Stranc M F, Sowa M G, Abdulrauf B, Mantsch H H
Department of Plastic Surgery, University of Manitoba, Health Sciences Centre, Winnipeg, Canada.
Br J Plast Surg. 1998 Apr;51(3):210-7. doi: 10.1054/bjps.1997.0088.
Prolonged and severe tissue hypoxia results in tissue necrosis in pedicled flaps. We demonstrate the potential of near-infrared spectroscopy for monitoring of skin flaps. This approach clearly identifies tissue regions with low oxygen supply, and also the severity of this challenge, in a rapid and non-invasive manner with a high degree of reproducibility. Tissue haemoglobin oxygen saturation and water content of pre-selected dorsal sites were monitored for 72 h prior to, and 72 h following elevation of a reversed McFarlane rat dorsal skin flap (n = 9). Oxygen delivery to flap tissue dropped immediately upon flap elevation. This was most pronounced in the distal half of the flap and least pronounced in the region nearest its base. Haemoglobin oxygen saturation of tissue proximal to the vascular base of the flap recovered, exceeding pre-elevation saturation values, within 6 h of raising the flap. Typically, this higher haemoglobin oxygen saturation persisted for the full 72 h post-elevation observation period. At a distance greater than 2 cm from the vascular pedicle, the tissue remained hypoxic over the post-elevation monitoring period. Tissues remaining below a certain haemoglobin oxygen saturation threshold (oxygen saturation index < 1) for prolonged periods (> 6 h) became increasingly dehydrated, eventually becoming visibly necrotic. Tissues above this threshold (oxygen saturation index > 1), despite being significantly hypoxic, relative to the pre-elevation saturation values, remained viable over the 72 h post-elevation monitoring period.
长时间严重的组织缺氧会导致带蒂皮瓣组织坏死。我们展示了近红外光谱技术在监测皮瓣方面的潜力。这种方法能够以快速、无创且高度可重复的方式清晰识别出氧气供应不足的组织区域以及这种挑战的严重程度。在翻转的麦克法兰大鼠背部皮瓣掀起前72小时及掀起后72小时，对预先选定的背部区域的组织血红蛋白氧饱和度和含水量进行监测（n = 9）。皮瓣掀起后，皮瓣组织的氧气输送立即下降。这在皮瓣远端最为明显，在最靠近其基部的区域最不明显。皮瓣血管基部近端组织的血红蛋白氧饱和度在皮瓣掀起后6小时内恢复，超过掀起前的饱和度值。通常，这种较高的血红蛋白氧饱和度在掀起后的整个72小时观察期内持续存在。在距血管蒂大于2厘米处，组织在掀起后的监测期内一直处于缺氧状态。长时间（> 6小时）保持低于一定血红蛋白氧饱和度阈值（氧饱和度指数< 1）的组织脱水越来越严重，最终明显坏死。高于此阈值（氧饱和度指数> 1）的组织，尽管相对于掀起前的饱和度值明显缺氧，但在掀起后的72小时监测期内仍保持存活。
