Tsunekawa Kazuhiro, Yanagisawa Daisuke, Yuzuriha Shunsuke
From the Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Plast Reconstr Surg Glob Open. 2025 Mar 20;13(3):e6627. doi: 10.1097/GOX.0000000000006627. eCollection 2025 Mar.
Accurately evaluating cutaneous blood flow during the elevation of a deep inferior epigastric perforator (DIEP) flap may reduce postoperative complications in breast reconstruction surgery. This study examined whether laser speckle flowgraphy (LSFG) could be used to help objectively identify the safe areas of DIEP flaps.
Forty-eight patients who underwent unilateral breast reconstruction with a DIEP flap at Shinshu University Hospital between 2020 and 2024 were prospectively studied. During flap elevation, skin blood flow throughout the flap was measured using LSFG and compared with results obtained by indocyanine green (ICG) angiography. The cohort was also divided according to the number and location of perforators, and an intergroup comparison was performed according to LSFG readings.
In all subjects, relative LSFG blood flow in zones 2 (89.1%) and 3 (87.9%) was comparable, whereas blood flow in zone 4 (72.8%) was significantly lower than in those areas (both < 0.001). In the lateral row group, blood flow in zone 2 tended to be lower and in zone 3 tended to be higher than in the medial row group (zone 2: 82.6% versus 89.5%, zone 3: 93.6% versus 86.8%). LSFG values did not differ significantly in relation to perforator number. LSFG-determined blood flow in the stained side of the ICG-determined staining border was significantly higher than in the nonstained side (80.6% versus 71.4%, < 0.001).
LSFG enables objective, noninvasive evaluation of safety margins in DIEP flaps that may support ICG angiography. Safe zones may vary depending on the location of the selected perforator.
在腹壁下深动脉穿支（DIEP）皮瓣掀起过程中准确评估皮肤血流，可能会减少乳房重建手术的术后并发症。本研究探讨了激光散斑血流图（LSFG）是否可用于帮助客观识别DIEP皮瓣的安全区域。
对2020年至2024年期间在信州大学医院接受单侧DIEP皮瓣乳房重建的48例患者进行前瞻性研究。在皮瓣掀起过程中，使用LSFG测量整个皮瓣的皮肤血流，并与吲哚菁绿（ICG）血管造影结果进行比较。根据穿支的数量和位置对队列进行分组，并根据LSFG读数进行组间比较。
在所有受试者中，2区（89.1%）和3区（87.9%）的相对LSFG血流相当，而4区（72.8%）的血流明显低于这些区域（均P<0.001）。在外侧排组中，2区血流往往低于内侧排组，3区血流往往高于内侧排组（2区：82.6%对89.5%，3区：93.6%对86.8%）。LSFG值与穿支数量无显著差异。在ICG确定的染色边界的染色侧，LSFG测定的血流明显高于未染色侧（80.6%对71.4%，P<0.001）。
LSFG能够对DIEP皮瓣的安全边缘进行客观、无创评估，这可能有助于ICG血管造影。安全区域可能因所选穿支的位置而异。
