Vaginal microcirculation to objectify wound healing after vaginal surgery
IUGA Academy. Kastelein A. Jun 30, 2018; 212870
Mr. Arnoud Kastelein
Mr. Arnoud Kastelein

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Vaginal microcirculation to objectify wound healing after vaginal surgery

Kastelein, A1; Diedrich, C1; Weber, M1; de Waal, L1; Ince, C1; Roovers, J1

1: Academic Medical Center

Introduction: Pelvic organ prolapse is a common condition that often requires surgical correction. After native tissue repair - which is the first line surgical treatment for most patients - up to 20% of patients require secondary surgery for recurrence of prolapse (1). An adequate blood supply facilitating oxygenation at a cellular level is critical for effective wound healing and regeneration of connective tissue (2, 3). Therefore, surgically induced microvascular trauma might negatively affect tissue condition, which possibly increases the risk of recurrence.

Objective: This study aimed to assess the practical feasibility of perioperative vaginal microvascular imaging. Moreover, we determined if surgery decreases microvascular function, if vascular trauma differs between individuals and whether the vasculature can be restored to a pre-surgical level.

Methods: In this prospective study, we visualized and quantified the vaginal microcirculation before and after (1 day (T1), 2 weeks (T2) and 6 weeks (T3) ) vaginal prolapse surgery. We used the CytoCam, a handheld video microscope based on incident dark field imaging, to determine the microvascular flow index (MFI) and the microvascular morphology.

Results: Ten patients with a POP-Q stage ≥ 2 prolapse undergoing anterior and/or posterior prolapse surgery were included. Microvascular flow at T1 at the surgical site was reduced significantly (MFI T0: 3 [2-3]; MFI T1: 2 [0-3]; p=0.03). Inter-individual differences were observed at T1 with regard to vascular flow (range MFI T1 [0 – 3]) and microvascular morphology (see Figure). After six weeks, MFI (MFI T3: 3 [2-3]) and microvascular morphology were restored in all patients. Surgery did not affect vascularization of the non-surgical sites

Conclusions: This is the first study to objectify vascular damage and restoration after vaginal surgery. Vaginal tissue reached functional re-vascularization in all patients after six weeks. The extent of the vascular trauma one day postoperatively vastly differed between patients that underwent seemingly identical surgical procedures. This suggests that some individuals are more susceptible to vascular trauma than others. Tissue regeneration may be poorer in these patients, possibly increasing their future risk of recurrence. Improving vascular resilience (i.e. by perioperative application of estrogen) might be beneficial in these patients. To demonstrate the long term consequences of these differences, more research with a longer follow up duration is required.

1. Denman MA, Gregory WT, Boyles SH, Smith V, Edwards SR, Clark AL. Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence. American journal of obstetrics and gynecology. 2008;198(5):555.e1-5.
2. Li J, Ollague Sierra J, Zhu L, Tang L, Rahill K, El-Sabawi B, et al. Effects of a topical aqueous oxygen emulsion on collagen deposition and angiogenesis in a porcine deep partial-thickness wound model. Experimental Dermatology. 2013;22(10):674-6.
3. Sen CK. Wound healing essentials: let there be oxygen. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2009;17(1):1-18.


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