Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA.
Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, Florida, USA.
Vet Surg. 2024 Aug;53(6):1073-1082. doi: 10.1111/vsu.14121. Epub 2024 Jun 4.
To describe the use of near-infrared angiography (NIRFA) to identify the vascularization of three canine axial pattern flaps (APFs) omocervical (OMO), thoracodorsal (THO), and caudal superficial epigastric (CSE); to establish a vascular fluorescence pattern (VFP) grading system; and to evaluate the effect of NIRFA on surgeon flap dimension planning compared to traditional landmark palpation (LP) and visualization assessments.
Experimental study.
A total of 15 healthy, client-owned dogs.
Dogs were sedated and flap sites were clipped. LP-based margins were drawn and preinjection images were recorded. Indocyanine green (ICG) was administered and VFP images were recorded. VFP scores were determined by five surgeons. Margin alterations were performed based on NIRFA-ICG images. Altered measurements were compared between LP and NIRFA-ICG images.
Vascularization of the CSE flap was most visible with NIRFA with VFP scores 4/4 for 13/15 dogs. Intersurgeon agreement for VFP grades was poorest for THO (ICC = 0.35) and intermediate for OMO (ICC = 0.49) flaps. Surgeons were more likely to adjust dimensions for CSE flaps relative to OMO (OR 17.3, 95% CI: 6.2, 47.8) or THO (25.5; 8.6, 75.7).
Using a grading system, we demonstrated that the CSE flap was most visible. Surgeons were more likely to adjust the LP-CSE flap margins based on fluorescence patterns and were more likely to rely on LP when visualization scores were low.
NIRFA has possible applications identifying some direct cutaneous arteries of APFs and their associated angiosomes in real-time. Further investigation is indicated to study NIRFA's potential to improve patient specific APF planning.
描述使用近红外血管造影（NIRFA）来识别三种犬轴向皮瓣（APF）——颈侧（OMO）、背侧（THO）和腹侧浅层腹壁（CSE）的血管化情况；建立血管荧光模式（VFP）评分系统；并评估与传统的标记触诊（LP）和可视化评估相比，NIRFA 对外科医生皮瓣尺寸规划的影响。
实验研究。
共 15 只健康的、有主人的狗。
狗被镇静，并对皮瓣部位进行修剪。根据 LP 绘制边界，并记录皮瓣预注射图像。给予吲哚菁绿（ICG），并记录 VFP 图像。五位外科医生确定 VFP 评分。根据 NIRFA-ICG 图像进行边界修改。将修改后的测量值与 LP 和 NIRFA-ICG 图像进行比较。
NIRFA 对 CSE 皮瓣的血管化显示最清晰，15 只狗中有 13 只的 VFP 评分为 4/4。对于 THO（ICC=0.35）和 OMO（ICC=0.49）皮瓣，外科医生之间的 VFP 分级一致性最差。与 OMO（OR 17.3，95%CI：6.2，47.8）或 THO（25.5；8.6，75.7）相比，外科医生更有可能调整 CSE 皮瓣的尺寸。
使用评分系统，我们表明 CSE 皮瓣最明显。外科医生更有可能根据荧光模式调整 LP-CSE 皮瓣的边界，并且在可视化评分较低时更有可能依赖 LP。
NIRFA 具有实时识别 APF 的一些直接皮动脉及其相关血管分布的应用潜力。需要进一步研究 NIRFA 改善患者特定 APF 规划的潜力。
