Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California.
Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
JAMA Facial Plast Surg. 2019 May 1;21(3):206-212. doi: 10.1001/jamafacial.2018.1829.
Identifying factors affecting forehead flap neovascularization during nasal reconstruction surgical procedures using quantitative dynamics of fluorescence from indocyanine green angiography may be associated with reduced vascular complications.
To identify quantifiable forehead flap perfusion measures using indocyanine green angiography during nasal reconstruction procedures and to evaluate clinical factors associated with neovascularization.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of 71 patients at a tertiary referral center of Stanford University, Stanford, California, between January 1, 2010, and March 31, 2018, undergoing forehead flap nasal reconstruction surgery with flap perfusion assessed by indocyanine green angiography.
Indocyanine green angiography was performed intraoperatively to record forehead flap neovascularization during the second stage of nasal reconstruction surgery after temporary clamping of the pedicle.
With use of quantifiable data of fluorescence dynamics, flap perfusion in association with a reference point in the cheek after pedicle clamping was assessed by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio and (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of indocyanine green flap inflow, maximum fluorescence [peak], and midpoint of indocyanine green flap outflow) and their calculated mean. Association of the perfusion measures with patient and procedural factors was performed using linear regression models.
Of the 71 patients included in the study, 43 (61%) were men; the mean (SD) age was 71.1 (11.0) years. The mean (SD) flap-to-cheek inflow ratio was 0.48 (0.40), peak fluorescence ratio was 0.59 (0.34), and outflow ratio was 0.88 (0.42). The calculated mean (SD) flap-to-cheek perfusion ratio of these measures was 0.65 (0.35). The mean (SD) flap-to-cheek ingress ratio was 0.54 (0.36) and egress ratio was 0.65 (0.98). With use of a multivariable regression model, the time between stages was positively associated with flap-to-cheek ingress ratio (β, 0.015; 95% CI, 0.001 to 0.030), and cartilage grafting was negatively associated with flap-to-cheek outflow ratio (β, -0.240; 95% CI, -0.472 to -0.008).
The findings suggest that indocyanine green angiography is an effective method to quantify relative neovascularization perfusion of forehead flaps. Future applications may include the use of this technology to aid in early flap division and ensure adequate perfusion among high-risk patients.
NA.
重要性：使用吲哚菁绿血管造影术对定量荧光动力学进行分析，以识别鼻重建手术过程中额瓣新生血管形成的影响因素，这可能与降低血管并发症的发生有关。
目的：确定在鼻重建手术过程中使用吲哚菁绿血管造影术进行额瓣灌注的可量化测量方法，并评估与新生血管形成相关的临床因素。
设计、地点和参与者：这是一项在加利福尼亚州斯坦福大学斯坦福分校三级转诊中心进行的回顾性队列研究，共纳入了 71 名患者，他们于 2010 年 1 月 1 日至 2018 年 3 月 31 日之间接受了额瓣鼻重建手术，术中使用吲哚菁绿血管造影术评估额瓣的新生血管形成。
暴露：在鼻重建手术的第二阶段，暂时夹闭蒂部后，术中使用吲哚菁绿血管造影术记录额瓣的新生血管形成。
主要结果和测量：使用荧光动力学的定量数据，通过 2 种方法评估皮瓣夹闭后脸颊上的皮瓣灌注情况：（1）流入（动脉流入）和流出（静脉流出）瓣-颊比，（2）在 3 个时间点（吲哚菁绿瓣流入中点、最大荧光[峰值]和吲哚菁绿瓣流出中点）和计算得到的平均值的瓣-颊灌注（荧光）比。使用线性回归模型评估灌注指标与患者和手术因素的相关性。
结果：在纳入的 71 名患者中，有 43 名（61%）为男性；平均（标准差）年龄为 71.1（11.0）岁。瓣-颊流入比的平均值（标准差）为 0.48（0.40），峰值荧光比为 0.59（0.34），流出比为 0.88（0.42）。这些测量值的平均（标准差）瓣-颊灌注比为 0.65（0.35）。瓣-颊流入比的平均值（标准差）为 0.54（0.36），流出比为 0.65（0.98）。使用多变量回归模型，阶段之间的时间间隔与瓣-颊流入比呈正相关（β，0.015；95%CI，0.001 至 0.030），软骨移植与瓣-颊流出比呈负相关（β，-0.240；95%CI，-0.472 至 -0.008）。
结论和相关性：研究结果表明，吲哚菁绿血管造影术是一种有效量化额瓣新生血管化灌注的方法。未来的应用可能包括使用这项技术来辅助早期皮瓣分割并确保高危患者的充分灌注。
证据水平：无。
