Accurate Prediction of Tissue Viability at Postoperative Day 7 Using Only Two Intraoperative Subsecond Near-Infrared Fluorescence Images.
Accurate Prediction of Tissue Viability at Postoperative Day 7 Using Only Two Intraoperative Subsecond Near-Infrared Fluorescence Images.
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DOI：
10.1097/prs.0000000000003009
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发表时间：
2017-02
影响因子：
3.6
通讯作者：
Frangioni JV
中科院分区：
文献类型：
--
作者：
Wada H;Vargas CR;Angelo J;Faulkner-Jones B;Paul MA;Ho OA;Lee BT;Frangioni JV
在手术室中预测组织未来生存能力并进行干预的能力，将对患者的预后产生重大影响。虽然已经报道了几种客观的评估组织灌注的方法，但迄今为止没有一种方法具有足够的准确性。在8只Sprague-Dawley大鼠中，创造了反向麦克法兰背侧皮瓣。术后立即使用吲哚菁绿（ICG）进行连续近红外（NIR）荧光血管造影，共30分钟。这些动态测量用于量化ICG的生物分布和清除，并开发一种简单的指标，准确预测术后一天（POD）的组织活力7。将新指标与先前描述的指标进行比较。ICG生物分布和皮瓣清除的可重复性模式允许开发定量指标来预测POD 7时皮瓣的生存能力。先前描述的指标将健康组织和坏死组织之间的界限设置为icg注射后2分钟近红外荧光峰值的17%或25%，分别低估了坏死面积的75%和48%。我们的数据表明，术中可以预测po7发生的临床坏死的形状和面积，其边界定义为近红外荧光强度在5分钟测量的峰值荧光的40-55%。注射ICG后0分钟和5分钟获得的两张750 msec术中近红外荧光图像准确预测了术后7天皮瓣的生存能力。
The ability to predict the future viability of tissue, while still in the operating room and able to intervene, would have a major impact on patient outcome. Although several objective methods to evaluate tissue perfusion have been reported, none to date has sufficient accuracy. In eight Sprague-Dawley rats, reverse McFarlane dorsal skin flaps were created. Continuous near-infrared (NIR) fluorescence angiography using indocyanine green (ICG) was performed immediately after surgery, for a total of 30 min. These dynamic measurements were used to quantify ICG biodistribution and clearance, and to develop a simple metric that accurately predicted tissue viability at post-operative day (POD) 7. The new metric was compared to previously described metrics. Reproducible patterns of ICG biodistribution and clearance from the flap permitted quantitative metrics to be developed for predicting flap viability at POD 7. Previously described metrics, which set the boundary between healthy and necrotic tissue as either 17% or 25% of peak NIR fluorescence at 2 min post-ICG injection underestimated the area of necrosis by 75% and 48%, respectively. Our data suggest that both the shape and area of clinical necrosis occurring at POD 7 can be predicted intraoperatively, with the boundary defined as NIR fluorescence intensities of 40-55% of peak fluorescence measured at 5 min. Two 750 msec intraoperative NIR fluorescence images obtained at times 0 and 5 min post-injection of ICG accurately predicted skin flap viability 7 days after surgery.