Lamby P, Prantl L, Gais S, Walter M, Bachthaler M, Nerlich M, Feuerbach S, Jung E M
Institute of General Surgery, University Hospital Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2008;39(1-4):253-63.
A free-flap graft refers to the free transfer of tissue to cover tissue defects caused by trauma or malperfusion in plastic surgery. The basic principle, which makes a free flap working is an adequate blood flow. We applied new techniques which are able to detect the blood flow of the anastomosis and of dermal and subdermal tissue layers in a reliable way.
To this end we applied innovative Ultrasound-techniques (contrast enhanced high resolution Ultrasound (US), color coded Doppler sonography (CCDS), Cross Beamtrade mark, Power Doppler, Tissue Harmonic Imagingtrade mark (THI), Speckle Reduction Imagingtrade mark (SRI)), as well as the Indocyanine Green (ICG) fluorescence angiography to evaluate the vascular integrity of 15 parascapular flaps implanted to the fore foot over a period of four years. The age of the subjects ranged from 16 to 60 years. The US machine (GE Logiq 9) was equipped with a Logiq 9L transducer (6-9 MHz) and the modalities of CHI (Contrast Harmonic Imaging) and True Agent Detection (dual view of B-Mode and contrast mode).
The borders of the investigated flaps could be best detected using Cross Beamtrade mark Technology with SRItrade mark and THItrade mark. Power Doppler was able to detect anastomotic vessels even if they were twisted or elongated. Reduced perfusion curves were seen in cases with low anastomotic flow in CCDS. The CHItrade mark allowed dynamic flow detection of the microcirculation of the tissue graft over a depth of up to 3 cm including quantitative perfusion curves of tissue microcirculation by using TICtrade mark analysis. There is a strong correlation between the perfusion indices measured by ICG fluorescence angiography and CHItrade mark. Furthermore the ICG showed a remarkable enhancement of fluorescence in the flap borders, which need to be explored in future investigations.
These new applications provide useful and effective methods for improved postoperative monitoring of free flaps in plastic surgery and can lead to substantial reduction in the overall risk of flap failure.
游离皮瓣移植是指在整形外科中，将组织进行游离转移以覆盖由创伤或灌注不良引起的组织缺损。使游离皮瓣发挥作用的基本原则是充足的血流。我们应用了能够可靠检测吻合口以及真皮和皮下组织层血流的新技术。
为此，我们应用了创新的超声技术（对比增强高分辨率超声（US）、彩色编码多普勒超声（CCDS）、Cross Beam商标、功率多普勒、组织谐波成像商标（THI）、斑点减少成像商标（SRI）），以及吲哚菁绿（ICG）荧光血管造影术，对15例在四年期间移植到前足的肩胛旁皮瓣的血管完整性进行评估。受试者年龄在16至60岁之间。超声机器（GE Logiq 9）配备了Logiq 9L探头（6 - 9 MHz）以及CHI（对比谐波成像）和真剂检测（B模式和对比模式的双视图）模式。
使用带有SRI商标和THI商标的Cross Beam商标技术能够最佳地检测所研究皮瓣的边界。功率多普勒即使在吻合血管扭曲或拉长时也能检测到。在CCDS中吻合口血流低的情况下可见灌注曲线降低。CHI商标通过使用TIC商标分析能够动态检测组织移植物高达3厘米深度的微循环，包括组织微循环的定量灌注曲线。ICG荧光血管造影术测量的灌注指数与CHI商标之间存在很强的相关性。此外，ICG在皮瓣边界显示出显著的荧光增强，这需要在未来的研究中进一步探索。
这些新应用为改善整形外科中游离皮瓣的术后监测提供了有用且有效的方法，并可大幅降低皮瓣失败的总体风险。
