Wanyan Chaojie, Wu Zhongming, Zhang Fengrui, Li Huan, Yang Zihui, Wang Jun, Han Xuejiao, Yang Xiangming, Lei Delin, Yang Xinjie, Wei Jianhua
State Key Laboratory of Military Stomatology, National Clinical Research Center for Oral Diseases, Shaanxi Clinical Research Center for Oral Diseases, Department of Oral and Maxillofacial Surgery, School of Stomatology, The Fourth Military Medical University, Xi'an, China.
Ann Transl Med. 2022 Feb;10(4):197. doi: 10.21037/atm-22-220.
This study sought to explore the application value of indocyanine green angiography (ICGA) in the harvest of multi-angiosome perforator flap and the effect of low molecular weight heparin (LMWH) on the survival of postoperative flap.
Twenty-four SD male rats were selected to construct a three-angiosome perforator flap model with the unilateral iliolumbar artery perforator. They were randomly divided into two groups: the control group was injected with indocyanine green (ICG) into the femoral vein during the operation, and the fluorescence signal was collected and quantitatively analyzed using Real-Time Image Guided System to determine the intraoperative fluorescence imaging length. The experimental group was injected subcutaneously with LMWH (400 U/kg) after 0.5 h postoperatively, and the control group was injected with the same amount of normal saline. The injection was repeated at the same time each day from 0 to 7 days postoperatively. After the flap was sutured , ICGA was performed at 0, 1, 3, 5, and 7 days postoperatively to observe the vascular structure of the two groups of flaps. The flap survival length of the control group was counted at 7 days postoperatively, and the correlation between the intraoperative fluorescence imaging length and the survival length at 7 days postoperatively was calculated. The proportion of distal necrosis of the flaps between the two groups was compared at 7 days postoperatively.
The average length of intraoperative fluorescence imaging in the control group was 6.29±0.50 cm, and the survival length of the flap at 7 days postoperatively was 8.24±0.52 cm. The actual survival length was higher than the intraoperative fluorescence imaging length, with a ratio of 1.31±0.08. The difference was statistically significant (P<0.05). At 7 days postoperatively, the flap necrosis ratio of experimental group and control group were 10.92%±1.30% and 19.11%±1.19%, and the flap necrosis ratio of experimental group was lower than that of control group (P<0.001).
ICGA can locate the position of perforator, and can be used to predict and observe the length of distal survival of multi-angiosome perforator flap postoperatively. LMWH can promote the distal survival of flap and reduce flap necrosis.
本研究旨在探讨吲哚菁绿血管造影（ICGA）在多血管体穿支皮瓣切取中的应用价值以及低分子量肝素（LMWH）对术后皮瓣存活的影响。
选取24只雄性SD大鼠，采用单侧髂腰动脉穿支构建三血管体穿支皮瓣模型。将其随机分为两组：对照组在手术中经股静脉注射吲哚菁绿（ICG），利用实时影像引导系统采集荧光信号并进行定量分析，以确定术中荧光成像长度。实验组在术后0.5小时皮下注射LMWH（400 U/kg），对照组注射等量生理盐水。术后0至7天每天同一时间重复注射。皮瓣缝合后，于术后0、I、3、5和7天进行ICGA，观察两组皮瓣血管结构。术后7天统计对照组皮瓣存活长度，计算术中荧光成像长度与术后7天存活长度的相关性。术后7天比较两组皮瓣远端坏死比例。
对照组术中荧光成像平均长度为6.29±0.50 cm，术后7天皮瓣存活长度为8.24±0.52 cm。实际存活长度高于术中荧光成像长度，比例为1.31±0.08。差异具有统计学意义（P<0.05）。术后7天，实验组和对照组皮瓣坏死率分别为10.92%±1.30%和19.11%±1.19%，实验组皮瓣坏死率低于对照组（P<0.001）。
ICGA可定位穿支位置，用于预测和观察多血管体穿支皮瓣术后远端存活长度。LMWH可促进皮瓣远端存活，减少皮瓣坏死。
