Newman Martin I, Samson Michel C
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.
J Reconstr Microsurg. 2009 Jan;25(1):21-6. doi: 10.1055/s-0028-1090617. Epub 2008 Oct 16.
The benefits of laser-assisted indocyanine green fluorescence angiography have previously been demonstrated in cardiac surgery. The purpose of this study was to determine the value of this technology in microsurgical breast reconstruction. Intraoperative laser-assisted indocyanine green fluorescence angiography was performed on all microsurgical breast reconstruction cases (deep inferior epigastric perforator flap or free transverse rectus abdominus muscle flap) during the study period. Ten consecutive free tissue transfer autologous breast reconstructions were performed on 8 women. In four cases, imaging demonstrated flow or perfusion deemed "marginal" or "poor" by the operating surgeons. In three of these cases, one involving poor arterial inflow, one of poor venous outflow, and one of poor perfusion of a mastectomy flap, the intraoperative plan was adjusted accordingly and follow-up imaging demonstrated improvement. In the fourth case, no adjustment was made at operation. However this patient required a return to the operating room for venous congestion of the flap, which was corrected without sequela. Overall flap survival was 100%. We concluded that laser-assisted indocyanine green fluorescence angiography appears to provide important information that has helped guide intraoperative decision making in our series.
激光辅助吲哚菁绿荧光血管造影术的益处此前已在心脏手术中得到证实。本研究的目的是确定该技术在显微外科乳房重建中的价值。在研究期间，对所有显微外科乳房重建病例（腹壁下深动脉穿支皮瓣或游离腹直肌肌皮瓣）均进行了术中激光辅助吲哚菁绿荧光血管造影术。对8名女性连续进行了10例游离组织移植自体乳房重建手术。在4例病例中，成像显示手术医生认为血流或灌注为“临界”或“不佳”。在其中3例病例中，1例为动脉流入不佳，1例为静脉流出不佳，1例为乳房切除皮瓣灌注不佳，术中计划相应调整，随访成像显示有所改善。在第4例病例中，术中未进行调整。然而，该患者因皮瓣静脉淤血需要返回手术室，淤血得到纠正且无后遗症。皮瓣总体存活率为100%。我们得出结论，激光辅助吲哚菁绿荧光血管造影术似乎能提供重要信息，有助于指导我们这一系列病例的术中决策。
