Carlson Andrew P, Denezpi Taryn, Akbik Omar S, Mohammad Laila M
Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, United States.
Department of Neurosurgery, Creighton University Medical Center, Omaha, United States.
Surg Neurol Int. 2021 Dec 30;12:632. doi: 10.25259/SNI_143_2021. eCollection 2021.
To measure the degree of relative ischemia caused by skin closure, we explored the potential utility of intraoperative surface blood flow measurement with laser speckle imaging (LSI).
Prospective observational study of eight subjects that underwent intraoperative LSI during elective cranial neurosurgical procedures at the time of skin closure.
Seven 1 time incisions, with closure techniques including sutures ( = 3), staples ( = 3), and one after galeal sutures. When compared to the control region, there was a mean 63.7% reduction in flow across all seven subjects (range 18.7-95.32%). Comparing by closure type, a higher flow reduction in the three subjects with suture closure (80.7% reduction) compared to staples (61.9% reduction, = 0.0379). One subject had a complex wound where tightening and loosening of sutures were performed to ensure adequate perfusion. Suturing resulted in significantly more local decreased flow compared to staples ( < 0.0001).
These findings demonstrate the relative feasibility of using LSI for preoperative vascular flow assessment in planning complex incision closure. These data also provide preliminary support for the hypothesis that skin closure itself causes relative ischemia compared to deep approximation or cautery of the skin edge and that the relative ischemia from staples closure is generally less than from suture closure.
为了测量皮肤缝合所导致的相对缺血程度，我们探讨了术中使用激光散斑成像（LSI）测量表面血流的潜在效用。
对8名在择期颅脑神经外科手术皮肤缝合时接受术中LSI的受试者进行前瞻性观察研究。
7个一期切口，缝合技术包括缝线（n = 3）、吻合钉（n = 3），以及1个在帽状腱膜缝合后的切口。与对照区域相比，所有7名受试者的血流平均减少了63.7%（范围为18.7 - 95.32%）。按缝合类型比较，采用缝线缝合的3名受试者血流减少幅度更高（减少80.7%），而采用吻合钉缝合的受试者血流减少幅度为61.9%（P = 0.0379）。1名受试者有复杂伤口，通过收紧和松开缝线来确保充足灌注。与吻合钉相比，缝合导致局部血流减少更显著（P < 0.0001）。
这些发现证明了在规划复杂切口缝合时使用LSI进行术前血管血流评估的相对可行性。这些数据也为以下假设提供了初步支持：与皮肤边缘的深层对合或烧灼相比，皮肤缝合本身会导致相对缺血，并且吻合钉缝合导致的相对缺血通常小于缝线缝合。
