ICG 血管造影在锁骨上动脉岛状瓣头颈部重建中的应用。
Use of ICG Angiography in Head and Neck Reconstruction With the Supraclavicular Artery Island Flap.
机构信息
Resident, Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Medical Student, Keck School of Medicine, University of Southern California, Los Angeles, CA.
出版信息
J Oral Maxillofac Surg. 2022 Aug;80(8):1424-1433. doi: 10.1016/j.joms.2022.04.011. Epub 2022 Apr 25.
PURPOSE
Adequate distal skin paddle perfusion is essential to preventing postoperative flap necrosis in head and neck reconstruction. To describe the use of indocyanine green angiography (ICGA), to assess skin paddle perfusion in the setting of head and neck reconstruction with the supraclavicular artery island flap at a single institution and assess the effect of ICGA use on the rate of postoperative skin paddle necrosis.
METHODS
A retrospective cohort study consistently of patients who underwent head and neck reconstruction with a supraclavicular artery island flap for any indication at a tertiary medical center from 2010 to 2018. The predictor variable was ICGA use. The primary outcome was rate of skin paddle necrosis. Secondary outcomes included rates of post-operative overall complications, dehiscence, fistula, and reoperation. Covariates included demographic, operative, flap perfusion assessment, and postoperative variables. Retrospective assessment of distal flap perfusion was performed on available ICGA video recordings. Descriptive and bivariate statistics were computed. Statistical significance was set at P ≤ .05.
RESULTS
A total of 104 patients were included and ICGA was used in 23 cases. In 10 of these cases, flap trimming was performed due to concern of flap hypoperfusion on ICGA. The median relative distal flap perfusion was 16.7 ± 2.6% in trimmed flaps, compared to 35 ± 13.2% in untrimmed flaps. ICGA use was not associated with rate of skin paddle necrosis (P = .76).
CONCLUSIONS
ICGA is a viable method of assessing intraoperative supraclavicular artery island skin paddle perfusion and can help determine the need for distal flap trimming when tissue viability based on clinical findings alone is uncertain. ICGA use for skin paddles with uncertain perfusion on intraoperative clinical findings prevented a potential increase in postoperative necrosis compared to that of skin paddles with adequate perfusion on intraoperative clinical findings. Future studies are required to determine the minimum distal perfusion value that indicates hypoperfusion and the need for flap modification.
目的
足够的远端皮瓣灌注对于预防头颈部重建术后皮瓣坏死至关重要。描述在单一机构使用吲哚菁绿血管造影（ICGA）评估锁骨下动脉岛状皮瓣头颈部重建时皮瓣灌注情况，并评估 ICGA 使用对术后皮瓣坏死率的影响。
方法
对 2010 年至 2018 年期间在三级医疗中心因任何原因行锁骨下动脉岛状皮瓣头颈部重建的患者进行了回顾性队列研究。预测变量为 ICGA 使用。主要结局为皮瓣坏死率。次要结局包括术后总并发症、裂开、瘘管和再次手术的发生率。协变量包括人口统计学、手术、皮瓣灌注评估和术后变量。对可用的 ICGA 视频记录进行了远端皮瓣灌注的回顾性评估。计算了描述性和双变量统计数据。设定统计显著性水平为 P ≤ 0.05。
结果
共纳入 104 例患者，其中 23 例使用了 ICGA。在这 10 例病例中，由于对 ICGA 显示的皮瓣灌注不足的担忧，进行了皮瓣修剪。修剪后的皮瓣远端皮瓣相对灌注中位数为 16.7±2.6%，未修剪的皮瓣为 35±13.2%。ICGA 使用与皮瓣坏死率无关（P=0.76）。
结论
ICGA 是评估锁骨下动脉岛状皮瓣术中皮瓣灌注的可行方法，当仅凭临床发现确定组织活力不确定时，有助于确定是否需要修剪远端皮瓣。与术中临床发现灌注充足的皮瓣相比，对于术中临床发现灌注不确定的皮瓣使用 ICGA 可防止术后坏死的潜在增加。需要进一步的研究来确定表示灌注不足和需要皮瓣修改的最小远端灌注值。
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