高选择性动脉吲哚菁绿造影在游离股前外侧皮瓣设计中的应用  

Application of highly selective arterial indocyanine green angiography in the design of anterolateral thigh free flap

作　　者：王石 董帅 曹阳 王桂洋 杨成鹏 孙丰文 黄永涛 郭礼平 杨亮 周荣 巨积辉 Wang Shi;Dong Shuai;Cao Yang;Wang Guiyang;Yang Chengpeng;Sun Fengwen;Huang Yongtao;Guo Liping;Yang Liang;Zhou Rong;Ju Jihui(Department of Hand Surgery,Suzhou Ruihua Orthopaedic Hospital,Suzhou 215104,China;Department of Wound Repair Surgery,Suzhou Ruihua Orthopaedic Hospital,Suzhou 215104,China)

机构地区：[1]苏州瑞华骨科医院手外科,苏州215104 [2]苏州瑞华骨科医院创面修复科,苏州215104

出　　处：《中华烧伤与创面修复杂志》2024年第10期948-954,共7页Chinese Journal of Burns And Wounds

基　　金：苏州市医学重点学科(SZXK202127);苏州市科技发展计划(SKYD2023026)。

摘　　要：目的介绍高选择性动脉吲哚菁绿造影(以下简称高选择性动脉造影)在游离股前外侧皮瓣设计中的应用。方法该研究为回顾性观察性研究。2023年11月—2024年4月,苏州瑞华骨科医院手外科和创面修复科共收治29例符合入选标准的采用高选择性动脉造影辅助设计的游离股前外侧皮瓣修复四肢创面的患者,其中男26例、女3例,年龄16~71岁,清创后创面面积为8.0 cm×4.5 cm~27.0 cm×16.0 cm。术中,采用高选择性动脉造影辅助设计皮瓣,观察皮瓣源动脉或穿支的荧光显影范围,根据皮肤的荧光显影情况判断皮瓣源动脉或穿支的供血范围,调整皮瓣的切取位置。皮瓣切取面积为9.0 cm×6.0 cm~29.0 cm×16.0 cm。术中观察并记录行高选择性动脉造影的次数、行穿刺的穿支源动脉类型、皮瓣切取位置变化。术后观察皮瓣血运及成活情况、皮瓣供区创面愈合情况和皮片成活情况、造影相关并发症情况。结果29例患者32个皮瓣均顺利切取,共行高选择性动脉造影37次,其中行旋股外侧动脉斜支穿刺者13例、降支穿刺者6例、斜支与降支双穿刺者8例、其他来源的源动脉穿刺者2例。术中28个皮瓣切取位置未改变,3个皮瓣切取位置向肢体近端移动,1个皮瓣切取位置向肢体远端移动。术后皮瓣均顺利成活,未出现皮瓣远近端部分坏死的情况;皮瓣供区创面愈合,皮片均成活;未出现造影相关并发症。结论采用高选择性动脉造影可在术中判断游离股前外侧皮瓣源动脉及穿支供血范围,更加直观、客观地评价皮瓣的血供,用于辅助皮瓣设计可一定程度上避免因术前设计不合理而导致的皮瓣部分坏死,且安全可靠。Objective To introduce the application of highly selective arterial indocyanine green angiography(hereinafter referred to as highly selective arterial angiography)in the design of anterolateral thigh free flap.MethodsThis study was a retrospective observational study.From November 2023 to April 2024,29 patients with wounds in extremities which were repaired by anterolateral thigh free flaps designed under the assistance of highly selective arterial angiography and met the inclusion criteria were admitted to the Department of Hand Surgery and Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital,including 26 males and 3 females,aged 16 to 71 years.The wound area after debridement ranged from 8.0 cm×4.5 cm to 27.0 cm×16.0 cm.During the surgery,highly selective arterial angiography was used to assist in flap design.The fluorescence development range of the source arteries or perforators of flaps was observed.The blood supply range of the source arteries or perforators of flaps was determined based on the fluorescence development of the skin,and the excision position of the flap was adjusted.The flap incision area ranged from 9.0 cm×6.0 cm to 29.0 cm×16.0 cm.During the surgery,the number of highly selective arterial angiography,the type of source artery of perforators for puncture,and changes in the excision position of flaps were observed and recorded.After surgery,the blood supply and survival of flaps,the healing of wounds and the survival of skin grafts in the flap donor sites,and the angiography-related complications were observed.ResultsAll the 32 flaps of 29 patients were successfully excised.The highly selective arterial angiography was performed 37 times,including 13 cases of puncture of the oblique branch of the lateral circumflex femoral artery,6 cases of puncture of the descending branch,8 cases of double puncture of the oblique and descending branches,and 2 cases of puncture of arteries from other branches.During the surgery,the excision position of 28 flaps did not change,the excis

关 键 词：血管造影术 外科皮瓣 穿支皮瓣 吲哚菁绿 动脉造影 股前外侧皮瓣 旋股外侧动脉 创面修复 

分 类 号：R658.2[医药卫生—外科学]