Vargas Christina R, Nguyen John T, Ashitate Yoshitomo, Angelo Joseph, Venugopal Vivek, Kettenring Frank, Neacsu Florin, Frangioni John V, Gioux Sylvain, Lee Bernard T
From the *Division of Plastic and Reconstructive Surgery, Department of Surgery, †Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; ‡Division of Cancer Diagnostics and Therapeutics, Hokkaido University Graduate School of Medicine, Sapporo, Japan; §Department of Biomedical Engineering, Boston University; ∥Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston; and ¶Curadel, LLC, Worcester, MA.
Ann Plast Surg. 2016 Feb;76(2):249-55. doi: 10.1097/SAP.0000000000000631.
Vascularized composite allotransplantation represents an important advancement in the field of reconstructive microsurgery and has continued to increase in popularity. The significant clinical morbidity associated with flap failure represents an important barrier to even more widespread use of these techniques. Early identification of vascular compromise has been associated with a higher salvage rate, yet most surgeons rely only on clinical assessment intraoperatively. Spatial frequency domain imaging (SFDI) presents a noncontact, objective measurement of tissue oxygenation over a large field of view. This study aims to evaluate the use of SFDI technology in hemifacial composite flap compromise as could occur during facial transplant.
Six composite hemifacial flaps were created in three 35-kg Yorkshire pigs and continuously imaged using SFDI before, during, and after 15-minute selective vascular pedicle occlusion. Arterial and venous clamping trials were performed for each flap. Changes in oxyhemoglobin concentration, deoxyhemoglobin concentration, and total hemoglobin were quantified over time.
The SFDI successfully measured changes in oxygenation parameters in all 6 composite tissue flaps. Significant changes in oxyhemoglobin, deoxyhemoglobin, and total hemoglobin were seen relative to controls. Early and distinct patterns of alteration were noted in arterial and in venous compromise relative to one another.
The need for noninvasive, reliable assessment of composite tissue graft viability is apparent, given the morbidity associated with flap failure. The results of this study suggest that SFDI technology shows promise in providing intraoperative guidance with regard to pedicle vessel integrity during reconstructive microsurgery.
血管化复合组织异体移植是重建显微外科领域的一项重要进展，并且其受欢迎程度持续上升。与皮瓣失败相关的显著临床发病率是这些技术更广泛应用的一个重要障碍。早期识别血管受损与更高的挽救率相关，但大多数外科医生在术中仅依赖临床评估。空间频域成像（SFDI）可在大视野范围内对组织氧合进行非接触式客观测量。本研究旨在评估SFDI技术在面部移植过程中可能出现的半侧面部复合组织瓣受损情况中的应用。
在三只35千克的约克夏猪身上制作了六个半侧面部复合组织瓣，并在15分钟选择性血管蒂阻断前、阻断期间和阻断后使用SFDI进行连续成像。对每个组织瓣进行动脉和静脉夹闭试验。随时间对氧合血红蛋白浓度、脱氧血红蛋白浓度和总血红蛋白的变化进行定量分析。
SFDI成功测量了所有6个复合组织瓣的氧合参数变化。相对于对照组，氧合血红蛋白、脱氧血红蛋白和总血红蛋白均出现了显著变化。相对于彼此，在动脉和静脉受损情况中观察到了早期且明显不同的变化模式。
鉴于与皮瓣失败相关的发病率，对复合组织移植物活力进行无创、可靠评估的需求显而易见。本研究结果表明，SFDI技术在重建显微外科手术中为蒂血管完整性提供术中指导方面显示出了前景。
