Yang Kai, Mu Lan, Liu Yan, Peng Zhe, Li Guangxue
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Sep;29(9):1113-6.
To investigate the utility of indocyanine green angiography in flap reconstructive surgery and possibility of decrease the complications.
Indocyanine green angiography was performed on 14 patients undergoing flap reconstructive surgery between February and December 2014 to evaluate the blood perfusion of the flap and to adjust the operation plan. Of 14 cases, 2 were male and 12 were female, aged 23-58 years (mean, 35.5 years); 11 flaps were used for breast reconstruction [including 3 free deep inferior epigastric antery perforator (DIEP) flaps, 4 pedicled transverse rectus abdominis myocutaneous flaps (TRAM), 2 pedicled TRAM and free TRAM, and 2 pedicled latissimus dorsi myocutaneous flaps and prosthesis], 1 pedicled latissimus dorsi myocutaneous flap for repairing chest wall defect, 1 pedicled profunda artery perforator (PAP) flap for upper leg defect, and 1 pedicled descending genicular artery perforator flap for knee defect. The size of the flaps ranged from 9 cm x 6 cm to 26 cm x 12 cm.
A total of 32 indocyanine green angiography were performed. There was no adverse reactions to the infusion of indocyanine green. The surgery management was adjusted according to results of indocyanine green angiography findings in 5 of 14 cases. The distal part of flap were discarded because of poor perfusion in 3 cases (1 DIEP flap, 1 TRAM, and 1 PAP flap) and the other 2 cases (pedicled TRAM) needed additional free anastomosis to ensure sufficient blood supply (pedicled TRAM and free TRAM); the other flaps were harvested according to preoperative plan and repaired defect successfully. The mean follow-up was 5 months (range, 1-9 months). The other flaps survived without infection or fat necrosis except 1 PAP flap with distal necrosis.
Intraoperative indocyanine green angiography can provide real-time information of flap perfusion and then the operation plan can be adjusted in time to ensure the flap survival.
探讨吲哚菁绿血管造影在皮瓣重建手术中的应用价值及降低并发症的可能性。
2014年2月至12月，对14例行皮瓣重建手术的患者进行吲哚菁绿血管造影，以评估皮瓣血供并调整手术方案。14例患者中，男性2例，女性12例，年龄23 - 58岁（平均35.5岁）；11块皮瓣用于乳房重建[包括3块游离腹壁下深动脉穿支（DIEP）皮瓣、4块带蒂腹直肌肌皮瓣（TRAM）、2块带蒂TRAM和游离TRAM、2块带蒂背阔肌肌皮瓣加假体]，1块带蒂背阔肌肌皮瓣用于修复胸壁缺损，1块带蒂股深动脉穿支（PAP）皮瓣用于修复大腿上段缺损，1块带蒂膝降动脉穿支皮瓣用于修复膝关节缺损。皮瓣大小为9 cm×6 cm至26 cm×12 cm。
共进行32次吲哚菁绿血管造影。输注吲哚菁绿未出现不良反应。14例中有5例根据吲哚菁绿血管造影结果调整了手术管理。3例（1块DIEP皮瓣、1块TRAM皮瓣和1块PAP皮瓣）因灌注不良而切除皮瓣远端，另外2例（带蒂TRAM皮瓣）需要额外的游离吻合以确保充足血供（带蒂TRAM和游离TRAM）；其他皮瓣按术前计划切取并成功修复缺损。平均随访5个月（范围1 - 9个月）。除1块PAP皮瓣远端坏死外，其他皮瓣均存活，无感染或脂肪坏死。
术中吲哚菁绿血管造影可提供皮瓣灌注的实时信息，进而及时调整手术方案以确保皮瓣存活。
