Department of Pediatric Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Department of Pediatric Surgery, ASST Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy.
Int J Environ Res Public Health. 2023 Jun 28;20(13):6246. doi: 10.3390/ijerph20136246.
First described by Duckett in 1981, and initially employed for the surgical correction of mid-penile hypospadias, the onlay preputial island flap urethroplasty has progressively gained increasing popularity, extending its indication to proximal forms. However, with the complexity of the penile anomaly, the rate of postoperative complications related to poor tissue perfusion (including skin and glans dehiscence, urethral stenoses, and fistulas) has also increased. Conventionally, the visual assessment of the onlay preputial island flap is the only option available to establish the appropriate tissue vascularization during surgery. To this end, we have first introduced the EleVision IR system (Medtronic Ltd., Hong Kong, China) to assess the vascular perfusion of the preputial island flap in a 13-month-old boy undergoing the onlay urethroplasty for the surgical correction of a mid-shaft hypospadias. This was possible 80 s after the intravenous injection of indocyanine green (ICG, 0.15 mg/kg, Diagnostic Green GmbH, Munich, Germany). ICG-based laser angiography helped define the proximal resection margin of the preputial flap, and proved to be safe, effective, and easy to employ. This innovative intraoperative imaging modality can be considered a useful adjunct for tissue perfusion evaluation and intraoperative decision-making during the onlay preputial island flap urethroplasty in children.
1981 年 Duckett 首次描述并最初应用于外科矫正阴茎中段下曲的皮瓣尿道成形术，游离带蒂包皮岛状皮瓣尿道成形术逐渐得到广泛应用，并扩展到近端型。然而，随着阴茎畸形的复杂性增加，与组织灌注不良相关的术后并发症发生率（包括皮肤和龟头裂开、尿道狭窄和瘘管）也有所增加。传统上，游离带蒂包皮岛状皮瓣的视觉评估是手术中确定适当组织血管化的唯一选择。为此，我们首次引入 EleVision IR 系统（美敦力有限公司，中国香港），以评估一名 13 个月大的男孩在接受游离带蒂包皮岛状皮瓣尿道成形术治疗阴茎中段下曲畸形时的包皮岛状皮瓣的血管灌注情况。在静脉注射吲哚菁绿（ICG，0.15mg/kg，Diagnostic Green GmbH，慕尼黑，德国）后 80 秒即可进行。基于 ICG 的激光血管造影有助于确定包皮皮瓣的近端切除边界，且安全、有效、易于操作。这种创新的术中成像方式可被视为游离带蒂包皮岛状皮瓣尿道成形术中评估组织灌注和术中决策的有用辅助手段。
