Giunta R E, Holzbach T, Taskov C, Holm P S, Brill T, Busch R, Gansbacher B, Biemer E
Department of Plastic and Reconstructive Surgery, Rechts der Isar Hospital, University of Technology, Ismaningerstrasse 22, 81675 Münich, Germany.
Br J Plast Surg. 2005 Jul;58(5):695-701. doi: 10.1016/j.bjps.2005.02.018.
Prediction of necrosis has a clinical relevance in all fields of plastic surgery. The new application of indocyanine green (ICG) fluoroscopy in plastic surgery allows an objective quantification of skin perfusion and a high topographical resolution. The aim of the present study is to determine threshold values for flap perfusion under well-defined experimental conditions. Twenty random pattern flaps with a length to width ratio of 4:1 (8 x 2 cm(2)) were dissected on the anterior abdominal wall of 20 male Sprague-Dawley rats. ICG fluoroscopy was performed at the end of the operation. The animals were sacrificed at the seventh postoperative day with a reliable necrosis of the distal part of the flaps. Postoperative ICG fluoroscopy then was analysed both in regions that will survive and undergo necrosis. At day 7 a mean area of 5.5 cm(2) (57% of the total flap area) survived and a mean of 3.8 cm(2) (43%) became necrotic. The surviving part of the flap had a mean perfusion index of 62% compared to reference skin. The distal parts of the flap that necrotised showed an average perfusion index of only 19% postoperatively. Differences were statistically highly significant (p<0.001). Indocyanine green fluoroscopy is a useful tool to evaluate perfusion topographically and predict necrosis. From a statistical point of view a perfusion index of less than 25% of the reference skin can be considered as a sign of developing flap necrosis.
坏死的预测在整形外科的各个领域都具有临床意义。吲哚菁绿（ICG）荧光成像技术在整形外科中的新应用能够对皮肤灌注进行客观量化，并具有高分辨率的局部成像。本研究的目的是在明确的实验条件下确定皮瓣灌注的阈值。在20只雄性Sprague-Dawley大鼠的腹壁上解剖了20个长宽比为4:1（8×2 cm²）的随意型皮瓣。在手术结束时进行ICG荧光成像。术后第7天处死动物，此时皮瓣远端出现可靠的坏死。然后对术后ICG荧光成像在皮瓣存活区和坏死区进行分析。术后第7天，平均有5.5 cm²（占皮瓣总面积的57%）存活，平均有3.8 cm²（占43%）发生坏死。与对照皮肤相比，皮瓣存活部分的平均灌注指数为62%。皮瓣坏死的远端术后平均灌注指数仅为19%。差异具有高度统计学意义（p<0.001）。吲哚菁绿荧光成像技术是一种用于局部评估灌注并预测坏死的有用工具。从统计学角度来看，灌注指数低于对照皮肤25%可被视为皮瓣坏死发生的迹象。
