Kuriyama Motone, Yano Akiko, Yoshida Yukitaka, Kubo Maiko, Akita Shinsuke, Mitsukawa Nobuyuki, Satoh Kaneshige, Yamamoto Shin, Sasaguri Shiro, Orihashi Kazumasa
Department of Plastic and Reconstructive Surgery, Kochi Medical School Hospital, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 206-8677, Japan.
Surg Today. 2016 Mar;46(3):326-34. doi: 10.1007/s00595-015-1181-8. Epub 2015 May 5.
In most general thoracic operations performed via standard posterolateral thoracotomy, such as for descending aortic aneurysms and lung cancer, the latissimus dorsi (LD) muscle is divided. However, division of the LD can hamper reconstructive surgery because the initial operation creates unstable blood flow to the divided LD. We conducted this study to assess blood flow in a divided distal LD muscle flap using intraoperative indocyanine green-fluorescence angiography (ICG-FA) with the Hyper Eye Medical System(®) (Mizuho Medical Co., Ltd., Tokyo, Japan).
The subjects were 11 patients who underwent posterolateral thoracotomy with reconstructive surgery using a divided distal LD and other peripheral muscle flaps. Intraoperative ICG-FA was conducted to assess blood flow to the LD.
Intraoperative ICG-FA revealed that at least two intercostal perforators from the sixth to the tenth intercostal spaces were preserved as feeding vessels to the divided distal LD. There were no major complications associated with inadequate blood flow to the muscle flaps.
Intraoperative ICG-FA proved extremely useful for assessing altered blood flow of the divided LD and for selecting preserved intercostal perforators.
在大多数通过标准后外侧开胸进行的普通胸科手术中，如下降主动脉瘤和肺癌手术，背阔肌（LD）会被切断。然而，切断背阔肌会妨碍重建手术，因为初次手术会导致流向切断的背阔肌的血流不稳定。我们开展这项研究，使用Hyper Eye Medical System（®）（日本东京瑞穗医疗株式会社）术中吲哚菁绿荧光血管造影（ICG-FA）评估切断的背阔肌远端肌瓣的血流情况。
研究对象为11例行后外侧开胸手术并使用切断的背阔肌远端及其他外周肌瓣进行重建手术的患者。术中进行ICG-FA以评估背阔肌的血流情况。
术中ICG-FA显示，第六至第十肋间间隙至少有两支肋间穿支血管作为流向切断的背阔肌远端的供血血管得以保留。未出现与肌瓣血流不足相关的重大并发症。
术中ICG-FA被证明在评估切断的背阔肌血流变化及选择保留的肋间穿支血管方面极为有用。
