This trial is registered under the name "Real-time assessment of capillary circulation using video-capillaroscopy," University Hospital Medical Information Network identification number UMIN000041092 (https://center6.umin.ac.jp/cgiopen-bin/ctr_e/ctr_view.cgi?recptno=R000046920).

Background: Multidirectional cranial distraction osteogenesis (MCDO) can achieve a desired shape for deformities of the cranium. In the past, visual estimation was used to reflect on the actual skull, but it was time-consuming and inaccurate. Here we demonstrate an effective osteotomy navigation method using surgical guides made from a dental impression silicone. Methods: Seven patients who underwent MCDO between August 2013 and September 2016 were included in the study. Five cases involved utilization of the surgical guide for osteotomy. Three-dimensional (3D) printed cranium models were made using 3D computed tomography (3DCT) imaging data and dental impression silicone sheets were molded using the printed cranium models. These surgical guides were sterilized and used for intraoperative osteotomy design. Vertical distance between nasion/porion and osteotomy lines were calculated using 3D printed cranial models and postoperative 3DCT images to assess reproducibility. Results: The average surgical time/design time was 535/37.0 minutes for the nonsurgical guide group and 486.8/11.8 minutes for the surgical guide group (SG).Treatment using the surgical guide was significantly shorter in terms of operative time and time required for design. For the vertical distance comparison, the average distance was 5.7mm (SD = 0.3) in the non-SG and 2.5mm (SD = 0.44) in the SG, and SG was more accurate. Conclusions: Shorter operative times and higher reproducibility rates could be achieved by using the proposed surgical guide, which is accurate, low-cost, and easily accessible.

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Summary: Video-capillaroscopy is being explored as a potential tool for microsurgical flap monitoring. A detailed examination of the effect of temperature on capillary changes using video-capillaroscopy is yet to be investigated. We analyzed the video-capillaroscopy findings on different skin areas often used for flap harvest at normal body temperatures and at lower temperatures. Skin capillaries at the lateral thigh, anterior forearm, mid-axillary line, abdomen, and fingertips were observed using video-capillaroscopy in 20 healthy Japanese individuals. Further, ImageJ software was used to measure the blood vessel area and blood flow velocity, and comparisons were drawn between normal body temperature and lower body temperature states. All measures of blood vessel area and average blood flow velocity for the different anatomical regions were significantly different before and after cooling ( P < 0.001). The mean reduction rate of the vessel area was significantly different among anatomic regions ( P < 0.001). Post-hoc analysis revealed a significant difference in the vessel area reduction rate between anatomic areas ( P < 0.05); except when comparing the thigh versus finger, the forearm versus abdomen, and the mid-axillary line versus abdomen. The mean blood flow velocity was significantly different among anatomic regions ( P < 0.001). Post-hoc analysis revealed a significant difference between the thigh and forearm ( P = 0.009), the forearm and fingertip ( P = 0.001), and the abdomen and fingertip ( P = 0.004). Decreasing the skin temperature resulted in a significant vasoconstriction and reduction in capillary flow velocity. It is imperative to keep the monitored area warm during video-capillaroscopy assessment to avoid false diagnosis of vascular occlusion.

tional methods. VC also avoids some shortcomings such as the strong enhancement of ICG, which limits observation of direct lymphatic flow, or the equivocal evaluation of nutrient vessels of the lymphatic vessels obtained with ultrasound and microscope.(Yamamoto et al., 2011) The incorporation of VC with conventional clinical examination and other evaluation methods may provide a more comprehensive diagnosis of patients and immediate postoperative assessment of lymphatic reconstruction.