吲哚菁绿血管造影技术辅助肱动脉穿支螺旋桨皮瓣修复躯干和上肢软组织缺损  

Indocyanine green angiography technique assisted brachial artery perforator propeller flap to repair soft tissue defects of trunk and upper limb

作　　者：谢婷珺 刘元波 韩婷璐 朱珊 臧梦青 陈博 李杉珊 XIE Tingjun;LIU Yuanbo;HAN Tinglu;ZHU Shan;ZANG Mengqing;CHEN Bo;LI Shanshan(Scar Comprehensive Treatm ent Center,Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing,100144,P.R.China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院瘢痕综合治疗中心,北京100144

出　　处：《中国修复重建外科杂志》2021年第2期200-205,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用吲哚菁绿(indocyanine green,ICG)血管造影技术探测肱动脉穿支血管的可行性,以及应用肱动脉穿支螺旋桨(brachial artery perforator propeller,BAPP)皮瓣修复躯干和上肢软组织缺损的临床效果。方法2016年8月—2019年2月,应用ICG血管造影技术探测肱动脉肌间隔穿支血管,并以探测到的穿支血管为蒂切取BAPP皮瓣,修复躯干和上肢软组织缺损19例。其中男12例,女7例;年龄5~66岁,平均28.6岁。病因:烧伤后瘢痕挛缩10例,软组织肉瘤5例,先天性黑色素痣2例,慢性胸壁溃疡1例,恶性黑色素瘤1例。部位:腋窝8例,胸壁4例,肘部5例,肩部2例。软组织缺损范围为15 cm×3 cm~20 cm×8 cm。11例于皮瓣转移前行扩张手术。13个皮瓣以1支穿支血管为蒂,6个皮瓣以2支穿支血管为蒂,血管蒂长度为2.5~4.5 cm,平均3.08 cm。皮瓣切取范围为11 cm×5 cm~22 cm×10 cm。皮瓣旋转角度分别为110°1例、120°1例、180°17例。除1个皮瓣供区植皮修复外,其他皮瓣供区均直接拉拢缝合。结果ICG血管造影技术共探测到24支肱动脉肌间隔穿支血管,术中找到26支,准确率为92.31%。术后所有皮瓣全部成活,无动、静脉危象发生。术中1个皮瓣远端4 cm处血液灌注不良,相对值低于32%,切除灌注不良区域后皮瓣顺利成活;术后1个皮瓣远端3 cm处出现静脉淤血,经针刺放血、按摩等保守治疗后成活。19例均获随访,随访时间3~23个月,平均8.6个月。所有皮瓣菲薄,颜色、质地与受区相似,无需二次手术去脂修薄。肘关节内侧和腋窝瘢痕挛缩患者术后挛缩症状明显改善;1例恶性黑色素瘤患者术后1年5个月因肿瘤复发再次行肿瘤切除术,其他肿瘤患者未见复发。结论ICG血管造影技术可用于探测肱动脉肌间隔穿支血管,以该穿支血管为蒂的BAPP皮瓣可用于胸壁、腋窝、肩部和肘关节内侧皮肤软组织缺损的修复。Objective To explore the feasibility of using indocyanine green(ICG) angiography to detect brachial artery perforators, and the clinical application of brachial artery perforator propeller(BAPP) flaps to repair soft tissue defects of the trunk and upper limbs. Methods Between August 2016 and February 2019, ICG angiography was used to detect the perforating vessels of the brachial artery muscle septum, and the BAPP flaps were cut out with the detected perforating vessels as the pedicle to repair 19 cases of trunk and upper limb soft tissue defects. There were 12 males and7 females, with an average age of 28.6 years(range, 5-66 years). Etiologies included the post-burn scar in 10 cases, softtissue sarcoma in 5 cases, congenital melanocytic nevi in 2 cases, chronic chest wall ulcer in 1 case, and malignant melanoma in1 case. Defects located in axilla in 8 cases, chest wall in 4 cases, elbow in 5 cases, and shoulder in 2 cases. The area of the defect ranged from 15 cm×3 cm to 20 cm×8 cm. Pre-transfer tissue expansion was used in 11 patients. Thirteen flaps were pedicled with 1 perforator vessel, and 6 flaps were pedicled with 2 perforator vessels. The length of the vascular pedicle was2.5-4.5 cm, with an average of 3.08 cm. The area of the skin flap ranged from 11 cm×5 cm to 22 cm×10 cm. The flap rotation angle was 110° in 1 case, 120° in 1 case, and 180° in 17 cases. Except for one donor site repaired by skin graft, the other donor sites were directly sutured. Results A total of 24 perforating vessels of the brachial artery muscle septum were detected by ICG angiography, 26 were identified during the operation, with an accuracy rate of 92.31%. Eighteen flaps survived without arteriovenous crisis. Venous congestion was observed in the distal 3-cm of one flap and the flap survived after conservative management. Intraoperative analysis showed that the blood perfusion of the distal 4-cm of one flap was poor, the relative value was less than 32%, the flap survived after removing the poor perfusion area. All the pa

关 键 词：肱动脉 肌间隔穿支血管 螺旋桨皮瓣 吲哚菁绿 血管造影技术 

分 类 号：R658.2[医药卫生—外科学]