Rook Anne R D, Chizari Ata, Knop Tom, Teunissen Sacha E M, Wijbenga Johan G, Evers Danny J, Steenbergen Wiendelt, Rakhorst Hinne A
Biomedical Photonic Imaging group, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
Biomedical Photonic Imaging group, Technical Medical Centre, Faculty of Science and Technology, University of Twente, Enschede, the Netherlands.
J Plast Reconstr Aesthet Surg. 2025 Jul;106:426-434. doi: 10.1016/j.bjps.2025.04.035. Epub 2025 May 6.
In reconstructive surgery, adequate perfusion of flaps is essential for successful outcomes. Assessing normal flap perfusion and differentiating it from problematic perfusion is important and time-consuming. Laser speckle contrast imaging (LSCI), an optical technique for quantitative microcirculation assessment, can be used to non-invasively monitor flap perfusion. We designed a wireless handheld LSCI device and investigated its clinical feasibility in Deep Inferior Epigastric Perforator (DIEP) flap reconstruction surgery.
In a case series study with 15 patients and 20 DIEP flaps, perfusion was measured perioperatively across the 4 Hartrampf zones at 4 specific time points and on the first post-operative day.
In unilateral reconstructions, the perfusion in dissected flaps showed a perfusion gradient across the zones, with the highest perfusion in zone I and lowest perfusion in zone IV. The decrease in perfusion between unilateral flap elevation and temporary occlusion measurements was detected in unilateral flaps, but not in bilateral flaps. The device could detect flap failure in 2 cases by measuring anomalous perfusion values.
The results indicate that our device is potentially valuable for flap monitoring. It detected differences in perfusion throughout the flap zones, a decrease in perfusion when clamping the pedicle and anomalous perfusion in flaps that failed. Motion artefact correction is needed to measure reliably during motion caused by patient breathing, pulse and operator motion. Further studies are needed to determine whether the wireless perfusion imager enables the early detection of complications, which could aid in prevention or prompt reintervention to salvage a flap.
在重建手术中，皮瓣的充分灌注是取得成功结果的关键。评估正常皮瓣灌注并将其与有问题的灌注区分开来既重要又耗时。激光散斑对比成像（LSCI）是一种用于定量微循环评估的光学技术，可用于无创监测皮瓣灌注。我们设计了一种无线手持式LSCI设备，并研究了其在腹壁下动脉穿支（DIEP）皮瓣重建手术中的临床可行性。
在一项包含15例患者和20个DIEP皮瓣的病例系列研究中，在围手术期的4个特定时间点以及术后第一天，对4个哈特朗普夫区的皮瓣灌注进行测量。
在单侧重建中，解剖后的皮瓣灌注在各区域呈现出灌注梯度，I区灌注最高，IV区灌注最低。在单侧皮瓣中检测到了单侧皮瓣掀起与临时阻断测量之间的灌注下降，但在双侧皮瓣中未检测到。该设备通过测量异常灌注值在2例中检测到皮瓣失败。
结果表明我们的设备在皮瓣监测方面可能具有价值。它检测到了整个皮瓣区域的灌注差异、夹闭蒂部时的灌注下降以及失败皮瓣中的异常灌注。在患者呼吸、脉搏和术者动作引起的运动过程中，需要进行运动伪影校正以进行可靠测量。需要进一步研究以确定无线灌注成像仪是否能够早期检测并发症，这可能有助于预防或促使及时进行再次干预以挽救皮瓣。
