Xiao Wentian, Zhang Shunuo, Li Hua, Feng Shaoqing, Nicoli Fabio, Huynh Richard, Lu Jiajing, Zhang Yixin, Min Peiru
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Plastic and Reconstructive Surgery, Royal Victoria Infirmary Hospital NHS Foundation Trust, Newcastle upon Tyne, UK.
Appl Bionics Biomech. 2022 Jul 26;2022:8564922. doi: 10.1155/2022/8564922. eCollection 2022.
The preexpanded bipedicled visor flap, supported by the bilateral superficial temporal vessels, stands as an ideal choice for upper and lower lip reconstruction in males. However, the bilateral tissue bridges after flap transfer caused patients significant cosmetic deformity and psychological burden. Early division of bilateral pedicles reduced the length of hospitalization and expenses. In this study, infrared thermography (IRT) was used to guide the early pedicle division after ischemic preconditioning.
This study retrospectively analyzed patients who underwent preexpanded bipedicled visor flap surgery from April 2018 to October 2021. Pedicle division was scheduled at two weeks postflap transfer. Ischemic preconditioning was initiated 3-5 days in advance by repeatedly clamping both pedicles. The temperature alteration of the flap and the temperature difference compared to the normal adjacent tissue were evaluated by IRT. The division surgery was not scheduled until the perfusion assessment indicated adequate. This comprised of subjective examination and indocyanine green angiography. The threshold of temperature difference to determine the pedicle division was analyzed based on the temperature changes between the clamps.
A total of 8 male patients successfully conducted the pedicle division without any complications. The delay period after ischemic preconditioning ranged from 14 to 19 days (average 16 days). Through ischemic preconditioning training, the average temperature of the flap gradually increased from 31.85 ± 0.36°C to 33.89 ± 0.50°C, and the temperature difference with the normal surrounding tissues decreased from 2.89 ± 0.30°C to 1.15 ± 0.46°C (95% confidence interval (1.5, 0.8)). The temperature difference stayed unchanged after pedicle division.
Ischemic preconditioning shortens the perioperative period to pedicle division. Monitoring the temperature change reflects the revascularization between the flap and the recipient site, thus guiding the pedicle division. The temperature difference less than 1.5°C after clamping both pedicles can be set as the safe threshold for pedicle division.
由双侧颞浅血管供血的预扩张双蒂遮阳板皮瓣是男性上下唇重建的理想选择。然而，皮瓣转移后的双侧组织桥给患者带来了明显的美容畸形和心理负担。早期切断双侧蒂可缩短住院时间和费用。在本研究中，红外热成像（IRT）被用于指导缺血预处理后的早期蒂切断。
本研究回顾性分析了2018年4月至2021年10月期间接受预扩张双蒂遮阳板皮瓣手术的患者。计划在皮瓣转移后两周进行蒂切断。通过反复夹闭双侧蒂，在术前3 - 5天开始缺血预处理。通过IRT评估皮瓣的温度变化以及与正常相邻组织的温差。直到灌注评估显示充足后才安排切断手术。这包括主观检查和吲哚菁绿血管造影。根据夹闭之间的温度变化分析确定蒂切断的温差阈值。
共有8例男性患者成功进行了蒂切断，无任何并发症。缺血预处理后的延迟期为14至19天（平均16天）。通过缺血预处理训练，皮瓣的平均温度从31.85±0.36°C逐渐升高至33.89±0.50°C，与周围正常组织的温差从2.89±0.30°C降至1.15±0.46°C（95%置信区间（1.5, 0.8））。蒂切断后温差保持不变。
缺血预处理缩短了至蒂切断的围手术期。监测温度变化反映了皮瓣与受区之间的血管再通，从而指导蒂切断。双侧蒂夹闭后温差小于1.5°C可设定为蒂切断的安全阈值。
