Characterization of cutaneous microvasculature using 3D imaging: A feasibility study in a cohort of head and neck surgery patients with attention to smoking status.

BACKGROUND

This study explored a new method to characterize cutaneous microvasculature and evaluated the associations between baseline vessel characteristics and post-operative wound healing outcomes.

MATERIALS AND

METHODS

We prospectively enrolled 17 adult patients undergoing major head and neck surgery. A full thickness cutaneous biopsy from the inferior surgical skin flap of the neck incision was obtained and processed for immunohistochemical analyses. Collagen IV antibody was immunolocalized along with secondary fluorophore-conjugated antibodies for confocal microscopy. The Vesselucida 360 software was used to morphologically characterize the cutaneous vasculature by tracing 3D sections of the collagen IV-stained vessels. Vessel structure metrics including isolated elements (individual vessel structures) and patient characteristics were evaluated for associations. Statistical analyses were performed using R version 3.6.1 and SAS version 9.4; a p-value of 0.05 was considered significant.

RESULTS

Males and prior chemotherapy patients trended toward higher isolated elements compared with females and patients without a history of chemotherapy. Vesselucida assessment results indicated that current and former smokers were found to have more tortuous vessels and irregular vessel walls than never-smokers. Isolated elements were significantly higher in patients who returned to the hospital owing to a wound complication, required long-term wound care, or had other complications. Vascular endothelial growth factor A was positively correlated with vessel endings and total surface area, whereas placental growth factor was positively correlated with isolated elements and endings.

CONCLUSIONS

We described the use of Vesselucida 360 as an innovative tool to characterize cutaneous vasculature; using this tool, the increase in isolated elements was found to be associated with poorer wound healing outcomes.