吲哚菁绿荧光造影在背部扩张穿支皮瓣设计中的应用  

Application of indocyanine green angiography in the design of perforator flaps in back region

作　　者：顾舒晨 李海洲[1] 高雅姗 黄昕[1] 顾斌[1] 李青峰[1] 昝涛[1] Gu Shuchen;Li Haizhou;Gao Yashan;Huang Xin;Gu Bin;Li Qingfeng;Zan Tao(Department of Plastic and Reconstructive Surgery,Ninth People′s Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,200011

出　　处：《中华整形外科杂志》2020年第3期251-256,共6页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81772086);上海交通大学医学院双百人计划;上海交通大学晨星优秀青年学者奖励计划;上海市“医苑新星”杰出青年医学人才培养计划。

摘　　要：目的探究吲哚菁绿荧光造影(indocyanine green angiography,ICGA)在采用扩张穿支皮瓣修复大面积缺损中的应用价值。方法回顾分析2018年10月至2019年10月,上海交通大学医学院附属第九人民医院收治的22例使用背部扩张穿支皮瓣行面颈部缺损修复的病例资料,其中,男12例,女10例,年龄4~26岁,平均19岁,均为烧伤后下面部、颈部软组织损伤患者,以背部为供区,设计单蒂或多蒂扩张穿支皮瓣进行治疗。术中切取皮瓣后保留主要穿支进行ICGA,评价穿支的血供范围,确定是否采用增压方式将皮瓣设计为多蒂皮瓣,皮瓣转移至面颈部、切口缝合后,再次行ICGA,判断皮瓣血运情况。术后统计皮瓣坏死等并发症发生情况。结果22例皮瓣平均大小27 cm×17 cm。在ICGA的指导下,15例设计为单蒂,其中5例带蒂颈浅动脉皮瓣,10例游离旋肩胛动脉穿支皮瓣;7例采用增压方式设计为多蒂皮瓣,包括2例带蒂颈浅动脉皮瓣+旋肩胛动脉穿支增压,5例游离旋肩胛动脉穿支皮瓣+胸背动脉穿支增压。术后静脉栓塞1例,重新吻合后血供恢复正常;术后1周20例皮瓣完全存活,2例尖端坏死,伤口换药后恢复。随访5~16个月,皮瓣色泽、质地均良好,面颈部功能改善。结论ICGA可作为一项安全、有效的术中检测手段,指导选择合适的穿支,判断是否采用血管增压的临床决策,优化皮瓣设计,提高手术成功率。Objective To investigate the effect of indocyanine green angiography(ICGA)in the design of pre-expanded perforator flaps in the reconstruction of large defects.Methods From October 2018 to October 2019,there were 22 patients undergoing facial and cervical reconstructive surgeries based on pre-expanded perforator flaps in the back region in Shanghai Ninth Peoples′Hospital.12 male and 10 female patients,ranging from 4 to 26 years old with an average age of 19,were all suffered from inferior facial and cervical defects after burns.Single-pedicled or multi-pedicled perforator flaps from back region were designed for treatment.ICGA was conducted after flap dissection intra-operatively to evaluate perfusion areas of perforators,which helped surgeons to determine whether supercharging should be conducted.After flap transplantation,ICGA was conducted again to evaluate the blood supply.Statistics of post-operative complications such as flap necrosis were collected.Results the average flap size was 27 cm×17 cm.With the guidance of ICGA,15 cases remained the design of single pedicle including 5 superficial cervical artery(SCA)flaps and 10 free circumflex scapular artery(CSA)perforator flaps.Supercharging was performed in 7 cases:including 2 SCA flaps supercharged with CSA perforator and 5 free CSA perforator flaps supercharged with thoracodorsal artery(TDA)perforator.Venous thrombus occurred in 1 case but recovered after re-anastomosis of vessels.Except for 2 tip necroses,20 flaps survived completely one week postoperatively.2 tip necroses were recovered after dressing changes.All the patients were followed up for 5 to 16 months,with good flap color and texture,and improved function of head and neck.Conclusions ICGA can be used as a safe and effective intraoperative detection method to guide the selection of appropriate perforators and the decisions on whether to conduct supercharging,which optimizes flap design and improves the success of surgery.

关 键 词：吲哚菁绿 穿支皮瓣 组织扩张 

分 类 号：R65[医药卫生—外科学]