The role of near-infrared angiography in the assessment of post-operative venous congestion in random pattern, pedicled island and free flaps
The role of near-infrared angiography in the assessment of post-operative venous congestion in random pattern, pedicled island and free flaps
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DOI：
10.1016/j.bjps.2004.10.003
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发表时间：
2005-04-01
期刊：
影响因子：
--
通讯作者：
Steinmeier, R
中科院分区：
文献类型：
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作者：
Krishnan, KG;Schackert, G;Steinmeier, R
最近引入吲哚菁绿近红外视频血管造影（ICG-NIR-VA）来测量皮瓣的灌注。该方法对于皮瓣转移后操作以及随后的皮瓣存活的预后价值在文献中没有充分记录。在本文中，我们报告了我们在各种重建手术中使用的 9 个皮瓣（2 个大随机模式、4 个带蒂岛状皮瓣和 3 个游离皮瓣）的术中评估和术后随访中使用 ICG-NIR-VA 的经验。两个皮瓣（1 个随机模式和 1 个游离皮瓣）在 ICG-NIR-VA 中显示延迟内吸收。在术后阶段（第 1-3 天），6 个皮瓣（1 个随机模式、2 个轴向模式和 3 个游离皮瓣）显示 ICG-NIR-VA 摄取和清除均延迟。然而，仅在 6 个皮瓣中的 2 个中观察到临床相关性，证明了这种延迟：分别在远端骨间后皮瓣和游离侧臂皮瓣中观察到全身和部分静脉充血。仅根据临床症状实施水蛭治疗。在一个基于远端的穿支皮瓣中，通过微吻合术增强灌注的决定是基于术中 ICG-NIR-VA 结果。所有襟翼均显示加热正常。根据我们的观察，出现的问题不是 ICG-NIR-VA 对静脉充血的预后是否敏感（皮瓣操作策略可能依赖于此），而是它是否过于敏感。此外，前瞻性研究也是必要的。 (c) 2004 年英国整形外科医生协会。由爱思唯尔有限公司出版。保留所有权利。
Indocyanine green near-infrared-video angiography (ICG-NIR-VA) was recently introduced for measuring perfusion of skin flaps. The prognostic value of this method with regards to post-transfer manipulations of the flap, and subsequently, flap survival is not adequately documented in the literature. In this paper, we report our experience with the ICG-NIR-VA in the intraciperative evaluation and postoperative follow-up of nine flaps (2 large random pattern, 4 pedicled island and 3 free flaps) used in various reconstructive procedures. Two flaps (1 random pattern and 1 free flap) showed delayed intraciperative uptake in ICG-NIR-VA. In the post-operative phase, (days 1-3) six flaps (1 random pattern, 2 axial pattern and 3 free flaps) showed a delay both in the ICG-NIR-VA uptake, as well as clearance. However, a clinical correlate was observed only in 2 of the 6 flaps demonstrating this delay: general and partial venous congestion was seen in a distally based interosseous posterior flap and a free lateral arm flap respectively. Leeches were implemented only based on the clinical signs. In one distally based perforator flap, the decision on perfusion augmentation via microanastomosis was based on the intraciperative ICG-NIR-VA finding. All flaps showed uneventful heating. Based on our observations, the question arises, not whether the ICG-NIR-VA is sensitive for the prognosis of venous congestion, upon which the flap manipulation strategy might rest-but whether it is too sensitive. Further, prospective studies are necessary. (c) 2004 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved.