Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head & Neck Surgery, Stanford University School of Medicine, Stanford, California.
Department of Otolaryngology-Head & Neck Surgery, Mansoura University Faculty of Medicine, Mansoura, Egypt.
JAMA Facial Plast Surg. 2019 May 1;21(3):230-236. doi: 10.1001/jamafacial.2018.1874.
Assessment of melolabial flap perfusion using indocyanine green (ICG) angiography for nasal reconstruction has not been previously described.
To assess melolabial flap relative perfusion using ICG angiography in nasal reconstruction and highlight its clinical relevance.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective case series at a tertiary referral center, 10 patients undergoing melolabial flap reconstruction of nasal defects between January 2015 to April 2018 with flap perfusion were assessed by ICG angiography.
Indocyanine green angiography was performed to assess melolabial flap perfusion at second stage surgery after temporary clamping of the pedicle and after pedicle division and flap inset.
Flap perfusion in relation to a reference point on the cheek was calculated after both pedicle clamping and division by 2 methods: (1) ingress (arterial inflow) and egress (venous outflow) flap-to-cheek ratio; (2) flap-to-cheek perfusion (fluorescence) ratio at 3 time points (midpoint of ICG flap inflow, maximum [peak] fluorescence, and midpoint of ICG outflow), and their calculated mean. Correlations of perfusion with time between stages, and patient factors were performed; perfusion parameters after temporary pedicle clamping and after division and flap inset were compared.
Ten patients (mean [SD] age, 66 [7.5] years) were enrolled with a mean (SD) interval of 23 (4) days between first and second surgery. No correlation existed between perfusion parameters and time interval between first and second stage, or any other patient factors. Of the different perfusion parameters, a statistically significant difference was observed when comparing temporary clamping and postdivision mean (SD) flap-to-cheek perfusion ratio (0.89 [0.22] and 0.80 [0.19]; 95% CI, 4.1-12.6; P = .001), as well as mean (SD) peak perfusion ratio (0.81 [0.2] and 0.77 [0.2]; 95% CI, 0.005-0.080; P = .02) only. No partial or complete flap necrosis was reported after pedicle division.
Indocyanine green angiography is an effective method to determine neovascularization perfusion of melolabial flaps, with a mean perfusion of 89% after pedicle clamping. Future applications of this technology include use in patients at high risk for flap necrosis, or those who may benefit from early flap division to ensure adequate perfusion and minimize the time interval between staged procedures.
NA.
评估使用吲哚菁绿（ICG）血管造影术进行鼻重建的唇颊瓣灌注尚未被描述。
评估鼻重建中 ICG 血管造影术对唇颊瓣的相对灌注，并强调其临床相关性。
设计、地点和参与者：在这个回顾性的三级转诊中心的病例系列研究中，对 2015 年 1 月至 2018 年 4 月期间接受唇颊瓣重建鼻缺损的 10 名患者的皮瓣灌注情况进行了评估，采用 ICG 血管造影术进行评估。
在皮瓣夹闭后和皮瓣分离后，通过 2 种方法评估唇颊瓣的 ICG 血管造影术灌注：（1）入口（动脉流入）和出口（静脉流出）瓣颊比；（2）在 3 个时间点（ICG 瓣流入的中点、最大[峰值]荧光和 ICG 流出的中点）测量的瓣颊灌注（荧光）比，以及它们的平均计算值。对灌注与分期之间的时间、患者因素之间的相关性进行了分析；比较了临时皮瓣夹闭后和皮瓣分离及植入后的灌注参数。
共纳入 10 名患者（平均[标准差]年龄，66 [7.5]岁），第一期和第二期手术之间的平均（标准差）间隔为 23（4）天。灌注参数与第一期和第二期手术之间的时间间隔或任何其他患者因素之间均无相关性。在比较临时夹闭和分离后平均（标准差）瓣颊灌注比（0.89 [0.22]和 0.80 [0.19]；95%CI，4.1-12.6；P = .001）和平均（标准差）峰值灌注比（0.81 [0.2]和 0.77 [0.2]；95%CI，0.005-0.080；P = .02）时，观察到统计学上的显著差异。皮瓣分离后，无部分或完全瓣坏死报告。
吲哚菁绿血管造影术是一种有效评估唇颊瓣新生血管化灌注的方法，皮瓣夹闭后平均灌注率为 89%。该技术的未来应用包括用于高风险瓣坏死患者，或那些可能受益于早期瓣分离以确保足够的灌注并最大限度地减少分期手术之间的时间间隔的患者。
NA。
