吲哚菁绿血管造影在以颞浅动脉为蒂的额部皮瓣修复面部软组织缺损中的临床应用  

Application of indocyanine green angiography in repair of facial soft tissue defect using superficial temporal artery based forehead flap

作　　者：周梦琪 刘元波 冉小叶 朱珊 李杉珊 陈子翔 韩婷璐 晋圣阳 汪淼 臧梦青 ZHOU Mengqi;LIU Yuanbo;RAN Xiaoye;ZHU Shan;LI Shanshan;CHEN Zixiang;HAN Tinglu;JIN Shengyang;WANG Miao;ZANG Mengqing(Scar&Wound Treatment 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与创面治疗中心,北京100144

出　　处：《中国修复重建外科杂志》2023年第10期1259-1265,共7页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨吲哚菁绿血管造影定位颞浅血管以及辅助以颞浅动脉为蒂的额部皮瓣设计和切取的可行性。方法 回顾分析2015年10月—2022年11月14例以颞浅动脉为蒂的额部皮瓣修复面部软组织缺损患者临床资料。其中,男9例,女5例;年龄3~38岁,中位年龄9.5岁。均为面部瘢痕(8例)或先天性黑色素细胞痣(6例)切除后遗留皮肤软组织缺损,缺损范围3 cm×2 cm~24 cm×9 cm。术前应用吲哚菁绿血管造影探测颞浅动、静脉走行和分支情况,了解动、静脉伴行情况;根据观测结果,2例选择以单侧颞浅筋膜为蒂的额部皮瓣修复较小面部缺损,筋膜蒂中包含颞浅动脉额支和血管周围2 cm的颞浅筋膜,以颞浅动脉额支的微小伴行静脉作为皮瓣回流静脉;12例以双侧或者单侧皮蒂为蒂的预扩张额部皮瓣修复较大面部缺损,皮蒂中包含颞浅动脉额支以及静脉主要分支,其中4例以颞浅静脉额支作为回流静脉,8例以顶支作为回流静脉。皮瓣切取范围为3 cm×2 cm~30 cm×13 cm。皮蒂皮瓣均在修复术后3周行断蒂手术。结果 吲哚菁绿血管造影可以清晰显示颞浅动、静脉走行和分支,颞浅动脉额支进入额部的位置存在个体差异,颞浅静脉分支变异性较大且通常不与动脉伴行。1例患者因扩张器相关并发症导致修复术后皮瓣远端3 cm全层坏死,行游离植皮后愈合;其余患者皮瓣均顺利成活,切口均Ⅰ期愈合。患者均获随访,随访时间2~24个月,中位时间11.5个月。皮瓣颜色、质地和厚度与周围皮肤相似,供、受区切口均未见明显瘢痕增生,患者对修复效果满意。结论 吲哚菁绿血管造影可以清晰显示颞浅血管走行和分支,明确颞浅动、静脉位置、分布和伴行关系,能辅助以颞浅动脉为蒂的额部皮瓣设计和切取。Objective To explore the feasibility of using indocyanine green angiography in mapping the superficial temporal vessels and assisting design and harvesting of the superficial temporal artery based forehead flap.Methods A clinical data of 14 patients with facial soft tissue defects repaired with superficial temporal artery based forehead flaps between October 2015 and November 2022 was retrospectively analyzed.There were 9 males and 5 females with a median age of 9.5 years(range,3-38 years).The forehead flaps were used to reconstruct facial soft tissue defects following excision of facial scar(8 cases)or congenital melanocyte nevus(6 cases).The size of defects ranged from 3 cm×2 cm to 24 cm×9 cm.Before operation,the indocyanine green angiography was used to map the superficial temporal artery and vein,and to analyze the relationship of the arteries and veins.The forehead flaps with unilateral superficial temporal fascia as the pedicle was transferred to repair the small facial defect in 2 cases.The facial pedicle contained the frontal branch of the superficial temporal artery and 2 cm of the superficial temporal fascia around the vessel,and the tiny accompanying vein of the frontal branch of the superficial temporal artery was used as the outflow of the flap.The forehead flaps with the skin pedicle including bilateral or unilateral superficial temporal fascia and the overlying skin was pre-expanded and transferred to repair the large facial defect in 12 cases.The skin pedicle contained the frontal branch of superficial temporal artery and one of main branches of superficial temporal vein.Among the 12 cases,the frontal branch of superficial temporal vein was used as the outflow in 4 cases,and the parietal branch was used as the outflow in 8 cases.The size of the flaps ranged from 3 cm×2 cm to 30 cm×13 cm.The skin pedicles were divided at 3 weeks after the flap transfer.Results Indocyanine green angiography could clearly showed the course and branching of the superficial temporal artery and vein.Individual diffe

关 键 词：吲哚菁绿血管造影 面部软组织缺损 额部皮瓣 颞浅静脉 静脉定位 

分 类 号：R622[医药卫生—整形外科]