Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
J Surg Res. 2013 Sep;184(1):714-21. doi: 10.1016/j.jss.2013.04.039. Epub 2013 May 10.
Facial transplantation is a complex procedure that corrects severe facial defects due to traumas, burns, and congenital disorders. Although face transplantation has been successfully performed clinically, potential risks include tissue ischemia and necrosis. The vascular supply is typically based on the bilateral neck vessels. As it remains unclear whether perfusion can be based off a single pedicle, this study was designed to assess perfusion patterns of facial transplant allografts using near-infrared (NIR) fluorescence imaging.
Upper facial composite tissue allotransplants were created using both carotid artery and external jugular vein pedicles in Yorkshire pigs. A flap validation model was created in n = 2 pigs and a clamp occlusion model was performed in n = 3 pigs. In the clamp occlusion models, sequential clamping of the vessels was performed to assess perfusion. Animals were injected with indocyanine green and imaged with NIR fluorescence. Quantitative metrics were assessed based on fluorescence intensity.
With NIR imaging, arterial perforators emitted fluorescence indicating perfusion along the surface of the skin. Isolated clamping of one vascular pedicle showed successful perfusion across the midline based on NIR fluorescence imaging. This perfusion extended into the facial allograft within 60 s and perfused the entire contralateral side within 5 min.
Determination of vascular perfusion is important in microsurgical constructs as complications can lead to flap loss. It is still unclear if facial transplants require both pedicles. This initial pilot study using intraoperative NIR fluorescence imaging suggests that facial flap models can be adequately perfused from a single pedicle.
面部移植是一种复杂的手术，可矫正因创伤、烧伤和先天畸形导致的严重面部缺陷。尽管面部移植已在临床上成功实施，但仍存在潜在风险，包括组织缺血和坏死。血管供应通常基于双侧颈部血管。由于尚不清楚是否可以基于单个蒂来实现灌注，因此本研究旨在使用近红外（NIR）荧光成像评估面部移植移植物的灌注模式。
使用颈总动脉和颈外静脉蒂在约克夏猪中创建上半面部复合组织同种异体移植。在 n = 2 头猪中创建了皮瓣验证模型，并在 n = 3 头猪中进行了夹闭阻塞模型。在夹闭阻塞模型中，依次夹闭血管以评估灌注。向动物注射吲哚菁绿并用 NIR 荧光成像。根据荧光强度评估定量指标。
使用 NIR 成像，动脉穿支发出荧光，表明皮肤表面有灌注。单独夹闭一个血管蒂可根据 NIR 荧光成像显示中线处的成功灌注。这种灌注在 60 秒内扩展到面部移植物，并在 5 分钟内灌注整个对侧。
确定血管灌注在显微外科结构中很重要，因为并发症可能导致皮瓣丢失。目前尚不清楚面部移植是否需要两个蒂。这项使用术中 NIR 荧光成像的初步试点研究表明，面部皮瓣模型可以从单个蒂得到充分灌注。
