Berggren Johanna, Castelo Nazia, Tenland Kajsa, Engelsberg Karl, Dahlstand Ulf, Albinsson John, Sheikh Rafi, Lindstedt Sandra, Malmsjö Malin
Departments of Clinical Sciences Lund, Ophthalmology.
Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden.
Ophthalmic Plast Reconstr Surg. 2021;37(3):269-273. doi: 10.1097/IOP.0000000000001799.
H-plasty reconstructive surgery is commonly used to close defects after tumor excision in the periorbital region. Revascularization of the bipedicle skin flaps is essential for healing. However, it has not previously been possible to study this revascularization in humans due to the lack of noninvasive perfusion monitoring techniques. The aim was to monitor perfusion in H-plasty flaps during surgery and during postoperative follow-up, using laser speckle contrast imaging.
H-plasty, i.e., bipedicle random advancement skin flaps, was used for reconstruction of the eyelids after tumor removal in 7 patients. The median length and width of the skin flaps were 13 mm (range, 8-20 mm) and 10 mm (range, 5-11 mm), respectively. Blood perfusion was measured using laser speckle contrast imaging during surgery and at follow up 1, 3, and 6 weeks postoperatively, to monitor revascularization.
Immediately postoperatively, the perfusion in the distal end of the flaps had fallen to 54% (95% CI, 38%-67%). The perfusion then quickly increased during the healing process, being 104% (86%-124%) after 1 week, 115% (94%-129%) after 3 weeks, and 112% (96%-137%) after 6 weeks. There was no clinically observable ischemia or tissue necrosis.
Revascularization of the H-plasty procedure flaps occurs quickly, within a week postoperatively, presumably due to the existing vascular network of the flap pedicle, and was not dependent on significant angiogenesis. This perfusion study confirms the general opinion that H-plasty is a good reconstructive technique, especially in the periorbital region with its rich vascular supply.
H 形整形重建手术常用于修复眶周区域肿瘤切除后的缺损。双蒂皮瓣的血管再生对愈合至关重要。然而，由于缺乏非侵入性灌注监测技术，此前无法在人体中研究这种血管再生情况。本研究旨在使用激光散斑对比成像技术，监测 H 形整形手术皮瓣在手术过程中和术后随访期间的灌注情况。
对 7 例患者采用 H 形整形手术，即双蒂随意推进皮瓣，用于肿瘤切除后眼睑的重建。皮瓣的中位长度和宽度分别为 13 毫米（范围 8 - 20 毫米）和 10 毫米（范围 5 - 11 毫米）。在手术期间以及术后第 1、3 和 6 周进行随访时，使用激光散斑对比成像测量血液灌注，以监测血管再生情况。
术后即刻，皮瓣远端的灌注降至 54%（95%可信区间，38% - 67%）。在愈合过程中，灌注随后迅速增加，术后 1 周为 104%（86% - 124%），术后 3 周为 115%（94% - 129%），术后 6 周为 112%（96% - 137%）。未观察到临床可见的缺血或组织坏死。
H 形整形手术皮瓣的血管再生在术后一周内迅速发生，推测是由于皮瓣蒂部现有的血管网络，且不依赖于显著的血管生成。这项灌注研究证实了普遍观点，即 H 形整形手术是一种良好的重建技术，尤其是在血管供应丰富的眶周区域。
