From the Department of Plastic and Reconstructive Surgery, Yamaguchi Grand Medical Center.
Plast Reconstr Surg. 2020 Feb;145(2):407e-411e. doi: 10.1097/PRS.0000000000006507.
The utility of nitroglycerin is well established in coronary angiography but less so in other surgical fields. In this study, the authors investigated the utility of preoperative computed tomographic angiography after sublingual nitroglycerin followed by three-dimensional visualization for selecting suitable perforators in planning the free anterolateral thigh flap. The authors performed preoperative computed tomographic angiography following sublingual nitroglycerin (after screening for contraindications) in patients for whom reconstructive surgery with the free anterolateral thigh flap was planned. Data were reconstructed three-dimensionally, mapping location and course of source arteries and perforators. Suitable perforators were selected, and flap design was planned. The characteristics of perforators were analyzed statistically. Of 14 patients for whom surgery was planned, two had contraindications to nitroglycerin and underwent computed tomographic angiography alone. Nitroglycerin allowed for the visualization of more peripheral branches. The Hounsfield units at the deep fascia of perforators selected for surgery were significantly higher than for those not selected (p = 0.003). The distance from the intermuscular septum to the selected perforators was significantly shorter than the distance to nonselected perforators (p = 0.017). There were no adverse events, and all flaps survived. Sublingual nitroglycerin before computed tomographic angiography was safe and increased the visibility of perforators, enabling preoperative planning of flap design based on the three-dimensionally-reconstructed image. The authors highly recommend this procedure. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Diagnostic, IV.
硝酸甘油在冠状动脉造影中已得到广泛应用，但在其他外科领域的应用则较少。在这项研究中，作者研究了在经舌下含服硝酸甘油预处理后行计算机断层血管造影（术前 CT 血管造影），并结合三维可视化技术，用于选择游离股前外侧皮瓣穿支血管的适宜穿支的效果。作者对计划行游离股前外侧皮瓣修复的患者进行了术前 CT 血管造影（排除禁忌证后）。对数据进行三维重建，描绘源动脉和穿支的位置和走行。选择合适的穿支，并设计皮瓣。对穿支的特征进行统计学分析。在计划手术的 14 例患者中，有 2 例对硝酸甘油有禁忌证，仅行 CT 血管造影。硝酸甘油可使更外周的分支显影。用于手术的穿支的深筋膜处的 CT 值显著高于未选择的穿支（p = 0.003）。选择的穿支与肌间隔膜之间的距离显著短于未选择的穿支（p = 0.017）。无不良事件发生，所有皮瓣均存活。计算机断层血管造影前行舌下含服硝酸甘油是安全的，可以增加穿支的显影效果，使术前根据三维重建图像设计皮瓣成为可能。作者强烈推荐这种方法。临床问题/证据水平：诊断，IV 级。
