Fiberoptic fluorometer for skin flap assessment

Comparison of ALA- and ALA hexyl-ester-induced PpIX depth distribution in human skin carcinoma

Photodynamic therapy (PDT) based on the use of photoactivable porphyrins, such as protoporphyrin IX (PpIX), induced by the topical application of amino-levulinic acid (ALA) or its derivatives, ALA methyl-ester (m-ALA), is a treatment for superficial basal cell carcinoma (BCC), with complete response rates of over 80%. However, in the case of deep, nodular-ulcerative lesions, the complete response rates are lower, possibly related to a lower bioavailability of PpIX. Previous in vitro skin permeation studies demonstrated an increased penetration of amino-levulinic acid hexyl-ester (h-ALA) over ALA. In this study, we tested the validity of this approach in vivo on human BCCs. An emulsion containing 20% ALA (w/w) and preparations of h-ALA at different concentrations were applied topically to the normal skin of Caucasian volunteers to compare the PpIX fluorescence intensities with an optical fiber-based spectrofluorometer. In addition, the PpIX depth distribution and fluorescence intensity in 26 BCCs were investigated by fluorescence microscopy following topical application of 20% ALA and 1% h-ALA. We found that, for application times up to 24h, h-ALA is identical to ALA as a PpIX precursor with respect to PpIX fluorescence intensity, depth of penetration, and distribution in basal cell carcinoma, but has the added advantage that much smaller h-ALA concentrations can be used (up to a factor 13). We observed a non-homogenous distribution in BCCs with both precursors, independent of the histological type and depth of invasion in the dermis.

Elevated intravesical pressure causes arterial hypoperfusion in canine colocystoplasty: a fluorometric assessment

Since 1988 there have been 15 reported cases of late, spontaneously ruptured intestinal cystoplasties at bowel sites remote from the anastomosis. Ischemic necrosis has been suggested as a possible etiology. We examined this hypothesis by quantifying the uptake of intravascular fluorescein in the augmented bowel of adult mongrel canines. There was a statistically significant decrease in fluorescein uptake at high intravesical pressures, which appeared to be most pronounced at the antimesenteric border. This laboratory study supports a recent clinical report of histological changes pathognomonic for chronic ischemia in the augmented bowel of patients with spontaneous rupture.

Application of the fiber-optic perfusion fluorometer to absorption and exsorption studies in hairless mouse skin

This study was undertaken to test the fiber-optic perfusion fluorometer as a direct means of evaluating skin absorption and exsorption in hairless mice. Skin-barrier compromise was accomplished in the absorption experiments by application of dimethyl sulfoxide to the skin surface or by partial removal of the stratum corneum with sticky tape. Absorbed fluorescein was measured easily in unanesthetized control (skin-barrier intact) and experimental mice. Unabsorbed chemical did not fluoresce 15 minutes after application, although it was present on the surface of the skin as a dry powder. The time course of fluorescein elimination from the skin was related to a rapid phase (vascular removal) and a slow phase (reservoir entrapment). In the exsorption experiments the fluorescein was injected intraperitoneally. Back skin on the right side was swabbed with either dimethyl sulfoxide or 1% capsaicin in alcohol prior to the injections, and differences in skin fluorescence on the left (control) and right sides were recorded. One application of dimethyl sulfoxide or capsaicin increased the level of skin exsorption. Three applications of dimethyl sulfoxide almost doubled the amount of exsorbed dye, whereas three applications of the capsaicin inhibited the exsorption process. It was concluded that the fiber-optic perfusion fluorometer provides an excellent technique in support of other methods of investigating the skin.

Venous outflow obstruction in myocutaneous flaps: changes in microcirculation detected by the perfusion fluorometer and laser Doppler

The effects of venous occlusion on the perfusion of porcine myocutaneous groin flaps were studied by means of the laser Doppler and the dermofluorometer. A consistent decrease in fluorometer readings following venous clamping with rebound to original or greater levels after unclamping was noted. A similar pattern was noted in laser Doppler studies. However, flow as measured by the Doppler remained significant (greater than 100 mV) even with venous outflow occlusion. It is hypothesized that the Doppler is more prone than the dermofluorometer to reflect non-nutritive flow in the flap during the early period following flap construction and, therefore, may be less accurate in the evaluation of actual flap microperfusion. The fluorometer was determined to be the more desirable instrument in monitoring the microcirculatory status of myocutaneous flaps during the immediate period after flap elevation and transposition.