Sacks Justin M, Nguyen Alexander T, Broyles Justin M, Yu Peirong, Valerio Ian L, Baumann Donald P
Eplasty. 2012;12:e30. Epub 2012 Jul 5.
The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. Because of the large amount of potential soft tissue, low donor site morbidity, and long pedicle lengths, many researchers consider it to be the perfect free flap. However, dissection of this and other perforator flaps can become an arduous experience with learning curves to overcome. Near-infrared laser angiography using indocyanine green provides a useful adjunctive tool to more predictably assess direct perforator perfusion zones. Laser-assisted angiography with SPY-Q analysis gives live localization of the flap's dominant perforator perfusion zones while quantifying the relative tissue perfusion for immediate skin paddle design.
Fifteen patients with head and neck cancer defects were reconstructed with a free anterolateral thigh flap using laser-assisted near-infrared indocyanine green perforator mapping. The mid-point of a line between the anterior superior iliac spine and the patella was determined and the laser was centered over this. Indocyanine green (12.5 mg) was injected intravenously and fluorescence patterns were recorded. Optimal perforators were chosen using real-time imaging and SPY-Q analysis software. The anterolateral thigh skin paddle was centered over perforators based on best relative perfusion values. The hand-held Doppler was not used to identify perforators. All flaps were elevated in standard fashion. Patient demographics, defect characteristics, reconstructive techniques, and clinical outcomes were assessed.
All 15 free flaps were raised with the assistance of laser-assisted angiography. Cutaneous Doppler did not aid in the design of the skin paddle. There was only 1 flap loss due to venous congestion. All donor defects were closed primarily without the need for a skin graft.
Laser-assisted indocyanine green angiography using SPY-Q analysis software provides robust, intraoperative, objective data to optimize anterolateral thigh skin paddle design while potentially minimizing patient morbidity. Future studies will be needed to further evaluate the use of this new technology.
股前外侧皮瓣是一种用途广泛的皮瓣，可游离或带蒂使用。由于其潜在的软组织量较大、供区并发症少且蒂长，许多研究者认为它是理想的游离皮瓣。然而，解剖这种皮瓣和其他穿支皮瓣可能会是一段需要克服学习曲线的艰巨经历。使用吲哚菁绿的近红外激光血管造影术提供了一种有用的辅助工具，能更可预测地评估直接穿支灌注区域。采用SPY-Q分析的激光辅助血管造影术能实时定位皮瓣的主要穿支灌注区域，同时量化相对组织灌注，以便即时设计皮瓣。
15例头颈部癌缺损患者采用激光辅助近红外吲哚菁绿穿支定位技术，以游离股前外侧皮瓣进行重建。确定髂前上棘与髌骨连线的中点，并将激光对准该点。静脉注射吲哚菁绿（12.5毫克），记录荧光模式。使用实时成像和SPY-Q分析软件选择最佳穿支。根据最佳相对灌注值，将股前外侧皮瓣置于穿支上方。未使用手持多普勒仪来识别穿支。所有皮瓣均采用标准方式掀起。评估患者的人口统计学特征、缺损特点、重建技术及临床结果。
所有15例游离皮瓣均在激光辅助血管造影术的辅助下掀起。皮肤多普勒对皮瓣设计没有帮助。仅1例皮瓣因静脉淤血而坏死。所有供区缺损均一期闭合，无需植皮。
采用SPY-Q分析软件的激光辅助吲哚菁绿血管造影术可提供可靠的术中客观数据，以优化股前外侧皮瓣设计，同时可能将患者的并发症降至最低。未来需要进一步研究来评估这项新技术的应用。
