Hill William F, Webb Carmen, Monument Michael, McKinnon Gregory, Hayward Victoria, Temple-Oberle Claire
Department of Plastic Surgery, University of Calgary, Cumming School of Medicine, Calgary, AB, Canada.
Department of Surgery and Oncology, Foothills Medical Centre, Calgary, AB, Canada.
Plast Reconstr Surg Glob Open. 2020 Apr 22;8(4):e2742. doi: 10.1097/GOX.0000000000002742. eCollection 2020 Apr.
Skin flap necrosis (SFN) is a morbid complication that is disfiguring, leads to acute and chronic wound issues, often requires further surgery, and can delay adjuvant chemotherapy. Although most surgeons rely on the clinical examination, near-infrared (NIR) spectroscopy can extrapolate tissue oxygenation and may serve as an important tool to assess flap perfusion intraoperatively. This cohort study was undertaken to evaluate the capacity of NIR spectroscopy to detect clinically relevant differences in tissue perfusion intraoperatively.
Patients undergoing oncologic resection of breast cancer, sarcomas, and cutaneous tumors requiring flap reconstruction (local, regional, or free) between January 2018 and January 2019 were analyzed in this study. Clinicians were blinded to device tissue oxygen saturation (SO) measurements taken intraoperatively after closure and at follow-up appointments in the first 30 days. Measurements were categorized as (1) control areas not affected by the procedure, (2) areas at risk, and (3) areas of necrosis. These areas were retrospectively demarcated by 2 blinded assessors on follow-up images and transposed onto anatomically correlated intraoperative SO measurements. Mean SO values were compared using a single-sample test and analysis of variance (ANOVA) to determine differences in oxygenation.
Forty-two patients were enrolled, and 51 images were included in the analysis. Oncologic procedures were predominantly breast (22), postextirpative melanoma (13), and sarcoma (3) reconstructions. Flap reconstruction involved 30 regional skin flaps, 3 pedicled flaps, and 3 free flaps. Nine patients (20.9%) and 11 surgical sites developed SFN. Mean intraoperative SO measurements for control areas, areas at risk, and areas of SFN were 74.9%, 71.1%, and 58.3%, respectively. Relative to control areas, mean intraoperative SO measurements were lower by 17.5% ( = 0.01) in ultimate areas of SFN and in areas at risk by 5.8% ( = 0.003). Relative to areas at risk, mean SO measurements from areas of ultimate SFN were lower by 8.3% ( = 0.04).
These preliminary data suggest that measuring skin flap tissue oxygenation intraoperatively, with NIR spectroscopy, can differentiate objective variations in perfusion that are associated with clinical outcomes.
皮瓣坏死（SFN）是一种致残性并发症，会导致毁容，引发急慢性伤口问题，常需进一步手术，还可能延迟辅助化疗。尽管大多数外科医生依靠临床检查，但近红外（NIR）光谱可推断组织氧合情况，可能成为术中评估皮瓣灌注的重要工具。本队列研究旨在评估NIR光谱检测术中组织灌注临床相关差异的能力。
本研究分析了2018年1月至2019年1月期间接受乳腺癌、肉瘤和需要皮瓣重建（局部、区域或游离）的皮肤肿瘤肿瘤切除手术的患者。临床医生对术中关闭后及术后30天随访预约时所测的设备组织氧饱和度（SO）数据不知情。测量结果分为三类：（1）未受手术影响的对照区域；（2）有风险区域；（3）坏死区域。这些区域由2名不知情的评估人员在随访图像上进行回顾性划定，并转换到与解剖结构相关的术中SO测量值上。使用单样本检验和方差分析（ANOVA）比较平均SO值，以确定氧合差异。
共纳入42例患者，分析了51张图像。肿瘤手术主要为乳房手术（22例）、切除术后黑色素瘤手术（13例）和肉瘤手术（3例）重建。皮瓣重建包括30个区域皮瓣、3个带蒂皮瓣和3个游离皮瓣。9例患者（20.9%）和11个手术部位发生了皮瓣坏死。对照区域、有风险区域和皮瓣坏死区域的术中平均SO测量值分别为74.9%、71.1%和58.3%。相对于对照区域，最终皮瓣坏死区域的术中平均SO测量值低17.5%（P = 0.01），有风险区域低5.8%（P = 0.003）。相对于有风险区域，最终皮瓣坏死区域的平均SO测量值低8.3%（P = 0.04）。
这些初步数据表明，术中使用NIR光谱测量皮瓣组织氧合，能够区分与临床结果相关的灌注客观差异。
