Microvascular Structure as a Predictor of Surgical Wound Healing

Alese OM, Wilson AC, Tessier KM, Loavenbruck A, Dedeker C, Lassig AA. Characterization of cutaneous microvasculature using 3D imaging: A feasibility study in a cohort of head and neck surgery patients with attention to smoking status. JPRAS Open 2025;44:493-505. doi: 10.1016/j.jpra.2025.03.020.

Background: This study aimed to evaluate a novel three-dimensional imaging method to characterize cutaneous microvasculature in patients undergoing major head and neck surgery and to examine associations between baseline vascular morphology and post-operative wound healing outcomes. Understanding how vascular structure relates to healing could improve prediction and management of surgical recovery.

Hypothesis: This study hypothesized that specific morphological features of the cutaneous microvasculature, quantified through three-dimensional imaging, are associated with poorer wound healing outcomes following surgery.

Methods: The authors prospectively enrolled 17 adult patients undergoing major head and neck surgery. Full-thickness neck flap biopsies were immunostained for collagen IV and imaged using confocal microscopy. The authors analyzed vessel morphology by tracing three-dimensional reconstructions with Vesselucida 360, quantifying parameters such as isolated elements, branching nodes, endings, loops, total length, surface area and volume. Vesselucida Explorer was used to extract and analyze quantitative vascular metrics. Statistical analyses were performed using R version 3.6.1 and SAS version 9.4, with significance set at p < 0.05.

Results: Males and patients with prior chemotherapy showed higher isolated elements. Current and former smokers exhibited more tortuous and irregular vessels than never-smokers. Increased isolated elements were significantly associated with wound complications, long-term wound care and re-hospitalization. VEGF-A correlated positively with vessel endings and surface area, and PLGF correlated with isolated elements.

Conclusions: The study demonstrated that increased isolated vascular elements correlate with poorer wound healing, supporting three-dimensional vascular analysis as a promising predictive tool.