Roberts J O, Jones B M
Stoke Mandeville Hospital, Aylesbury, England.
Ann Plast Surg. 1987 Sep;19(3):219-24. doi: 10.1097/00000637-198709000-00007.
An experimental comparison of two techniques for direct monitoring of anastomoses postoperatively is presented. Arterial differential temperature measurements indicated arterial occlusion (n = 24) in island flaps by mean temperature decreases in the affected artery of 0.5 degrees = C, but temperature changes in cases of venous occlusion (n = 17) were small (mean, 0.2 degrees C), inconsistent, and not of predictive value. The technique did not distinguish success (n = 4) from failure (n = 2) in experimental free flaps, and occlusion of deep arteries produced little or no change in the arterial wall temperature. In contrast, an implanted ultrasound Doppler probe reliably indicated arterial and venous occlusion in island flaps (n = 10), because in both circumstances the mean arterial Doppler signal invariably decreased to 0. The two could be distinguished between by changes in Doppler sound and instantaneous signal. In experimental free flaps, success (n = 10) was clearly distinguished from failure (n = 3) by characteristic patterns of Doppler sound and signal. Arterial differential thermometry had serious limitations, but implanted ultrasound Doppler showed great potential as a postoperative monitor applicable to all microvascular procedures.
本文介绍了两种术后直接监测吻合口技术的实验比较。动脉温差测量显示，岛状皮瓣中动脉阻塞（n = 24）时，患侧动脉平均温度下降0.5摄氏度，但静脉阻塞（n = 17）时温度变化较小（平均0.2摄氏度），变化不一致且无预测价值。该技术在实验性游离皮瓣中无法区分成功（n = 4）与失败（n = 2）情况，深部动脉阻塞时动脉壁温度变化很小或无变化。相比之下，植入式超声多普勒探头能可靠地显示岛状皮瓣中的动脉和静脉阻塞（n = 10），因为在这两种情况下动脉多普勒信号平均值均降至0。可通过多普勒声音和瞬时信号的变化对二者进行区分。在实验性游离皮瓣中，通过多普勒声音和信号的特征模式可清晰区分成功（n = 10）与失败（n = 3）情况。动脉温差测量有严重局限性，但植入式超声多普勒作为适用于所有微血管手术的术后监测手段显示出巨大潜力。
