Department of Plastic, Aesthetic Reconstructive and Hand Surgery, AGAPLESION Evangelical Hospital Central State of Hesse, Giessen, Germany.
Department of Plastic and Aesthetic Reconstructive and Hand Surgery, AGAPLESION Markus Hospital, Frankfurt am Main, Germany.
Int Wound J. 2021 Dec;18(6):881-888. doi: 10.1111/iwj.13590. Epub 2021 Mar 24.
The paramedian forehead flap is considered the gold standard for nasal reconstruction following oncologic surgery. During the 21-day delay in two-stage surgery protocols, many patients report considerably reduced quality of life because of the pedicle. This prospective case series study examined the usefulness of near-infrared (NIR) fluorescence with indocyanine green (ICG) for flap perfusion assessment and identified variables associated with time to flap perfusion. Ten patients (mean age 75.3 ± 11.6 years) with diagnosis of basal cell carcinoma (n = 9) or squamous cell carcinoma (n = 1) underwent intravenous indocyanine injection and NIR fluorescence imaging for assessment of flap vascularisation 2 to 3 weeks after stage 1 surgery. NIR fluorescence imaging showed 90% to 100% perfusion areas in all patients after 14 to 21 days. Early pedicle division occurred in two patients on postoperative days 14 and 16. One minor complication (wound healing disorder) was seen following flap takedown after 14 days. There were no associations between time to flap perfusion and defect size or flap area. NIR fluorescence imaging with ICG dye is a useful method for non-invasive perfusion assessment when used in conjunction with clinical assessment criteria. However, a decision for early pedicle division may raise risk of complications in specific patient groups and must therefore be made with great care.
正中额部皮瓣被认为是肿瘤手术后鼻重建的金标准。在两阶段手术方案的 21 天延迟期间，由于蒂部的存在，许多患者报告生活质量明显下降。这项前瞻性病例系列研究检查了近红外（NIR）荧光吲哚菁绿（ICG）在皮瓣灌注评估中的有用性，并确定了与皮瓣灌注时间相关的变量。10 名患者（平均年龄 75.3±11.6 岁），诊断为基底细胞癌（n=9）或鳞状细胞癌（n=1），在第一阶段手术后 2 至 3 周，进行静脉注射吲哚菁绿和近红外荧光成像，以评估皮瓣血管化。NIR 荧光成像显示，所有患者在 14 至 21 天后皮瓣灌注面积达到 90%至 100%。两名患者分别在术后第 14 天和第 16 天发生早期蒂部切断。在 14 天后皮瓣取下后出现一例轻微并发症（伤口愈合障碍）。皮瓣灌注时间与缺损大小或皮瓣面积之间无相关性。NIR 荧光成像联合 ICG 染料是一种有用的非侵入性灌注评估方法，当与临床评估标准结合使用时。然而，在某些特定患者群体中，早期蒂部切断可能会增加并发症的风险，因此必须谨慎决定。
