止血带控制再灌注增强红外热成像术辅助设计腓肠内侧动脉穿支皮瓣的临床应用  

Clinical application of tourniquet-reperfusion augmented infrared thermography to assist design of medial sural artery perforator flap

作　　者：肖栋超 潘佳栋[1] 周贤挺 沈航崇 黄天翔 陆陈林 黄耀鹏[1] 王欣[1] Xiao Dongchao;Pan Jiadong;Zhou Xianting;Shen Hangchong;Huang Tianxiang;Lu Chenlin;Huang Yaopeng;Wang Xin(Department of Hand Surgery,Ningbo Sixth Hospital,Ningbo 315040,China;Department of Plastic and Reconstructive Surgery,Ningbo Sixth Hospital,Ningbo 315040,China)

机构地区：[1]宁波市第六医院手外科,宁波315040 [2]宁波市第六医院整复外科,宁波315040

出　　处：《中华整形外科杂志》2023年第12期1324-1330,共7页Chinese Journal of Plastic Surgery

基　　金：宁波市医学科技计划项目(2020Y53);宁波市重大科技任务攻坚项目(2022Z146)。

摘　　要：目的探讨使用止血带控制再灌注增强红外热成像术(TRAIRT)定位优势穿支辅助设计游离腓肠内侧动脉穿支皮瓣的效果。方法回顾性分析2019年5月至2022年1月于宁波市第六医院手外科利用游离腓肠内侧动脉穿支皮瓣修复上肢皮肤软组织缺损的患者资料。于术前采用彩色多普勒超声(CDU)、麻醉后采用TRAIRT定位优势穿支辅助皮瓣设计,在TRAIRT视频中,选择"出现早、亮度高、扩展快"的热点标记为优势穿支。术中按照设计好的标记点切取皮瓣转移至受区覆盖缺损创面,可吸收线间断缝合固定,再依次行血管端端吻合。供区依据创面宽度予直接缝合或缝合后以全厚皮片移植修复。术后观察皮瓣供、受区情况,记录患者满意度。穿支血管定位准确性以术中发现的穿支血管实际位置为金标准,将TRAIRT与CDU探查的穿支位置与金标准比较,距离小于10 mm被认为定位准确(阳性)。分别计算2种方法定位穿支血管的敏感度(定位准确穿支数/术中实际穿支数×100%)和阳性预测值(定位准确穿支数/定位穿支总数×100%),用百分数表示,采用配对χ^(2)检验比较2种方法探测穿支的敏感度;使用Kappa系数分析2种方法探测穿支血管的一致性。记录TRAIRT和CDU探测穿支时间,用±s表示,采用配对样本t检验进行统计比较。结果共纳入23例患者,男性14例,女性9例;年龄21~70岁,平均43岁;创面位于前臂5例,腕部2例,手部16例;创面面积为4.5 cm×5.5 cm~6.5 cm×12.0 cm;术中皮瓣切取面积为5.0 cm×6.0 cm~7.0 cm×13.0 cm。术后22例皮瓣顺利成活,1例远端出现浅层坏死,经反复换药后愈合;皮瓣供区均愈合良好,一期缝合20例,大部分缝合后移植全厚皮片修复3例。术后随访5~16个月,平均8.4个月。皮瓣无臃肿,无肿胀及磨损,质地、颜色与小腿内侧皮肤相似,皮瓣供、受区瘢痕不明显。患者对皮瓣供、受区恢复均表示满意。23例患者中,TRAIRT共发�Objective To investigate the effect of tourniquet-reperfusion augmented infrared thermography(TRAIRT)on locating the dominant perforator to assist design of free medial sural artery perforator flap.Methods The data of patients with skin soft tissue defect of upper limb repaired by free medial sural artery perforator flap in Department of Hand Surgery,Ningbo Sixth Hospital from May 2019 to January 2022 were retrospectively analyzed.Color Doppler ultrasonography(CDU)and TRAIRT were used to locate the dominant perforator auxiliary flap design before surgery and after anesthesia.In the TRAIRT video,the hot spot with"early emergence,high brightness and fast expansion"was selected as the advantageous perforator.During the operation,the flap was elevated and transferred to the affected area to cover the defect wound according to the designed mark points,and fixed by the absorbable sutures with an interrupted suturing method,then end-to-end vascular anastomosis was performed successively.The donor area was sutured directly or sutured with full thickness skin grafts depending on the area of the wound.The donor and recipient areas of the flap were observed and the patients’satisfaction was recorded.The gold standard was the actual location of the perforating vessel found during the operation.Compared with the gold standard,the location of the perforating vessel explored by TRAIRT and CDU was considered to be accurate(positive)if the distance was less than 10 mm.The sensitivity(accurate number of perforators/actual number of perforators during operation×100%)and positive predictive value(accurate number of perforators/total number of perforators×100%)of the two methods were calculated,expressed as%,and the sensitivity of the two methods was compared by pairedχ^(2)test.Kappa coefficient was used to analyze the consistency of the two methods to detect perforating vessels.The perforator detection time of TRAIRT and CDU were recorded,expressed as Mean±SD,and statistically analyzed by paired sample t-test.Results A total o

关 键 词：外科皮瓣 红外热成像术 彩色多普勒超声 腓肠内侧动脉穿支 止血带 

分 类 号：R687.3[医药卫生—骨科学]