Wolff K D, Marks C, Uekermann B, Specht M, Frank K H
Department of Maxillofacial Plastic Surgery, Benjamin Franklin University Medical Centre, Berlin, Germany.
Br J Oral Maxillofac Surg. 1996 Dec;34(6):524-9. doi: 10.1016/s0266-4356(96)90250-8.
To find out whether measurements of intracapillary haemoglobin oxygenation made with the non-invasive Erlangen microlightguide spectrophotometer (EMPHO II) provided accurate data about the oxygen supply as well as the blood flow to free flaps in rats and humans.
Experimental, and prospective open clinical study.
University hospital, Germany. ANIMALS and
Thirty male Wistar rats and 20 patients who underwent microsurgical transplant of free flaps (radial forearm, n = 8; osteocutaneous fibula, n = 7; and myocutaneous from the lateral thigh, n = 5).
Measurement of the haemoglobin oxygenation of the skin before, during, and after transfer of the flap.
Reproducibility and mean curves for haemoglobin oxygenation and haemoglobin concentration.
All values were reproducible, and there were only slight fluctuations. Uninjured skin in rats (baseline value) oxygenation of the total haemoglobin concentration ranged from 15% to 45% (mean 23%). After the flaps were raised there was a slight increase (to a mean of 37%), probably as a result of reactive hyperaemia. There was a rapid decrease within a few minutes of arterial occlusion, and residual oxygenation of up to 20% after perfusion stopped. The flap was totally deoxygenated after 1 h. Venous occlusion caused a similar pattern and all flaps were deoxygenated by 30 min. In the clinical study ligation of the vascular pedicle caused a massive reduction in values but after anastomosis there was significantly higher haemoglobin oxygenation (P = 0.05) and this continued to increase postoperatively. There were no complications and oxygenation gradually and continuously decreased from the base of the flap to the periphery.
The non-invasive EMPHO II provides reliable and easily assessable data about the circulation and supply of oxygen to a transplanted free flap.
探讨使用非侵入性的埃尔朗根微光导分光光度计（EMPHO II）测量毛细血管内血红蛋白氧合情况，能否提供关于大鼠和人类游离皮瓣氧供及血流的准确数据。
实验性及前瞻性开放性临床研究。
德国大学医院。
30只雄性Wistar大鼠和20例行游离皮瓣显微外科移植的患者（桡侧前臂皮瓣，8例；腓骨骨皮瓣，7例；股外侧肌皮瓣，5例）。
在皮瓣转移前、转移过程中及转移后测量皮肤的血红蛋白氧合情况。
血红蛋白氧合及血红蛋白浓度的可重复性和平均曲线。
所有数值均可重复，仅有轻微波动。大鼠未受伤皮肤（基线值）总血红蛋白浓度的氧合范围为15%至45%（平均23%）。掀起皮瓣后有轻微升高（平均升至37%），可能是反应性充血所致。动脉阻断后几分钟内迅速下降，灌注停止后残余氧合高达20%。1小时后皮瓣完全脱氧。静脉阻断导致类似模式，所有皮瓣在30分钟内脱氧。在临床研究中，血管蒂结扎导致数值大幅下降，但吻合后血红蛋白氧合显著升高（P = 0.05），且术后持续升高。未出现并发症，氧合从皮瓣基部向周边逐渐持续下降。
非侵入性的EMPHO II能提供关于移植游离皮瓣血液循环和氧供的可靠且易于评估的数据。
