Kreidstein M L, Levine R H, Knowlton R J, Pang C Y
Division of Surgical Research, Hospital for Sick Children, Toronto, Ontario, Canada.
Br J Plast Surg. 1995 Jul;48(5):288-93. doi: 10.1016/0007-1226(95)90066-7.
The applicability of serial skin surface fluorometry for repeated assessments of skin flap perfusion was investigated using the isolated perfused human transverse paraumbilical (TP) skin flap model. The flow rate, perfusion pressure and skin surface temperature were kept constant in seven human TP skin flaps and a low dose of fluorescein (3 x 10(-5) M) was used for each assessment. It was observed that the mean values for total dye fluorescence measured by a fluorometer and the maximum distance of perfusion estimated by dye fluorescein index remained consistent in five repeated assessments at 15 min interval. The variation in the maximum distance of perfusion within each TP skin flap over 5 repeated assessments was also relatively small, as judged by the mean coefficient of variation (6.1%; SEM 0.4%). Furthermore, a highly significant correlation between microsphere (15 microns) radioactivity index and dye fluorescence index was observed at corresponding locations in these seven TP skin flaps (r = 0.81; p < 0.001, n = 75). Taken together, these observations indicate that serial skin surface fluorometry provided consistent repeated assessments of skin perfusion in human skin flaps in vitro and the dye fluorescence index provided a consistent assessment of skin perfusion distance along the length of the TP skin flap. These observations lead us to speculate that critical (threshold) dye fluorescence index determined at various postoperative time points should be useful for prediction of skin viability in clinical skin flaps; thus, a clinical investigation is recommended.
使用离体灌注的人体脐旁横形（TP）皮瓣模型，研究了连续皮肤表面荧光测定法在重复评估皮瓣灌注中的适用性。在7个人体TP皮瓣中，流速、灌注压力和皮肤表面温度保持恒定，每次评估使用低剂量荧光素（3×10⁻⁵ M）。观察到，荧光计测量的总染料荧光平均值和染料荧光指数估计的最大灌注距离在每隔15分钟的5次重复评估中保持一致。根据平均变异系数（6.1%；标准误0.4%）判断，每个TP皮瓣在5次重复评估中最大灌注距离的变化也相对较小。此外，在这7个TP皮瓣的相应位置观察到微球（15微米）放射性指数与染料荧光指数之间存在高度显著的相关性（r = 0.81；p < 0.001，n = 75）。综上所述，这些观察结果表明，连续皮肤表面荧光测定法在体外对人体皮瓣的皮肤灌注提供了一致的重复评估，并且染料荧光指数对沿TP皮瓣长度的皮肤灌注距离提供了一致的评估。这些观察结果使我们推测，在术后不同时间点确定的临界（阈值）染料荧光指数对于预测临床皮瓣的皮肤活力应该是有用的；因此，建议进行临床研究。
