Hallock G G, Rice D C
Dorothy Rider Pool Microsurgery and Laser Laboratory, Allentown, Pa.
Plast Reconstr Surg. 1993 Feb;91(2):217-22. doi: 10.1097/00006534-199302000-00002.
The end point for incremental filling of any tissue expander normally may reliably be assessed using subjective parameters, especially pain, as a guideline. However, in unusual circumstances, such as within denervated areas, the presence of marginal skin circulation, or if rapid expansion is required, an objective monitor may be beneficial to ensure safer expansion. We have previously examined the role of serial measurement of transcutaneous oxygen in this regard. In an effort to refine this sometimes cumbersome approach, a comparison using laser Doppler flowmetry as well has been undertaken in 13 consecutive patients. Both monitoring devices demonstrated a progressive impediment to blood flow with increased expansion. At the pain threshold, both techniques recorded values consistent with adequate skin circulation, thereby proving in general the relative safety of subjective evaluation during the usual course of tissue expansion. Greater sensitivity was noted for the laser Doppler as a monitor, though, via the recording of earlier changes in flow characteristics and more rapid identification of critical thresholds for nonviability. From a more practical standpoint, immediate application without a period for equilibration is another major asset of laser Doppler flowmetry as a system for objective monitoring.
通常，使用主观参数，尤其是疼痛，作为指导原则，可以可靠地评估任何组织扩张器增量填充的终点。然而，在特殊情况下，如在去神经支配区域内、边缘皮肤循环存在时，或需要快速扩张时，客观监测器可能有助于确保更安全的扩张。我们之前已经研究了经皮氧分压连续测量在这方面的作用。为了改进这种有时繁琐的方法，我们还对13例连续患者进行了激光多普勒血流仪的比较。随着扩张增加，两种监测设备均显示血流量逐渐受到阻碍。在疼痛阈值时，两种技术记录的值均与充足的皮肤循环一致，从而总体证明了在组织扩张的常规过程中主观评估的相对安全性。不过，作为一种监测器，激光多普勒的灵敏度更高，它能够记录血流特征的早期变化，并更快地识别非存活的临界阈值。从更实际的角度来看，无需平衡期即可立即应用是激光多普勒血流仪作为客观监测系统的另一大优点。
