With the advent of microsurgery, new interest in the effects of warm ischemial has been stimulated, and following a microvascular anastomosis, a hypoperfused state(i.e., "no reflow") may occur. However, adequate circulation distal to the anastomosis is equally important for ultimate tissue survival. So, the search for an accurate method of predicting flap viability has long intrigued surgeons. Prior to the developement of non-invasive techniques(i.e., platysmography, thermography, laser doppler flowmeter and dermatofluorometer, etc.) to measure nutritive blood flow, assessment was limited to such criteria as subjective techniques(i.e., temperature, color, capillary refilling time, marginal bleeding etc.), radioactive isotope clearance tests and other invasive techniques.
Various clinical methods have been used, but the distressing continued incidence of flap necrosis and anastomotic leak attests to their imperfect predictive accuracy and invasive proce-
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