artery. After 48 to 72 hours, fluorescein was injected IV. The data showed a significant regional variation in baseline laser Doppler blood flow that was further altered by surgically raising the flap. Whereas proximal axial laser Doppler blood flow was essentially unchanged from the preoperative baseline, distal axial laser Doppler blood flow decreased 10 to 50 percent, and proximal and distal dependent laser Doppler blood flow decreased 50 to 80 percent. Thus no single value accurately reflected total flap perfusion. Necrosis occurred only in the dependent flap regions, which confirmed previous work. In the dependent regions, especially along the incision line, postoperative laser Doppler blood flow was lowest.(ABSTRACT TRUNCATED AT 250 WORDS)     

Evaluation of the parameters of total,nutritive, and shunt blood flows in the skin microvasculature using laser Doppler flowmetry

Examination of 28 healthy subjects and 66 patients was performed using laser Doppler flowmetry (LDF) of the skin of fingers in the red and infrared ranges and wavelet analysis of microvascular blood flow oscillations. Formulas were suggested for the total (TF), nutritive (NF), and shunt (SF) local blood flows. TF = MI × A_c × A_n /(P_m × ), where MI is the microcirculation index in perfusion units (PU), A_n and A_c are the averaged maximum amplitudes of the neurogenic and cardiac rhythms (in PU), P_m is the mean arterial pressure (in mm Hg), and is the mean square deviation of the amplitude of blood flow oscillations (in PU). NF = TF/SP, where SP is the shunting parameter. SP = A_n/A_m, where A_m is the averaged maximum amplitude of the myogenic rhythm (in PU). SF = TF - NF. Significant positive relationships between the skin oxygenation and NF (red), temperature and TF (red), and blood flow measured by hydrogen clearance and TF (infrared) were revealed by comparison of the LDF parameters with polarographic and thermographic data. The advantages of the LDF parameters compared with the MI were shown, especially in skin denervation syndromes. The TF decreased in the case of complete anatomic rupture of the median nerve and increased in reflex sympathetic dystrophy, with both cases being accompanied by a deficit of the NF (red).Translated from Fiziologiya Cheloveka, Vol. 31, No. 1, 2005, pp. 114–119.Original Russian Text Copyright © 2005 by Krupatkin.     

Detection of small vessels for microsurgery by a Doppler flowmeter.

The Doppler flowmeter saved time and helped us to quickly find the exact position of the donor and the recipient vessels in the microvascular transfer of a free deltopectoral flap to the face.     

Comparison of responses to tensile and compressive stimuli in C-mechanosensitive nociceptors in rat hairy skin

Mechanosensitive nociceptors with unmyelinated axons (C-fibers) were studied in a preparation of isolated skin and nerve from rat. Afferent discharges were recorded while the skin was mechanically stimulated using quantitative stretch (tension) and indentation (compression). The apparatus allowed for generating stimuli of equal magnitudes in both tension and compression. Stimulus-response functions were obtained for individual afferents relating discharge rate to tensile stress or compressive stress. A response threshold and maximal slope were obtained from each function. Thresholds did not differ significantly for compression and tension nor did the maximal slopes. We conclude that C-nociceptors are equally sensitive to tensile and compressive stress.     

Identification of the Ruffini corpuscle in human hairy skin

Summary A Ruffini corpuscle was identified in the dense reticular dermis of the human scalp from a patient with alopecia areata. The corpuscle measured approximately 50 m in diameter. One afferent myelinated axon with a diameter of 4–6 m supplies the corpuscle. Branched axon terminals and the associated Schwann cells tightly envelop parallel bundles of collagen fibrils. Axon terminals evidenced focal swellings, and small finger-like protrusions projected into the endoneural connective tissue. The terminals are characterized by the presence of abundant mitochondria, numerous vesicles, particles of glycogen and electron-opaque lipid material. A thin perineural capsule envelops the bundles of collagen fibrils and associated terminals. The present study provides the first electron-microscopic characterization of a Ruffini corpuscle in human hairy skin.This study was supported in part by the Deutsche ForschungsgemeinschaftSupported in part by U.S. Public Health Service Research Contracts NIDR72-2401 and HD4-2869 and Research Grant HD 11216     

Biospeckle‐characterization of hairy root cultures using laser speckle photometry

Monitoring is indispensable for the optimization and simulation of biotechnological processes. Hairy roots (hr, plant tissue cultures) are producers of valuable relevant secondary metabolites. The genetically stable cultures are characterized by a rapid filamentous growth, making monitoring difficult with standard methods. This article focuses on the application of laser speckle photometry (LSP) as an innovative, non‐invasive method to characterize Beta vulgaris (hr). LSP is based on the analysis of time‐resolved interference patterns. Speckle interference patterns of a biological object, known as biospeckles, are characterized by a dynamic behavior that is induced by physical and biological phenomena related to the object. Speckle contrast, a means of measuring the dynamic behavior of biospeckles, was used to assess the biospeckle activity. The biospeckle activity corresponds to processes modifying the object and correlates with the biomass growth. Furthermore, the stage of the cultures’ physiological development was assessed by speckle contrast due to the differentiation between active and low active behavior. This method is a new means of monitoring and evaluating the biomass growth of filamentous cultures in real time. As a potential tool to characterize hairy roots, LSP is non‐invasive, time‐saving, can be used online and stands out for its simple, low‐cost setup.     

Isometric handgrip exercise-induced muscarinic vasodilation in the human skin microvasculature

The existence of an active vasodilator system in the human skin microvasculature is well documented, but its physiological role and the underlying mechanisms are not completely understood. Cutaneous blood flow increases during isometric handgrip exercise. To examine whether this response is mediated by active vasodilation, isometric handgrip exercise testing was performed in nine healthy subjects. Local iontophoresis of atropine was applied to the forearm skin. Skin blood flow (SBF) monitoring by means of laser Doppler flowmetry was combined with continuous noninvasive blood pressure monitoring. SBF monitoring was performed at a site pretreated with atropine and an adjacent control area. Mean arterial pressure (MAP) was recorded noninvasively. Cutaneous vascular resistance (CVR) was calculated as MAP/SBF for the atropine treated and the control areas. Changes in CVR were expressed as percent deviation from the baseline (dCVR). Isometric handgrip exercise resulted in a marked reduction in CVR at the control site (dCVR: -66 +/- 4%). In contrast, the CVR was not significantly altered at the atropinetreated site (2.4 +/- 7%). It is concluded that isometric exercise induces an atropine-sensitive vasodilation which is mediated by muscarinic receptors in the human skin.