Mohammad Arbab, Escandón Joseph M, Matsui Chihiro, Tanaka Takakuni, Wei-Kai Lao William, Yoshitsugu Hattori, Matsui Yuki, Mizuno Hiroshi
Aarupadai Veedu Medical College and Hospital, Puducherry, India.
Division of Plastic and Reconstructive Surgery, Strong Memorial Hospital, University of Rochester Medical Center, N.Y.
Plast Reconstr Surg Glob Open. 2022 Nov 3;10(11):e4613. doi: 10.1097/GOX.0000000000004613. eCollection 2022 Nov.
Temporary or prolonged vascular spasm can be appreciated when perivascular dissection is performed for microvascular reconstruction. Due to a lack of reliable assessment modalities, the resolution of spasm at the periphery of perforators cannot be determined by naked eyes or surgical loupes. To address this conundrum, we aimed to observe the state of perforator vessel spasm after flap elevation using video-capillaroscopy. Between November 2021 and February 2022, seven free flaps were evaluated with video-capillaroscopy to determine the incidence of vasospasm in less than 1 mm-diameter perforators. The type of perforator spasm after flap elevation was divided into six types according to the video-capillaroscopy findings: type A, no spasm/decreased pulsation (S/DP); type B, S/DP with recovery within 5 minutes; type C, S/DP requiring papaverine hydrochloride spraying and hot water treatment (PHS+HWT) resulting in recovery within 5 minutes; type D, S/DP requiring PHS+HWT resulting in recovery within 10 minutes; type E, S/DP requiring PHS+HWT resulting in recovery within 15 minutes; and type F, S/DP with no recovery of pulsation even after PHS+HWT. Twenty-five perforators were evaluated, 3.57 perforators (range, 3-4) per flap. Using our classification for perforator vessel spasms on video-capillaroscopy, observations of five perforating branches were classified as type A, seven as type B, six as type C, five as type D, and two as type E. No type F spasm was observed. With video-capillaroscopy it is possible to confirm if blood flow deterioration occurs even in areas that are difficult to determine macroscopically. Video-capillaroscopy, a noninvasive imaging modality, is a useful alternative for the intraoperative evaluation of perforator flow and spasm.
在进行微血管重建的血管周围剥离时，可以察觉到暂时性或持续性的血管痉挛。由于缺乏可靠的评估方式，穿支血管周围痉挛的缓解情况无法通过肉眼或手术放大镜来确定。为了解决这一难题，我们旨在通过视频毛细血管镜观察皮瓣掀起后穿支血管痉挛的状态。在2021年11月至2022年2月期间，对7个游离皮瓣进行了视频毛细血管镜评估，以确定直径小于1毫米的穿支血管中血管痉挛的发生率。根据视频毛细血管镜检查结果，皮瓣掀起后穿支血管痉挛的类型分为六种：A型，无痉挛/搏动减弱（S/DP）；B型，S/DP且在5分钟内恢复；C型，S/DP需要喷洒盐酸罂粟碱和热水处理（PHS+HWT）并在5分钟内恢复；D型，S/DP需要PHS+HWT并在10分钟内恢复；E型，S/DP需要PHS+HWT并在15分钟内恢复；F型，即使经过PHS+HWT搏动也未恢复。共评估了25条穿支血管，每个皮瓣平均3.57条穿支血管（范围为3 - 4条）。根据我们对视频毛细血管镜下穿支血管痉挛的分类，观察到五个穿支分支为A型，七个为B型，六个为C型，五个为D型，两个为E型。未观察到F型痉挛。通过视频毛细血管镜，即使在宏观上难以确定的区域，也能够确认血流是否恶化。视频毛细血管镜作为一种非侵入性成像方式，是术中评估穿支血流和痉挛的一种有用的替代方法。
