Lee Linda N, Smith David F, Boahene Kofi D, Byrne Patrick J
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Facial Plast Surg. 2014 Sep-Oct;16(5):343-7. doi: 10.1001/jamafacial.2014.106.
Reconstruction of oncologic or traumatic head and neck defects often requires complex planning of locoregional, pedicled, or interpolated flaps. In cases with a higher risk of flap failure, vascular delay with staged reconstruction can help improve tissue perfusion and increase chances of flap survival. An objective tool is needed to help guide reconstructive surgeons with the intraoperative decision to pursue vascular delay.
To describe a pilot study using a novel application of a technique that quantifies and validates the benefit of the vascular delay procedure in locoregional flaps and to demonstrate a practical and broadly applicable technology that can be easily incorporated into intraoperative decision making and improve outcomes for high-risk flaps.
DESIGN, SETTING, AND PARTICIPANTS: A pilot study using intraoperative laser-assisted indocyanine green imaging measurements and fluorescence videos to objectively measure the benefit of vascular delay procedures in patients with head and neck defects and wound healing risk factors requiring locoregional flap reconstruction at an academic tertiary care center.
Intraoperative laser-assisted indocyanine green imaging with video documentation and quantitative measurements was used to evaluate flap perfusion before a vascular delay procedure. Measurements were repeated after a 3-week vascular delay procedure.
Two patients were identified based on comorbid conditions that resulted in a higher risk of flap failure, as well as the need for a locoregional flap for reconstruction. At the initial elevation of the flap, quantitative results from flap imaging demonstrated low perfusion numbers and minimal fluorescence, suggesting poor tissue perfusion and increased likelihood of postoperative flap compromise or failure. Following a vascular delay of 3 weeks, repeat measurements were substantially improved. No wound healing issues were observed.
This is the first study to date to quantitatively demonstrate the benefit of the vascular delay technique in patients with potential vascular compromise in locoregional head and neck flap reconstruction. Data obtained suggest that this technology can be used to guide intraoperative decision making in complicated reconstructions and help optimize patient outcomes.
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肿瘤性或创伤性头颈部缺损的重建通常需要对头颈部局部、带蒂或插入式皮瓣进行复杂的规划。在皮瓣失败风险较高的情况下，分期重建的血管延迟术有助于改善组织灌注并增加皮瓣存活几率。需要一种客观工具来帮助指导重建外科医生在术中决定是否采用血管延迟术。
描述一项初步研究，该研究使用一种新技术的新颖应用来量化和验证血管延迟术在头颈部局部皮瓣中的益处，并展示一种实用且广泛适用的技术，该技术可轻松纳入术中决策过程并改善高风险皮瓣的治疗效果。
设计、地点和参与者：一项初步研究，在一家学术性三级医疗中心，对有头颈部缺损且存在伤口愈合风险因素、需要进行头颈部局部皮瓣重建的患者，使用术中激光辅助吲哚菁绿成像测量和荧光视频来客观测量血管延迟术的益处。
术中使用激光辅助吲哚菁绿成像并进行视频记录和定量测量，以评估血管延迟术前皮瓣的灌注情况。在进行为期3周的血管延迟术后重复测量。
根据合并症确定了两名患者，这些合并症导致皮瓣失败风险较高，且需要进行头颈部局部皮瓣重建。在皮瓣初次掀起时，皮瓣成像的定量结果显示灌注数值较低且荧光微弱，提示组织灌注不良以及术后皮瓣出现并发症或失败的可能性增加。经过3周的血管延迟后，重复测量结果有显著改善。未观察到伤口愈合问题。
这是迄今为止第一项定量证明血管延迟技术对存在潜在血管受损的头颈部局部皮瓣重建患者有益的研究。所获得的数据表明，该技术可用于指导复杂重建手术中的术中决策，并有助于优化患者治疗效果。
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