腹壁下动脉穿支皮瓣穿支特征的临床影响 - 一项前瞻性吲哚菁绿荧光成像研究。
Clinical Impact of DIEP Flap Perforator Characteristics - A Prospective Indocyanine Green Fluorescence Imaging Study.
机构信息
Centre for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
Centre for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Regensburg and Caritas Hospital St. Josef Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany.
出版信息
J Plast Reconstr Aesthet Surg. 2020 Aug;73(8):1526-1533. doi: 10.1016/j.bjps.2020.01.019. Epub 2020 Jan 23.
BACKGROUND
The question to what extent perfusion in deep inferior epigastric perforator (DIEP) flaps depends on specific perforator characteristics has been raised. Anatomical studies and previous clinical trials focussing on DIEP flap perfusion resulted in discrepancies. This prospective study investigates how perforator row, number and diameter affect DIEP flap microperfusion via Indocyanine Green (ICG) fluorescence angiography.
METHODS
The fractional weight of insufficiently perfused flap tissue in Zone 4 related to the total DIEP flap weight was measured based on ICG fluorescence angiography and defined as Zone 4 %. As a surrogate for overall DIEP flap perfusion, Zone 4 % was assessed according to the row, number and diameter of perforators included in the flap.
RESULTS
In 42 unilateral DIEP flap breast reconstructions, neither medial (33.6 ± 14.2 %)/lateral perforator row (29.9 ± 7.5 %, p = 0.683) nor the parameter perforator number (single perforator 31.5 ± 14.4 %, two perforators 30.2 ± 10.2 %, p = 0.727) had a statistically significant effect on flap tissue availability as measured via Zone 4 %. A negative correlative trend between perforator diameter and Zone 4 % (r = -0.096, p = 0.588) was observed.
CONCLUSION
Zone 4 % provides a novel method for an objective assessment of DIEP flap perfusion. Medial/lateral row selection and other perforator properties (number, diameter) within the standard ranges, did not affect Zone 4 % as indicated by ICG fluorescence angiography.
背景
深腹壁下动脉穿支（DIEP）皮瓣的灌注程度在多大程度上取决于特定穿支特征这一问题已经提出。解剖研究和之前专注于 DIEP 皮瓣灌注的临床试验结果存在差异。本前瞻性研究通过吲哚菁绿（ICG）荧光血管造影调查了穿支排、数量和直径如何影响 DIEP 皮瓣的微血管灌注。
方法
根据 ICG 荧光血管造影，测量 Zone 4 中灌注不足的皮瓣组织相对于 DIEP 皮瓣总重量的分数重量，并将其定义为 Zone 4%。作为 DIEP 皮瓣整体灌注的替代指标，根据皮瓣中包含的穿支排、数量和直径评估 Zone 4%。
结果
在 42 例单侧 DIEP 皮瓣乳房重建中，内侧（33.6 ± 14.2%）/外侧穿支排（29.9 ± 7.5%，p=0.683）和穿支数量参数（单支穿支 31.5 ± 14.4%，两支穿支 30.2 ± 10.2%，p=0.727）均与通过 Zone 4%测量的皮瓣组织可用性无统计学显著相关性。穿支直径与 Zone 4%之间呈负相关趋势（r=-0.096，p=0.588）。
结论
Zone 4%为 DIEP 皮瓣灌注的客观评估提供了一种新方法。在标准范围内，内侧/外侧排选择和其他穿支特性（数量、直径）不会影响 ICG 荧光血管造影所示的 Zone 4%。
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