全身毛細血管スコープを形成外科診療で使用した経験—皮弁，レーザー治療，熱傷，褥瘡など—

How Can a Novel Surficial Capillaroscope Be Used in the Field of Plastic Surgery?

はじめに

　近年，持ち運びできる拡大鏡で体表面の毛細血管などを非侵襲的に観察できるツールとして，全身毛細血管スコープ「Bscan-Z Ⓡ（GOKO映像機器社）」（以下，スコープ）が登場した。このスコープを皮膚に直接当てることで，ダーモスコープよりも高倍率で体表の変化を捉えることができ，さらに皮膚表層の毛細血管内を流れる赤血球の流れをもリアルタイムで観察することができる。今回われわれはこのスコープを利用して，形成外科の診療で日々目にする疾患の観察および正常組織との比較を行った。本稿ではその結果を，代表症例を示しつつ報告する。

　We have used a novel type of capillaroscope that can visualize capillaries on the body surface for the assessment of various diseases commonly seen in plastic surgery, e.g., skin flaps, vascular malformations, burns, and pressure ulcers. For example, The capillaroscope was also used for monitoring flap circulation and checking congestion or ischemia of red blood cells in free flaps. a capillary malformation in a patientʼs palm was observed in real time by the capillaroscope before and after laser irradiation, and after being lased, the capillaries were cauterized and the blood flow disappeared. In a scald burn case, the scope made a clear differentiation between the superficial dermal burn (SDB) and the deep dermal burn (DDB). In another case, when the vessels distributed in bedsores were pressed, the capillaroscope demonstrated that the movement of red blood cells in the blood vessels stopped.

　Because this capillaroscope can capture real-time changes in blood vessels, it will be valuable for various clinical procedures in plastic surgery.