Department of Plastic, Reconstructive and Hand Surgery, Burn Centre, Klinikum Bogenhausen, Technical University Munich, Englschalkingerstrasse 77, Munich 81925, Germany.
Microsurgery. 2009;29(7):509-14. doi: 10.1002/micr.20645.
: Technical problems at the site of the anastomosis compromise an underappreciated proportion of microsurgical free tissue transfers. Intraoperative identification of technical errors may be able to prevent reexploration surgery and early flap failure. We report the first human study on a new microscope-integrated fluorescence angiography technique, which allows for intraoperative imaging of the anastomotic site.
: Fifty consecutive patients undergoing reconstructive microsurgical procedures were enrolled in the study. Intraoperative near infrared indocyanine green videoangiography (ICGA) was performed on all microsurgical anastomoses, after they had been assessed by the operating surgeon by conventional clinical patency tests. Anastomoses deemed to be occluded by the ICG-angiography were intraoperatively revised, and the result of revision was compared with angiographic findings.
: In 11/50 (22%) of patients, where the surgeon had classified the anastomoses as patent, microangiography identified a total luminal occlusion (six) and/or significant alterations in blood flow (five), potentially predisposing toward postoperative flap failure. Intraoperative revision confirmed angiographic findings in 100% of cases, and was always associated with flap survival. The decision not to revise despite anastomotic occlusion by the intraoperative angiogram was always followed by flap loss or early reexploration. A delayed return of venous blood from the flap predisposed toward postoperative flap failure.
: Hand-sewn anastomoses are subject to technical errors, and conventional patency tests have a low sensitivity for revealing anastomotic failure. Microscope integrated microangiography is an excellent method for identifying significant anastomotic problems, which would have otherwise gone unnoticed. The potential impact on early flap failure and reexploration surgery is considerable. (c) 2009 Wiley-Liss, Inc. Microsurgery 2009.
吻合口处的技术问题会影响一小部分显微游离组织移植的效果，而这些问题往往容易被忽视。术中识别技术错误可能会避免再次探查手术和早期皮瓣失败。我们报告首例关于新型显微镜集成荧光血管造影技术的人体研究，该技术允许对吻合口进行术中成像。
连续 50 例接受重建显微手术的患者参与了这项研究。所有显微吻合口均进行术中近红外吲哚菁绿血管造影（ICGA）检查，且在此之前手术医生已通过常规临床通畅试验对其进行了评估。ICG 血管造影显示吻合口闭塞的，术中进行修正，修正结果与血管造影结果进行比较。
在 11/50（22%）的患者中，手术医生将吻合口分类为通畅，但微血管造影显示完全管腔闭塞（6 例）和/或血流明显改变（5 例），这可能导致术后皮瓣失败。术中修正术总是与皮瓣存活相关，100%的病例中，吻合口的血管造影结果得到了证实。尽管术中血管造影显示吻合口闭塞，但不进行修正的情况下，总是会导致皮瓣丢失或早期再次探查。皮瓣静脉回流延迟会增加术后皮瓣失败的风险。
手工吻合口容易出现技术错误，而常规通畅试验对发现吻合口失败的敏感性较低。显微镜集成微血管造影术是识别重要吻合口问题的一种极好方法，否则这些问题可能会被忽视。对早期皮瓣失败和再次探查手术的潜在影响是相当大的。（c）2009 年 Wiley-Liss，Inc. 显微外科学 2009 年。
