Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Science, University of Okayama, Okayama 700-8558, Japan.
Microsurgery. 2013 May;33(4):265-9. doi: 10.1002/micr.22079. Epub 2013 Jan 24.
The position of perforator vessels varies between individuals. In this report, we present our experience on the use of combining multidetector-row computed tomography (MDCT), Doppler flowmetry, and indocyanine green (ICG) fluorescent angiography to identify perforator vessels of flaps for reconstruction. We evaluated the advantages, disadvantages, and chose the necessary examination, depending on characteristics of the flap.
The combination of MDCT, Doppler flowmetry, and ICG fluorescent angiography examinations to identify perforators was performed in 50 patients before reconstructive surgery. The patients first underwent MDCT of the prospective flap donor region. Perforators were then marked for this site by using Doppler flowmetry in the neighborhood of the points identified by MDCT. After placing the patient in the intraoperative posture, ICG fluorescent angiography was performed to confirm the intensity and position of the perforators.
In all 50 patients examined by using this approach, perforators were intraoperatively identified near the preoperatively determined sites. Flap harvesting was possible in all patients with the identified perforators as the vascular pedicle. But it was difficult to identify the perforators on the MDCT in the patients who had a flap thickness of less than 8 mm and the identification of the perforators was difficult on ICG fluorescent angiography in the patients with a flap thickness greater than 20 mm. The transferred free flaps survived in all patients without complications.
On the basis of the results, selection of the most suitable mode of examination depending on the characteristics of flap is recommended.
穿支血管在个体之间存在差异。在本报告中，我们介绍了一种将多排螺旋 CT（MDCT）、多普勒血流仪和吲哚菁绿（ICG）荧光血管造影结合使用以识别皮瓣穿支血管的经验，用于重建。我们根据皮瓣的特点评估了每种检查方法的优缺点，并选择了必要的检查。
在重建手术前，对 50 例患者同时进行 MDCT、多普勒血流仪和 ICG 荧光血管造影检查，以识别穿支血管。首先对皮瓣供区进行 MDCT 扫描，然后在 MDCT 标记点附近使用多普勒血流仪标记该部位的穿支血管。将患者置于术中体位后，进行 ICG 荧光血管造影以确认穿支血管的强度和位置。
所有 50 例患者均通过该方法在术前确定的部位附近识别出了穿支血管。在所有患者中，均可以识别出所确定的穿支血管作为皮瓣的血管蒂来进行皮瓣游离移植。但在皮瓣厚度小于 8mm 的患者中，MDCT 难以识别穿支血管；在皮瓣厚度大于 20mm 的患者中，ICG 荧光血管造影难以识别穿支血管。所有患者的游离移植皮瓣均存活，无并发症发生。
根据结果，建议根据皮瓣的特点选择最合适的检查方式。
