Shi Chenchen, Guo Linxiumei, Song Ruihu, Xu Heng, Zhang Yixin
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Molecular Imaging Center, State Key Laboratory of Chemical Biology, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China.
Front Med (Lausanne). 2024 May 20;11:1389384. doi: 10.3389/fmed.2024.1389384. eCollection 2024.
Predicting flap viability benefits patients by reducing complications and guides flap design by reducing donor areas. Due to varying anatomy, obtaining individual vascular information preoperatively is fundamental for designing safe flaps. Although indocyanine green angiography (ICGA) is a conventional tool in intraoperative assessment and postoperative monitoring, it is rare in preoperative prediction.
ICGA was performed on 20 male BALB/c mice under five wavelengths (900/1,000/1,100, /1,250/1,450 nm) to assess vascular resolution after ICG perfusion. A "mirrored-L" flap model with three angiosomes was established on another 20 male BALB/c mice, randomly divided into two equal groups. In Group A, a midline between angiosomes II and III was used as a border. In Group B, the points of the minimized choke vessel caliber marked according to the ICG signal at 1,450 nm wavelength (ICG) were connected. Necrotic area calculations, pathohistological testing, and statistical analysis were performed.
The vascular structure was clearly observed at 1,450 nm wavelength, while the 900 to 1,100 nm failed to depict vessel morphology. Necrosis was beyond the borderline in 60% of Group A. Conversely, 100% of Group B had necrosis distal to the borderline. The number of choke vessels between angiosomes II and III was positively correlated with the necrotic area (%). The pathohistological findings supported the gross observation and analysis.
ICG can delineate the vessel structure in vivo and predict the viability of pedicled skin flaps using the choke vessel as the border between angiosomes.
预测皮瓣存活情况可减少并发症，从而使患者受益，还能通过减少供区来指导皮瓣设计。由于个体解剖结构存在差异，术前获取个体血管信息对于设计安全的皮瓣至关重要。尽管吲哚菁绿血管造影（ICGA）是术中评估和术后监测的常用工具，但在术前预测中却很少使用。
对20只雄性BALB/c小鼠进行ICGA，采用五个波长（900/1000/1100/1250/1450 nm）评估ICG灌注后的血管分辨率。在另外20只雄性BALB/c小鼠上建立了一个具有三个血管体区的“镜像-L”皮瓣模型，并随机分为两组，每组数量相等。A组以血管体区II和III之间的中线为边界。B组连接根据1450 nm波长的ICG信号标记的最小卡压血管口径点。进行坏死面积计算、病理组织学检测和统计分析。
在1450 nm波长处可清晰观察到血管结构，而900至1100 nm波长未能描绘血管形态。A组60%的皮瓣坏死超出边界。相反，B组100%的皮瓣在边界远端出现坏死。血管体区II和III之间的卡压血管数量与坏死面积（%）呈正相关。病理组织学结果支持大体观察和分析。
ICG可在体内描绘血管结构，并以卡压血管作为血管体区之间的边界来预测带蒂皮瓣的存活情况。
