Intraoperative Hemifacial Composite Flap Perfusion Assessment Using Spatial Frequency Domain Imaging: A Pilot Study in Preparation for Facial Transplantation.
Intraoperative Hemifacial Composite Flap Perfusion Assessment Using Spatial Frequency Domain Imaging: A Pilot Study in Preparation for Facial Transplantation.
复制标题
使用空间频域成像进行术中半面部复合皮瓣灌注评估：面部移植准备的初步研究。
DOI：
10.1097/sap.0000000000000631
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发表时间：
2016
影响因子：
1.5
通讯作者：
Lee,BernardT
中科院分区：
文献类型：
--
作者：
Vargas,ChristinaR;Nguyen,JohnT;Ashitate,Yoshitomo;Angelo,Joseph;Venugopal,Vivek;Kettenring,Frank;Neacsu,Florin;Frangioni,JohnV;Gioux,Sylvain;Lee,BernardT
血管化复合同种异体移植代表了重建显微外科领域的重要进步，并且越来越受欢迎。与皮瓣失败相关的显着临床发病率是更广泛使用这些技术的重要障碍。早期识别血管受损与较高的挽救率相关，但大多数外科医生仅依赖术中临床评估。空间频域成像 (SFDI) 是一种在大视场内非接触式、客观地测量组织氧合的方法。本研究旨在评估 SFDI 技术在面部移植过程中可能发生的半面部复合瓣修复中的应用。在三只 35 公斤重的约克夏猪中制作了 6 个复合半面部皮瓣，并在 15 分钟选择性血管蒂闭塞之前、期间和之后使用 SFDI 连续成像。对每个皮瓣进行动脉和静脉夹紧试验。对氧合血红蛋白浓度、脱氧血红蛋白浓度和总血红蛋白随时间的变化进行定量。 SFDI 成功测量了所有 6 个复合组织瓣的氧合参数变化。相对于对照组，氧合血红蛋白、脱氧血红蛋白和总血红蛋白发生显着变化。在动脉和静脉相互损害中注意到早期和独特的改变模式。考虑到与皮瓣失败相关的发病率，显然需要对复合组织移植物的活力进行无创、可靠的评估。这项研究的结果表明，SFDI 技术有望在重建显微外科手术期间提供有关椎弓根血管完整性的术中指导。
Vascularized composite allotransplantation represents an important advancement in the field of reconstructive microsurgery and has continued to increase in popularity. The significant clinical morbidity associated with flap failure represents an important barrier to even more widespread use of these techniques. Early identification of vascular compromise has been associated with a higher salvage rate, yet most surgeons rely only on clinical assessment intraoperatively. Spatial frequency domain imaging (SFDI) presents a noncontact, objective measurement of tissue oxygenation over a large field of view. This study aims to evaluate the use of SFDI technology in hemifacial composite flap compromise as could occur during facial transplant. Six composite hemifacial flaps were created in three 35-kg Yorkshire pigs and continuously imaged using SFDI before, during, and after 15-minute selective vascular pedicle occlusion. Arterial and venous clamping trials were performed for each flap. Changes in oxyhemoglobin concentration, deoxyhemoglobin concentration, and total hemoglobin were quantified over time. The SFDI successfully measured changes in oxygenation parameters in all 6 composite tissue flaps. Significant changes in oxyhemoglobin, deoxyhemoglobin, and total hemoglobin were seen relative to controls. Early and distinct patterns of alteration were noted in arterial and in venous compromise relative to one another. The need for noninvasive, reliable assessment of composite tissue graft viability is apparent, given the morbidity associated with flap failure. The results of this study suggest that SFDI technology shows promise in providing intraoperative guidance with regard to pedicle vessel integrity during reconstructive microsurgery.