Kenan Plastic Surgery Research Labs, Division of Plastic and Reconstructive Surgery, Department of Surgery, Duke University School of Medicine, Durham, NC.
Profusa, Inc, South San Francisco, CA.
Surgery. 2020 Nov;168(5):926-934. doi: 10.1016/j.surg.2020.04.040. Epub 2020 Jul 8.
The success of surgical flaps is improved by timely correction of vascular compromise. Current monitoring methods are labor or cost intensive or have limited clinical benefit. We hypothesize that injectable oxygen sensors can identify acute vascular compromise. The purpose of this study was to use a long-term, real-time method of tissue oxygenation detection in a rat flap model with vascular manipulation.
Sensors incorporated benzo-porphyrin dye into a microporous hydrogel and were injected intradermally 1 day before flap elevation. Inspired oxygen was modulated between 100% and 12% to confirm sensor O sensitivity. Eight random flaps (4 cm wide, 8 cm long) were elevated. Sensor and clinical observation to temporary clamping of the flap vascular pedicle was recorded. Sodium fluorescein in saline was injected intraperitoneally on postoperative days 0, 3, and 7 with subsequent perfusion area analysis.
Tissue oxygen tension measurements reflected the changes in inspired oxygen levels. Clinical observation of the flaps did not show any significant change in color or temperature with pedicle clamping. However, clamping of the pedicle resulted in a significant decrease in sensor tissue oxygen tension within 70 seconds.
Oxygen monitoring of myocutaneous flaps is sensitive and can detect acute vascular occlusion. This technique is faster than current methods and offers a cost-effective and accurate means of monitoring surgical tissues.
通过及时纠正血管受压，可提高外科皮瓣的成活率。目前的监测方法要么劳动强度大、成本高，要么临床获益有限。我们假设可注射氧传感器可识别急性血管受压。本研究旨在利用血管操作大鼠皮瓣模型中一种长期实时的组织氧检测方法。
传感器将苯并卟啉染料结合到微孔水凝胶中，并在皮瓣抬高前 1 天皮内注射。调节吸入氧浓度在 100%和 12%之间，以确认传感器的 O 灵敏度。抬高 8 个随机皮瓣（4cm 宽，8cm 长）。记录传感器和临床观察到皮瓣血管蒂临时夹闭的情况。术后第 0、3、7 天经腹腔注射生理盐水荧光素钠，随后进行灌注面积分析。
组织氧张力测量反映了吸入氧水平的变化。皮瓣的临床观察显示，蒂夹闭时皮瓣的颜色或温度没有明显变化。然而，夹闭蒂部会导致传感器组织氧张力在 70 秒内显著下降。
肌皮瓣的氧监测灵敏，可检测急性血管阻塞。该技术比现有方法更快，为监测手术组织提供了一种经济有效、准确的方法。
