微血管吻合腓骨瓣和桡骨前臂瓣中的发光比率氧成像（LROI）

Luminescence ratiometric oxygen imaging (LROI) in microvascular anastomosed fibular and radial forearm flaps.

作者信息

Meier J K, Prantl L, Geis S, Mueller S, Hullmann M, Liebsch G, Gosau M

机构信息

Department of Cranio-Maxillo-Facial Surgery, University Medical Centre Regensburg, Regensburg, Germany.

出版信息

Clin Hemorheol Microcirc. 2013;55(1):169-82. doi: 10.3233/CH-131700.

DOI:10.3233/CH-131700

PMID:24201245

Abstract

BACKGROUND

In a preliminary trial, we were able to show first promising results in the analysis of perioperative and postoperative perfusion of free flaps by means of a new monitoring system for detecting thrombotic vessel occlusion before clinical signs become evident.

OBJECTIVE

We investigated whether flap monitoring by measuring perfusion-dependent parameters differs between radial forearm and fibular free flaps and whether a threshold value requiring anastomosis revision could be determined.

METHODS

37 radial forearm flaps (RF) and 15 fibular flaps (FF) were harvested and transplanted. Perfusion was determined by measuring a fluorescent oxygen sensor foil covering a flap's skin surface with a handheld fluorescence microscope. The sensor contained an oxygen reservoir, which was consumed by the tissue corresponding to the perfusion status of the flap. Measurements were done before explantation, after successful anastomosis and one day after surgery.

RESULTS

We found a significant difference (p < 0.005) in the relative transdermal oxygen consumption (RTOC) between clinically well-perfused grafts (RF: mean: 0.13 ± 0.08; FF: mean: 0.15 ± 0.07) and clinically poorly perfused grafts (RF: mean: 0.40 ± 0.09; FF: mean: 0.55 ± 0.28). A threshold RTOC value of 0.3 for differentiating between well-perfused and poorly perfused flaps was confirmed for both RF and FF.

摘要

背景

在一项初步试验中，我们通过一种新的监测系统，在临床症状出现之前检测血栓性血管闭塞，从而首次在游离皮瓣围手术期和术后灌注分析中显示出有前景的结果。

目的

我们研究了通过测量灌注相关参数进行皮瓣监测在桡侧前臂游离皮瓣和腓骨游离皮瓣之间是否存在差异，以及是否可以确定一个需要进行吻合口修复的阈值。

方法

切取并移植了37个桡侧前臂皮瓣（RF）和15个腓骨皮瓣（FF）。通过用手持式荧光显微镜测量覆盖皮瓣皮肤表面的荧光氧传感器箔来确定灌注情况。该传感器含有一个储氧器，其会被与皮瓣灌注状态相对应的组织消耗。在移植前、吻合成功后及术后一天进行测量。

结果

我们发现，临床灌注良好的移植物（RF：平均值：0.13±0.08；FF：平均值：0.15±0.07）和临床灌注不良的移植物（RF：平均值：0.40±0.09；FF：平均值：0.55±0.28）之间的相对经皮氧消耗（RTOC）存在显著差异（p<0.005）。对于RF和FF，区分灌注良好和灌注不良皮瓣的RTOC阈值均确定为0.3。