Application of digital vital capillaroscopy for assessing dynamic microcirculatory changes during closure of anterior hard palatal defects

Relevance. In recent years, the number of children born with severe forms of cleft lip and palate has increased. Surgical treatment in these patients is often associated with postoperative complications, including recurrent defects of the anterior hard palate. Impaired microcirculation at the surgical site is a key factor in the pathogenesis of these complications and may result in tissue loss, delayed healing, postoperative defect formation, and the need for repeat surgery. Standard clinical assessment of flap viability based on color, turgor, and capillary refill remains subjective and lacks sufficient sensitivity for early detection of deep or central ischemia. This highlights the need for objective methods of intraoperative and postoperative monitoring. Digital vital capillaroscopy (DVC) is a promising noninvasive technique that enables objective real-time assessment of microcirculation. It allows flap monitoring, assessment of angiogenesis, detection of early signs of impaired perfusion, and prediction of the risk of flap ischemia and tissue necrosis. Understanding these processes is essential for improving tongue flap reconstruction techniques and optimizing surgical outcomes.

Materials and methods. This prospective study included 15 patients aged 12–18 years with secondary anterior hard palatal defects measuring 2–4 cm². All patients underwent two-stage defect closure using a thin split-thickness tongue flap. Microcirculation was assessed by DVC using the OKO device (Russia) before surgery in the defect area, donor site, and intact mucosa, and then daily from postoperative day 1 to day 16. Functional capillary density (capillaries/ mm2), linear erythrocyte velocity (LEV, μm/s), and volumetric erythrocyte velocity (VEV, μm³/s) were assessed.

Results. A three-phase pattern of microcirculatory changes was identified. In the early postoperative period (days 1–3), functional capillary density decreased to 5–8 capillaries/mm², LEV to 0–50 μm/s, and VEV to 0–2,000 μm³/s. During the initial regeneration phase (days 4–7), the capillary network began to recover, with LEV increasing to 250–400 μm/s and VEV to 15,000–25,000 μm³/s. During the active healing and flap integration phase (days 8–16), these parameters stabilized, with LEV reaching 550–700 μm/s and VEV 45,000–60,000 μm³/s.

Conclusion. DVC is a highly informative method for objective monitoring of microcirculation during healing after tongue flap reconstruction. Capillary blood flow parameters are early indicators of ischemic changes and prognostic markers of flap viability and successful integration. Dynamic DVC monitoring allows individualized therapy and helps determine the optimal timing of the second stage of surgery (postoperative days 14–16), thereby reducing the risk of complications.

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