Department of Hand, and Plastic Surgery, Luzerner Kantonsspital, Lucerne, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Zentrum für Plastische Chirurgie, Pyramide Clinic, Zurich, Switzerland.
J Plast Reconstr Aesthet Surg. 2024 Oct;97:147-155. doi: 10.1016/j.bjps.2024.07.047. Epub 2024 Jul 25.
Over the last decade, microsurgical soft-tissue transfer became the gold standard for various reconstructions throughout the body. Continuous improvement of instruments and surgical techniques, such as intraoperative indocyanine green angiography (ICG-A), allowed for a very high success rate. This study aimed to assess and validate the role of a standard intraoperative ICG-A in free and pedicled flap surgery to improve overall outcomes.
From April 2018 to April 2023, 400 consecutive patients who underwent reconstruction using free and pedicled flaps were enrolled. ICG-A was always performed in a free flap after flap elevation, after microsurgical anastomosis, immediately after the flap inset, and after wound closure. In the pedicled flap, the sequential procedure was performed after flap elevation, flap inset, and wound closure.
All 400 patients who underwent flap reconstruction using intraoperative ICG-A had an extremely low incidence of necrosis (0.75% partial necrosis among free and pedicled flaps) and reoperation for perfusion-related complications (0.75% due to acute ischemia and 0.50% due to flap congestion). Minor complications, such as hematoma, seroma, wound dehiscence, and wound infections, were managed with a second operation. No flaps were lost, and all patients were successfully treated.
This study showed how systematic multistep ICG-A for intraoperative assessment of free and pedicled flap perfusion can significantly reduce the complication rate, including flap loss and re-exploration surgeries, in a time- and cost-effective manner.
在过去的十年中，显微软组织转移已成为全身各种重建的金标准。仪器和手术技术的不断改进，如术中吲哚菁绿血管造影（ICG-A），使得成功率非常高。本研究旨在评估和验证标准术中 ICG-A 在游离皮瓣和带蒂皮瓣手术中的作用，以提高整体效果。
2018 年 4 月至 2023 年 4 月，连续纳入 400 例接受游离皮瓣和带蒂皮瓣重建的患者。游离皮瓣抬高后、显微吻合后、皮瓣即刻插入后和伤口关闭后均行 ICG-A。带蒂皮瓣在皮瓣抬高、皮瓣插入和伤口关闭后进行序贯检查。
所有接受术中 ICG-A 皮瓣重建的 400 例患者的坏死发生率极低（游离皮瓣和带蒂皮瓣的部分坏死发生率为 0.75%），与灌注相关的并发症需要再次手术的发生率也很低（急性缺血导致的再手术率为 0.75%，皮瓣淤血导致的再手术率为 0.50%）。血肿、血清肿、伤口裂开和伤口感染等轻微并发症通过二次手术进行处理。没有皮瓣丢失，所有患者均成功治疗。
本研究表明，系统的多步骤 ICG-A 术中评估游离皮瓣和带蒂皮瓣的灌注情况，可以显著降低并发症发生率，包括皮瓣丢失和再次探查手术，同时具有时间和成本效益。
