Krishnan Kartik G, Schackert Gabriele, Steinmeier Ralf
Department of Neurological Surgery, Carl Gustav Carus University Hospital, Technical University of Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany.
Br J Plast Surg. 2005 Apr;58(3):330-8. doi: 10.1016/j.bjps.2004.10.003.
Indocyanine green near-infrared-video angiography (ICG-NIR-VA) was recently introduced for measuring perfusion of skin flaps. The prognostic value of this method with regards to post-transfer manipulations of the flap, and subsequently, flap survival is not adequately documented in the literature. In this paper, we report our experience with the ICG-NIR-VA in the intraoperative evaluation and post-operative follow-up of nine flaps (2 large random pattern, 4 pedicled island and 3 free flaps) used in various reconstructive procedures. Two flaps (1 random pattern and 1 free flap) showed delayed intraoperative uptake in ICG-NIR-VA. In the post-operative phase, (days 1-3) six flaps (1 random pattern, 2 axial pattern and 3 free flaps) showed a delay both in the ICG-NIR-VA uptake, as well as clearance. However, a clinical correlate was observed only in 2 of the 6 flaps demonstrating this delay: general and partial venous congestion was seen in a distally based interosseous posterior flap and a free lateral arm flap respectively. Leeches were implemented only based on the clinical signs. In one distally based perforator flap, the decision on perfusion augmentation via microanastomosis was based on the intraoperative ICG-NIR-VA finding. All flaps showed uneventful healing. Based on our observations, the question arises, not whether the ICG-NIR-VA is sensitive for the prognosis of venous congestion, upon which the flap manipulation strategy might rest-but whether it is too sensitive. Further, prospective studies are necessary.
吲哚菁绿近红外视频血管造影术（ICG-NIR-VA）最近被用于测量皮瓣灌注。关于该方法对皮瓣转移后操作及随后皮瓣存活的预后价值，文献中尚无充分记录。在本文中，我们报告了ICG-NIR-VA在9例用于各种重建手术的皮瓣（2例大型随意型、4例带蒂岛状和3例游离皮瓣）术中评估及术后随访中的应用经验。2例皮瓣（1例随意型和1例游离皮瓣）在ICG-NIR-VA中显示术中摄取延迟。在术后阶段（第1 - 3天），6例皮瓣（1例随意型、2例轴型和3例游离皮瓣）在ICG-NIR-VA摄取及清除方面均显示延迟。然而，在这6例显示延迟的皮瓣中，仅2例观察到临床相关性：分别在远端蒂骨间后皮瓣和游离侧臂皮瓣中观察到全身和部分静脉淤血。仅根据临床体征使用水蛭。在1例远端蒂穿支皮瓣中，通过显微吻合进行灌注增强的决策基于术中ICG-NIR-VA的发现。所有皮瓣均顺利愈合。基于我们的观察，问题不在于ICG-NIR-VA对静脉淤血预后是否敏感（皮瓣操作策略可能基于此），而在于它是否过于敏感。此外，前瞻性研究是必要的。
