Chin Michael S, Chappell Ava G, Giatsidis Giorgio, Perry Dylan J, Lujan-Hernandez Jorge, Haddad Anthony, Matsumine Hajime, Orgill Dennis P, Lalikos Janice F
Worcester and Boston, Mass.
From the Division of Plastic Surgery, University of Massachusetts Medical School; and Brigham and Women's Hospital, Harvard Medical School.
Plast Reconstr Surg. 2017 Jun;139(6):1285e-1290e. doi: 10.1097/PRS.0000000000003352.
Necrosis remains a significant complication in cutaneous flap procedures. Monitoring, and ideally prediction, of vascular compromise in the early postoperative period may allow surgeons to limit the impact of complications by prompt intervention. Hyperspectral imaging could be a reliable, effective, and noninvasive method for predicting flap survival postoperatively. In this preclinical study, the authors demonstrate that hyperspectral imaging is able to correlate early skin perfusion changes and ultimate flap survival in a preclinical model.
Thirty-one hairless, immunocompetent, adult male mice were used. Random pattern dorsal skin flaps were elevated and sutured back into place with a silicone barrier. Hyperspectral imaging and digital images were obtained 30 minutes, 24 hours, or 72 hours after flap elevation and before sacrifice on postoperative day 7.
Areas of high deoxygenated hemoglobin change (124; 95 percent CI, 118 to 129) seen at 30 minutes after surgery were associated with greater than 50 percent flap necrosis at postoperative day 7. Areas demarcated by high deoxygenated hemoglobin at 30 minutes postoperatively had a statistically significant correlation with areas of macroscopic necrosis on postoperative day 7. Analysis of images obtained at 24 and 72 hours did not show similar changes.
These findings suggest that early changes in deoxygenated hemoglobin seen with hyperspectral imaging may predict the region and extent of flap necrosis. Further clinical studies are needed to determine whether hyperspectral imaging is applicable to the clinical setting.
坏死仍然是皮瓣手术中的一个重要并发症。在术后早期监测并理想地预测血管受损情况，可能使外科医生通过及时干预来限制并发症的影响。高光谱成像可能是一种可靠、有效且无创的预测皮瓣术后存活情况的方法。在这项临床前研究中，作者证明了高光谱成像能够在临床前模型中关联早期皮肤灌注变化和最终的皮瓣存活情况。
使用了31只无毛、具有免疫能力的成年雄性小鼠。掀起随机模式的背部皮瓣，并用硅胶屏障将其缝合回原位。在皮瓣掀起后30分钟、24小时或72小时以及术后第7天处死前获取高光谱图像和数字图像。
术后30分钟时出现的高脱氧血红蛋白变化区域（124；95%可信区间，118至129）与术后第7天超过50%的皮瓣坏死相关。术后30分钟时由高脱氧血红蛋白划定的区域与术后第7天的宏观坏死区域具有统计学上的显著相关性。对术后24小时和72小时获取的图像分析未显示类似变化。
这些发现表明，通过高光谱成像观察到的早期脱氧血红蛋白变化可能预测皮瓣坏死的区域和程度。需要进一步的临床研究来确定高光谱成像是否适用于临床环境。
