Deegan Anthony J, Lu Jie, Sharma Rajendra, Mandell Samuel P, Wang Ruikang K
Department of Bioengineering, University of Washington, Seattle, WA, USA.
Division of Trauma, Critical Care, and Burn, University of Washington, Harborview Medical Center, Seattle, WA, USA.
Quant Imaging Med Surg. 2021 Feb;11(2):784-796. doi: 10.21037/qims-20-750.
Skin autografting is a common clinical procedure for reconstructive surgery. Despite its widespread use, very few studies have been conducted to non-invasively evaluate and monitor the vascular and structural features of skin grafts. This study, therefore, aims to demonstrate the potential of optical coherence tomography (OCT) alongside OCT-based angiography (OCTA) to non-invasively image and monitor human skin graft health and integration over time.
An in-house-built clinical prototype OCT system was used to acquire OCT/OCTA images from patients who underwent split-thickness skin graft surgery following severe burn damage to the skin. The OCT imaging was carried out at multiple locations over multiple time points with a field of view of ~9 mm × 9 mm and a penetration depth of ~1.5 mm. In addition to obtaining high-resolution qualitative images, we also quantitatively measured and compared specific structural and vascular parameters, such as identifiable layer thickness and corresponding vascular area density and diameter.
Two patients (patient #1 and #2) were enrolled for this preliminary study. Vascular and structural features were successfully imaged and measured in the graft tissue and integration layer immediately beneath at different time points. Revascularization, healing, and integration were monitored with patient-specific details. Results of the quantitative image analysis from patient #1 indicated that integration layer thickness 16-day post-surgery was significantly less (50%) than that of 7-day post-surgery. Additionally, with patient #2, significant growth (20%) was seen with the vascular area density of both the graft and corresponding integration layer beneath between 6 and 14 days post-surgery.
Our preliminary studies show that OCT/OCTA has clinical potential to image and measure numerous features of human skin graft health and integration in the days and weeks following split-thickness surgery. For the first time, we demonstrate the applicability of non-invasive imaging technology for novel clinical uses that could eventually aid in the betterment of surgical practices and clinical outcomes.
自体皮肤移植是重建手术中一种常见的临床操作。尽管其应用广泛，但很少有研究对皮肤移植的血管和结构特征进行无创评估和监测。因此，本研究旨在证明光学相干断层扫描（OCT）以及基于OCT的血管造影（OCTA）在无创成像和监测人类皮肤移植健康状况及随时间的整合情况方面的潜力。
使用自行搭建的临床原型OCT系统，从因严重烧伤而接受中厚皮片移植手术的患者身上获取OCT/OCTA图像。OCT成像在多个时间点的多个位置进行，视野约为9毫米×9毫米，穿透深度约为1.5毫米。除了获得高分辨率的定性图像外，我们还定量测量并比较了特定的结构和血管参数，如可识别层的厚度以及相应的血管面积密度和直径。
两名患者（患者1和患者2）参与了这项初步研究。在不同时间点成功对移植组织及其下方的整合层中的血管和结构特征进行了成像和测量。对血管再生、愈合和整合情况进行了针对患者的详细监测。患者1的定量图像分析结果表明，术后16天的整合层厚度比术后7天显著减少（约50%）。此外，对于患者2，术后6至14天期间，移植组织及其下方相应整合层的血管面积密度均有显著增长（约20%）。
我们的初步研究表明，OCT/OCTA在中厚皮片移植术后数天和数周内对人类皮肤移植健康状况及整合情况的众多特征进行成像和测量方面具有临床潜力。我们首次证明了无创成像技术在新型临床应用中的适用性，这最终可能有助于改善手术操作和临床结果。
