Saracoglu Ayten, Cabakli Gamze Tanirgan, Saracoglu Kemal Tolga, Cakmak Gul, Erdem Ilhan, Umuroglu Tumay, Sacak Bulent, Ratajczyk Pawel
Department of Anaesthesiology, ICU, and Perioperative Medicine, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar.
College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar.
Diseases. 2024 Oct 16;12(10):255. doi: 10.3390/diseases12100255.
Intraoperative fluid management is one of the most important factors affecting optimal perfusion in the microcirculatory area in patients that undergo flap surgery. While insufficient fluid administration in the intraoperative period leads to flap complications and organ dysfunction, volume load can cause complications such as edema in the denervated flap tissue, the opening of the sutures, or fat necrosis. The Infrared Fluorescent Angiography Perfusion Evaluation Device (SPY) is one of the many noninvasive techniques that evaluate the well-being of microcirculation at the tissue level. This device monitors and scores the perfusion distribution in the flap area. This retrospective study aimed to investigate the effect of fluid resuscitation in head and neck free flap transfer surgery on flap quality and patient outcomes according to the change in SPY scores.
This study included 39 ASA I-II patients who were aged 18-60 years and underwent simultaneous free flap reconstruction of the head and neck between 2015 and 2021. Patients' blood pressure, body temperature, hemoglobin, pH, and lactate values were recorded at both baseline and end of the operation. Also, the SPY "Infrared Fluorescent Angiography Perfusion Evaluation Device" scores, the amount of intraoperative fluid and transfusion, bleeding and urine output, and the duration of mechanical ventilation, anesthesia and surgery, and the duration and amount of drainage, the length of stay in hospital and intensive care unit, and the presence of flap infection, detachment, necrosis and loss, and re-exploration rate were recorded for the patients.
The difference between the first and last measured SPY values was observed to be positively correlated with the length of stay in the hospital and intensive care unit and the duration of drainage. There was a positive correlation between the length of stay in the hospital and intensive care unit and the duration of drainage, the amount of drainage, as well as the duration of anesthesia and the duration of surgery ( < 0.001). A positive correlation was found between the amount of drainage and the amount of crystalloid solution administered (r = 0.36, < 0.05). In patients with flap infection, the difference between SPYfirst and SPYlast, the duration of anesthesia, and the duration of surgery were significantly higher. The amount of crystalloid solution given and bleeding and the duration of anesthesia and surgery were found to be significantly higher in mechanically ventilated patients ( < 0.05).
It has been concluded that SPY-guided fluid management can be beneficial in preventing morbidities, such as extended hospital and intensive care stay, by reducing flap infection, mechanical ventilation duration, and drainage, with early diagnosis of insufficient perfusion.
术中液体管理是影响接受皮瓣手术患者微循环区域最佳灌注的最重要因素之一。术中液体输注不足会导致皮瓣并发症和器官功能障碍，而容量负荷会引起诸如失神经皮瓣组织水肿、缝线裂开或脂肪坏死等并发症。红外荧光血管造影灌注评估设备（SPY）是众多在组织水平评估微循环健康状况的非侵入性技术之一。该设备可监测并对皮瓣区域的灌注分布进行评分。这项回顾性研究旨在根据SPY评分的变化，探讨头颈部游离皮瓣移植手术中液体复苏对皮瓣质量和患者预后的影响。
本研究纳入了39例年龄在18至60岁之间、于2015年至2021年期间接受头颈部同期游离皮瓣重建手术的美国麻醉医师协会（ASA）I-II级患者。记录患者在基线和手术结束时的血压、体温、血红蛋白、pH值和乳酸值。此外，还记录了患者的SPY“红外荧光血管造影灌注评估设备”评分、术中液体和输血量、出血量和尿量、机械通气时间、麻醉和手术时间、引流时间和引流量、住院和重症监护病房的住院时间，以及皮瓣感染、脱离、坏死和丢失的情况以及再次探查率。
观察到首次和末次测量的SPY值之间的差异与住院和重症监护病房的住院时间以及引流持续时间呈正相关。住院和重症监护病房的住院时间与引流持续时间、引流量以及麻醉时间和手术时间之间存在正相关（<0.001）。引流量与晶体溶液输注量之间存在正相关（r = 0.36，<0.05）。在发生皮瓣感染的患者中，首次和末次SPY值之间的差异、麻醉时间和手术时间显著更高。在机械通气患者中，晶体溶液给予量、出血量以及麻醉和手术时间显著更高（<0.05）。
得出的结论是，SPY引导下的液体管理通过减少皮瓣感染、机械通气时间和引流，并早期诊断灌注不足，有助于预防诸如延长住院和重症监护时间等并发症。
