吲哚菁绿血管造影引导下“强化”胸大肌肌皮瓣对坏死高风险患者重建的有益影响
Beneficial Impact of "Supercharged" Pectoralis Major Musculocutaneous Flap With Indocyanine Green Angiography on Reconstruction in a Patient at High Risk for Necrosis.
作者信息
Fujita Maako, Hihara Masakatsu, Satou Ai, Fukui Michika, Mitsui Toshihito, Okamoto Maki, Kako Ayako, Kakudo Natsuko
机构信息
Department of Plastic and Reconstructive Surgery, Kansai Medical University, Hirakata, Osaka, Japan.
Department of Plastic and Reconstructive Surgery, Hikone Municipal Hospital, Hikone, Shiga, Japan.
出版信息
Eplasty. 2023 Feb 15;23:e10. eCollection 2023.
BACKGROUND
The pectoralis major musculocutaneous (PMMC) flap is a versatile and commonly used technique for reconstruction of the head and neck in patients at high risk in free tissue transfer procedures. In this report, a "supercharged" PMMC flap, in which the lateral thoracic artery was cut, preserved, and anastomosed to the cervical vessels, was developed to stabilize blood flow.
METHODS
The supercharged PMMC flap was introduced in a patient who was at high risk for partial necrosis of the flap and underwent surgery for reconstruction of the tongue. Intraoperative perfusion monitoring using laser-assisted indocyanine green angiography (ICGA) was also performed to verify the status of blood flow in the flap.
RESULTS
ICGA monitoring of blood flow in the flap revealed instability. Subsequently, a supercharged PMMC flap was applied, which prevented partial necrosis of the flap.
CONCLUSIONS
Combined with ICGA, a supercharged PMMC flap contributed to successful reconstruction in a patient at high risk for necrosis of the flap region.
背景
胸大肌肌皮瓣（PMMC）是一种多功能且常用的技术，用于在游离组织移植手术中对高风险患者进行头颈部重建。在本报告中，开发了一种“增压”PMMC瓣，即切断、保留胸外侧动脉并将其与颈部血管吻合，以稳定血流。
方法
在一名皮瓣部分坏死风险高且接受舌重建手术的患者中引入了增压PMMC瓣。还使用激光辅助吲哚菁绿血管造影（ICGA）进行术中灌注监测，以验证皮瓣中的血流状况。
结果
ICGA对皮瓣血流的监测显示血流不稳定。随后应用了增压PMMC瓣，从而防止了皮瓣部分坏死。
结论
结合ICGA，增压PMMC瓣有助于在皮瓣区域坏死风险高的患者中成功进行重建。
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