Kikuchi Shinsuke, Miyake Keisuke, Tada Yuki, Uchida Daiki, Koya Atsuhiro, Saito Yukihiro, Ohura Takehiko, Azuma Nobuyoshi
1 Department of Vascular Surgery, Asahikawa Medical University, Asahikawa, Japan.
2 Pressure Ulcers and Wound Healing Research Center, Sapporo, Japan.
Vascular. 2019 Jun;27(3):242-251. doi: 10.1177/1708538118810664. Epub 2018 Nov 12.
Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization.
A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure. The laser speckle flowgraphy device was used to visualize the blood flow distribution of the target skin and processed the pulse wave velocity of synchronized heart beats. The mean blood flow, which was expressed as the area of the pulse wave as the beat strength of skin perfusion on laser speckle flowgraphy converted into a numerical value, was assessed as dynamic changes following surgery. Beat strength of skin perfusion was also investigated in non-peripheral arterial disease controls (23 patients/46 limbs).
The suitability of beat strength of skin perfusion in non-peripheral arterial disease controls was achieved; the beat strength of skin perfusion value was significantly higher in every area of interest in non-peripheral arterial disease controls compared to that in peripheral arterial disease limbs at the preoperative stage (105.8 ± 8.2 vs. 26.3 ± 8.2; P < 0.01). Although the pulse wave before surgery was visually flat in peripheral arterial disease patients, the pulse wave was remarkably and immediately improved through surgical revascularization. Beat strength of skin perfusion showed a dynamic change in foot blood flow (26.3 ± 8.2 at preoperation, 98.5 ± 6.7 immediately after surgery, 107.6 ± 5.7 at seven days after surgery, P < 0.01 for each compared to preoperation) that correlated with an improvement in skin perfusion pressure.
Laser speckle flowgraphy is a noninvasive, contact-free modality that is easy to implement, and beat strength of skin perfusion is a useful indicator of foot circulation during the perioperative period. Further analysis with a larger number of cases is necessary to establish appropriate clinical use.
激光散斑血流图是一种无需接触皮肤就能快速评估足部血流的新方法。我们使用激光散斑血流图评估外周动脉疾病患者手术血运重建前后的足部血流情况。
一项前瞻性单中心研究。纳入31例患者的33条肢体，这些患者因外周动脉疾病接受了手术血运重建。术前和术后通过激光散斑血流图和皮肤灌注压在足底表面测量足部血流。使用激光散斑血流图设备可视化目标皮肤的血流分布，并处理同步心跳的脉搏波速度。将平均血流表示为激光散斑血流图上皮肤灌注搏动强度的脉搏波面积转换为数值，评估其作为手术后的动态变化。还在非外周动脉疾病对照组（23例患者/46条肢体）中研究了皮肤灌注搏动强度。
实现了非外周动脉疾病对照组皮肤灌注搏动强度的适用性；与术前外周动脉疾病肢体相比，非外周动脉疾病对照组每个感兴趣区域的皮肤灌注搏动强度值显著更高（105.8±8.2对26.3±8.2；P<0.01）。尽管术前外周动脉疾病患者的脉搏波在视觉上较为平坦，但通过手术血运重建，脉搏波明显且立即得到改善。皮肤灌注搏动强度显示足部血流有动态变化（术前26.3±8.2，术后即刻98.5±6.7，术后7天107.6±5.7，与术前相比各阶段P<0.01），且与皮肤灌注压的改善相关。
激光散斑血流图是一种无创、无需接触且易于实施的方法，皮肤灌注搏动强度是围手术期足部循环的有用指标。需要进行更多病例的进一步分析以确立其适当的临床应用。
