Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Plastic and Reconstructive Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Plast Reconstr Aesthet Surg. 2023 Sep;84:165-175. doi: 10.1016/j.bjps.2023.05.009. Epub 2023 May 18.
Photoacoustic tomography is a noninvasive vascular imaging modality that uses near-infrared pulsed laser light and ultrasound to visualize vessels. We previously demonstrated the utility of photoacoustic tomography for anterolateral thigh flap surgery involving body-attachable vascular mapping sheets. However, it was not possible to obtain clear separate images of arteries and veins. In this study, we tried to visualize subcutaneous arteries that cross the midline of the abdomen, since these arteries are known to be important for obtaining large perfusion areas in transverse abdominal flaps.
Four patients scheduled to undergo breast reconstruction with abdominal flaps were examined. Photoacoustic tomography was performed preoperatively. The tentative arteries and veins were traced according to the S-factor, an approximate hemoglobin oxygen saturation parameter calculated using 2 laser excitation wavelengths (756 and 797 nm). Intraoperatively, arterial-phase indocyanine green (ICG) angiography was performed after abdominal flap elevation. Images of vessels speculated to be arteries by preoperative photoacoustic tomography were merged with those of intraoperative ICG angiography and analyzed in an 8 × 4-cm area below the umbilical region.
The S-factor was used to visualize the midline-crossing subcutaneous arteries in all 4 patients. A matching analysis compared preoperative tentative arteries according to photoacoustic tomography with ICG angiography results in the 8 × 4-cm area below the umbilical region and indicated a 71.3-82.1% match (average: 76.9% match).
This study demonstrates that the S-factor, a noninvasive, label-free imaging modality, can be used to successfully visualize subcutaneous arteries. This information can aid in selecting perforators for abdominal flap surgery.
光声断层扫描是一种非侵入性的血管成像方式，它使用近红外脉冲激光和超声波来可视化血管。我们之前证明了光声断层扫描在涉及可附着于身体的血管测绘片的前外侧大腿皮瓣手术中的效用。然而，无法获得动脉和静脉的清晰的单独图像。在这项研究中，我们试图可视化穿过腹部中线的皮下动脉，因为众所周知，这些动脉对于获得横腹皮瓣的大灌注区域很重要。
对 4 名计划接受腹部皮瓣乳房再造的患者进行了检查。术前进行了光声断层扫描。根据 S 因子（使用 2 种激光激发波长（756 和 797nm）计算的近似血红蛋白氧饱和度参数）追踪疑似动脉和静脉。在腹部皮瓣抬高后，进行动脉期吲哚菁绿（ICG）血管造影术。将术前光声断层扫描推测为动脉的血管图像与术中 ICG 血管造影术的图像合并，并在脐下 8×4cm 区域进行分析。
S 因子用于可视化所有 4 名患者的中线穿过的皮下动脉。一项匹配分析比较了术前根据光声断层扫描推测的动脉与脐下 8×4cm 区域的 ICG 血管造影结果，结果显示匹配率为 71.3-82.1%（平均：76.9%匹配）。
这项研究表明，S 因子作为一种非侵入性、无标记的成像方式，可以成功地可视化皮下动脉。这些信息可以帮助选择腹部皮瓣手术的穿支。
