Department of Trauma and Plastic Surgery, University Hospital Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2011;48(1):81-94. doi: 10.3233/CH-2011-1396.
Free flap transplantation is used more and more frequently in order to cover extensive wound defects. The basic prerequisite for successful flap salvage after flap failure is a short time interval from failure until revision. For this reason many different flap monitoring systems have been tested over the last years.
The aim of the experiment was to detect critical capillary perfusion using contrast enhanced ultrasound. Quantitative analysis should be performed by a special perfusion software (QONTRAST; Bracco, Italy) appraising digital raw data of contrast enhanced ultrasound (CEUS). Additionally diverse risk factors for free flap transplantation were determined.
Thirty-one patients were examined after free flap transplantation during the first 72 hours after operation. CEUS was performed with a linear transducer (6-9 MHz, LOGIQ E9/GE) and a bolus injection of 2.4 ml of contrast agent (SonoVue, Bracco, Italy). Operation and examination were performed by either an experienced plastic surgeon or an experienced ultrasound examiner. Depth dependent capillary perfusion was analysed and quantitative perfusions analysis was performed using the perfusions software QONTRAST (Bracco, Italy). Eleven revisions had to be performed: 7 due to haematoma and 4 due to superficial necrosis.
Reduced capillary perfusion was seen in all 11 complications using CEUS. Significant difference comparing the no complication and the complication group was observed using TTP (time to PEAK) and RBV (regional blood volume) quantitative analysis. Mean RBV was 922.1 ± 150.9 in the no complication and 303.0 ± 53.9 in the complication group (p = 0.001). Mean TTP was 37.6 ± 3.8 in the no complication and 21.3 ± 3.4 in the complication group (p = 0.006). Tendency to higher complication rate was seen in older male patients with vascular or malignant primary disease.
In this clinical trial, capillary perfusion after free flap transplantation as well as detection of vascular complications was demonstrated using CEUS. Quantitative perfusions analysis could be performed and flap viability could be assessed easily.
为了覆盖广泛的创伤缺损，游离皮瓣移植的应用越来越频繁。皮瓣失败后成功挽救皮瓣的基本前提是从失败到修复的时间间隔较短。出于这个原因，过去几年已经测试了许多不同的皮瓣监测系统。
该实验的目的是使用对比增强超声检测临界毛细血管灌注。应通过特殊的灌注软件（QONTRAST；Bracco，意大利）对定量分析进行评估，该软件评估对比增强超声（CEUS）的数字原始数据。此外，还确定了游离皮瓣移植的各种危险因素。
31 例患者在术后第 1 至 72 小时内接受游离皮瓣移植检查。使用线性探头（6-9 MHz，LOGIQ E9/GE）和 2.4 ml 造影剂（SonoVue，Bracco，意大利）进行 CEUS。手术和检查由经验丰富的整形外科医生或经验丰富的超声检查人员进行。分析深度依赖的毛细血管灌注，并使用灌注软件 QONTRAST（Bracco，意大利）进行定量灌注分析。需要进行 11 次修订：7 次由于血肿，4 次由于浅表坏死。
使用 CEUS 观察到所有 11 例并发症的毛细血管灌注减少。使用 TTP（到达峰值时间）和 RBV（局部血容量）定量分析观察到无并发症和并发症组之间存在显著差异。无并发症组的平均 RBV 为 922.1±150.9，并发症组为 303.0±53.9（p=0.001）。无并发症组的平均 TTP 为 37.6±3.8，并发症组为 21.3±3.4（p=0.006）。在有血管或恶性原发性疾病的老年男性患者中，并发症发生率较高。
在这项临床试验中，使用 CEUS 证明了游离皮瓣移植后的毛细血管灌注以及血管并发症的检测。可以进行定量灌注分析，并且可以轻松评估皮瓣的存活能力。
