Rammos Charalambos K, Jones Glyn E, Taege Sara M, Lemaster Chelsey M
Department of Plastic and Reconstructive Surgery, University of Illinois College of Medicine, Peoria, Ill.
Plast Reconstr Surg Glob Open. 2020 Nov 9;8(11):e3245. doi: 10.1097/GOX.0000000000003245. eCollection 2020 Nov.
Perforator selection is of paramount importance when performing a Deep Inferior Epigastric Perforator flap. Technological advancements within imaging modalities have proved invaluable in preoperative planning and intraoperative assessment. Computed tomographic angiography remains the gold standard for preoperative perforator mapping, while color ultrasound Doppler is considered more reliable for determining vessel caliber. Intraoperatively, an imaging modality that provides sequential, real-time assessment of various perforators' supply to the flap would provide helpful insight to determine which perforator will optimize flap viability, especially of the most distal, lateral margins. Multispectral imaging, a variant of near infrared imaging, has emerged as an alternative method to assess tissue viability in the operating room as well as postoperatively. Unlike Spy technology, which is invasive and cost ineffective, the Snapshot (KD203) is a handheld multispectral imaging device utilizing NIR to measure the oxygenation of the hemoglobin in the area to calculate the tissue oxygen content (SO) displayed in a color image. The following case of a 46-year-old woman undergoing tertiary breast reconstruction for treatment of progressive grade 2 capsular contracture illustrates the utility and ease of KD203 application to intra-operative perforator determination in deep inferior epigastric perforator flap assessment.
在进行腹壁下深动脉穿支皮瓣手术时，穿支的选择至关重要。成像技术的进步已被证明在术前规划和术中评估中具有不可估量的价值。计算机断层血管造影仍然是术前穿支定位的金标准，而彩色超声多普勒在确定血管管径方面被认为更可靠。在术中，一种能够对皮瓣的各种穿支供血进行连续、实时评估的成像方式，将有助于确定哪条穿支能优化皮瓣的存活能力，尤其是对最远端、外侧边缘的皮瓣。多光谱成像作为近红外成像的一种变体，已成为在手术室以及术后评估组织存活能力的一种替代方法。与具有侵入性且成本效益低的Spy技术不同，Snapshot（KD203）是一种手持式多光谱成像设备，利用近红外光测量该区域血红蛋白的氧合情况，以计算彩色图像中显示的组织氧含量（SO）。以下是一名46岁女性因进行性2级包膜挛缩接受三级乳房重建的病例，该病例说明了KD203在腹壁下深动脉穿支皮瓣评估中用于术中穿支确定的实用性和便捷性。
