高选择性动脉吲哚菁绿造影在游离股前外侧皮瓣设计中的应用

王石; 董帅; 曹阳; 王桂洋; 杨成鹏; 孙丰文; 黄永涛; 郭礼平; 杨亮; 周荣; 巨积辉

doi:10.3760/cma.j.cn501225-20240513-00174

高选择性动脉吲哚菁绿造影在游离股前外侧皮瓣设计中的应用

doi: 10.3760/cma.j.cn501225-20240513-00174

1.
苏州瑞华骨科医院手外科,苏州　　215104
2.
苏州瑞华骨科医院创面修复科,苏州　　　　215104

基金项目:

苏州市医学重点学科 SZXK202127

苏州市科技发展计划 SKYD2023026

详细信息

通讯作者:
巨积辉,Email：gkswk2013@163.com

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出版历程
- 收稿日期: 2024-05-13

Application of highly selective arterial indocyanine green angiography in the design of anterolateral thigh free flap

1.
Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
2.
Department of Wound Repair Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202127

Suzhou Science and Technology Development Plan SKYD2023026

More Information

Corresponding author: Ju Jihui, Email: gkswk2013@163.com

摘要

摘要: 目的介绍高选择性动脉吲哚菁绿造影（以下简称高选择性动脉造影）在游离股前外侧皮瓣设计中的应用。方法该研究为回顾性观察性研究。2023年11月—2024年4月,苏州瑞华骨科医院手外科和创面修复科共收治29例符合入选标准的采用高选择性动脉造影辅助设计的游离股前外侧皮瓣修复四肢创面的患者,其中男26例、女3例,年龄16~71岁,清创后创面面积为8.0 cm×4.5 cm~27.0 cm×16.0 cm。术中,采用高选择性动脉造影辅助设计皮瓣,观察皮瓣源动脉或穿支的荧光显影范围,根据皮肤的荧光显影情况判断皮瓣源动脉或穿支的供血范围,调整皮瓣的切取位置。皮瓣切取面积为9.0 cm×6.0 cm~29.0 cm×16.0 cm。术中观察并记录行高选择性动脉造影的次数、行穿刺的穿支源动脉类型、皮瓣切取位置变化。术后观察皮瓣血运及成活情况、皮瓣供区创面愈合情况和皮片成活情况、造影相关并发症情况。结果 29例患者32个皮瓣均顺利切取,共行高选择性动脉造影37次,其中行旋股外侧动脉斜支穿刺者13例、降支穿刺者6例、斜支与降支双穿刺者8例、其他来源的源动脉穿刺者2例。术中28个皮瓣切取位置未改变,3个皮瓣切取位置向肢体近端移动,1个皮瓣切取位置向肢体远端移动。术后皮瓣均顺利成活,未出现皮瓣远近端部分坏死的情况；皮瓣供区创面愈合,皮片均成活；未出现造影相关并发症。结论采用高选择性动脉造影可在术中判断游离股前外侧皮瓣源动脉及穿支供血范围,更加直观、客观地评价皮瓣的血供,用于辅助皮瓣设计可一定程度上避免因术前设计不合理而导致的皮瓣部分坏死,且安全可靠。
- 血管造影术 /
- 外科皮瓣 /
- 穿支皮瓣 /
- 吲哚菁绿 /
- 动脉造影 /
- 股前外侧皮瓣 /
- 旋股外侧动脉 /
- 创面修复
Abstract: Objective To introduce the application of highly selective arterial indocyanine green angiography (hereinafter referred to as highly selective arterial angiography) in the design of anterolateral thigh free flap. Methods This study was a retrospective observational study. From November 2023 to April 2024, 29 patients with wounds in extremities which were repaired by anterolateral thigh free flaps designed under the assistance of highly selective arterial angiography and met the inclusion criteria were admitted to the Department of Hand Surgery and Department of Wound Repair Surgery of Suzhou Ruihua Orthopedic Hospital, including 26 males and 3 females, aged 16 to 71 years. The wound area after debridement ranged from 8.0 cm×4.5 cm to 27.0 cm×16.0 cm. During the surgery, highly selective arterial angiography was used to assist in flap design. The fluorescence development range of the source arteries or perforators of flaps was observed. The blood supply range of the source arteries or perforators of flaps was determined based on the fluorescence development of the skin, and the excision position of the flap was adjusted. The flap incision area ranged from 9.0 cm×6.0 cm to 29.0 cm×16.0 cm. During the surgery, the number of highly selective arterial angiography, the type of source artery of perforators for puncture, and changes in the excision position of flaps were observed and recorded. After surgery, the blood supply and survival of flaps, the healing of wounds and the survival of skin grafts in the flap donor sites, and the angiography-related complications were observed. Results All the 32 flaps of 29 patients were successfully excised. The highly selective arterial angiography was performed 37 times, including 13 cases of puncture of the oblique branch of the lateral circumflex femoral artery, 6 cases of puncture of the descending branch, 8 cases of double puncture of the oblique and descending branches, and 2 cases of puncture of arteries from other branches. During the surgery, the excision position of 28 flaps did not change, the excision position of 3 flaps moved towards proximal extremity of the thigh, and the excision position of 1 flap moved towards distal extremity of the thigh. All the flaps survived successfully after the surgery, and there was no partial necrosis of the flaps at the proximal or distal ends. The wounds in the flap donor sites healed, and all skin grafts survived. No angiography-related complications occurred. Conclusions Highly selective arterial angiography can be used to determine the blood supply range of the source artery and perforators of the anterolateral thigh free flaps during the surgery. It can evaluate the blood supply of flaps more intuitively and objectively. Its application in assisting flap design can avoid partial flap necrosis caused by unreasonable preoperative design to a certain extent, and it is safe and reliable.
- Angiography /
- Surgical flaps /
- Perforator flap /
- Indocyanine green /
- Arteriography /
- Anterolateral thigh flap /
- Lateral circumflex femoral artery /
- Wound repair
王石：酝酿和设计研究、论文撰写与修改、实施手术、数据采集与分析；董帅、王桂洋：实施手术、数据采集与分析；曹阳、杨成鹏、孙丰文、黄永涛、郭礼平、杨亮：实施手术、数据采集；周荣：实施手术；巨积辉：酝酿和设计研究、实施手术、论文修改、论文指导、经费支持

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参考文献(36)

[1]	周荣,巨积辉,柳志锦,等.多穿支超长股前外侧皮瓣修复足踝部环形创面[J].中华整形外科杂志,2021,37(11):1244-1250.DOI: 10.3760/cma.j.cn114453-20200309-00130.
[2]	芮永军.股前外侧皮瓣在中国的研究进展[J].中华显微外科杂志,2020,43(4):313-325.DOI: 10.3760/cma.j.cn441206-20200628-00277.
[3]	蒋玲丽,李海,魏在荣,等.股前外侧嵌合穿支皮瓣修复糖尿病足溃疡创面[J].中华显微外科杂志,2021,44(2):141-145.DOI: 10.3760/cma.j.cn441206-20200813-00320.
[4]	高钦锋,杨林,黄永涛,等. 穿支位置与穿支穿深筋膜后走行方式对股前外侧皮瓣发生部分坏死的影响初探[J/CD]. 中华损伤与修复杂志(电子版),2024,19(2):141-146. DOI: 10.3877/cma.j.issn.1673-9450.2024.02.008.
[5]	杨林,曹阳,程俊楠,等.以旋股外侧动脉斜支为蒂股前外侧皮瓣的穿支分布特点与临床应用[J].中华整形外科杂志,2023,39(5):463-471.DOI: 10.3760/cma.j.cn114453-20230213-00031.
[6]	邓呈亮,肖顺娥,魏在荣.旋股外侧动脉斜支作为股前外侧游离皮瓣优选血管蒂的可行性研究[J].中华烧伤杂志,2020,36(7):636.DOI: 10.3760/cma.j.cn501120-20190428-00217.
[7]	黄永涛,杨林,程俊楠,等.以旋股外侧动脉横支为蒂的股前外侧皮瓣修复四肢皮肤软组织缺损[J].中华整形外科杂志,2022,38(10):1128-1133.DOI: 10.3760/cma.j.cn114453-20220222-00044.
[8]	柳志锦,巨积辉,刘胜哲,等.内增压型股前外侧双叶皮瓣修复四肢创面的临床应用[J].中华创伤杂志,2020,36(10):920-925.DOI: 10.3760/cma.j.cn501098-20200615-00445.
[9]	胡朝波,裴世杰,孔令福,等.血管增压和超回流技术在游离股前外侧皮瓣中的临床应用[J].中华显微外科杂志,2023,46(3):241-246.DOI: 10.3760/cma.j.cn441206-20220417-00076.
[10]	李星逸,李佳,王曦滔,等.吲哚菁绿荧光成像在胰腺外科中的应用进展[J].中华肝胆外科杂志,2021,27(5):393-396.DOI: 10.3760/cma.j.cn113884-20200603-00301.
[11]	周建峰,沈启阳,李涛.吲哚菁绿荧光显影技术在13例儿童肝母细胞瘤切除中的应用分析[J].中华肝胆外科杂志,2022,28(7):495-498.DOI: 10.3760/cma.j.cn113884-20211119-00376.
[12]	韩涛,季易,邹继军,等.吲哚菁绿淋巴造影在儿童囊性淋巴管畸形诊断中的应用[J].中华整形外科杂志,2021,37(12):1333-1338.DOI: 10.3760/cma.j.cn114453-20200818-00474.
[13]	罗思思,杨喆,李养群.吲哚菁绿血管造影技术在评价带蒂皮瓣血流灌注中的研究进展[J].中华整形外科杂志,2024,40(5):571-575.DOI: 10.3760/cma.j.cn114453-20221031-00347.
[14]	马小睦,刘春军.吲哚菁绿血管造影在皮瓣外科中的应用[J].中华整形外科杂志,2020,36(7):810-816.DOI: 10.3760/cma.j.cn114453-20190828-00261.
[15]	ShokriT,LighthallJG.Perfusion dynamics in pedicled and free tissue reconstruction: infrared thermography and laser fluorescence video angiography[J].Am J Otolaryngol,2021,42(2):102751.DOI: 10.1016/j.amjoto.2020.102751.
[16]	LiK,ZhangZ,NicoliF,et al.Application of indocyanine green in flap surgery: a systematic review[J].J Reconstr Microsurg,2018,34(2):77-86.DOI: 10.1055/s-0037-1606536.
[17]	顾舒晨,李海洲,高雅姗,等.吲哚菁绿荧光造影在背部扩张穿支皮瓣设计中的应用[J].中华整形外科杂志,2020,36(3):251-256.DOI: 10.3760/cma.j.cn114453-20200218-00056.
[18]	徐军辉,张伟,周锦秀,等.游离移植腹股沟皮瓣修复四肢电烧伤创面的临床效果[J].中华烧伤与创面修复杂志,2023,39(11):1030-1037.DOI: 10.3760/cma.j.cn501225-20230804-00039.
[19]	薛乐,刘宾,韩悦,等.吲哚菁绿血管造影在评估皮瓣末梢血运中的应用研究[J].中国美容整形外科杂志,2023,34(3):140-144.DOI: 10.3969/j.issn.1673-7040.2023.03.004.
[20]	完颜超杰,吴中明,张峰瑞,等.吲哚菁绿造影在穿支皮瓣术后血管危象监测中的实验研究[J].实用口腔医学杂志,2022,38(2):178-183.DOI: 10.3969/j.issn.1001-3733.2022.02.005.
[21]	高文华,赵书明,张路,等.吲哚菁绿血管造影技术在四肢软组织缺损修复术中对游离穿支皮瓣血液灌注监测的价值[J].中华创伤杂志,2023,39(10):919-924.DOI: 10.3760/cma.j.cn501098-20230522-00291.
[22]	ShaarawyE,HegazyRA,Abdel HayRM.Intralesional botulinum toxin type A equally effective and better tolerated than intralesional steroid in the treatment of keloids: a randomized controlled trial[J].J Cosmet Dermatol,2015,14(2):161-166.DOI: 10.1111/jocd.12134.
[23]	PhillipsBT,MunabiNCO,RoederRA,et al.The role of intraoperative perfusion assessment: what is the current state and how can I use it in my practice?[J].Plast Reconstr Surg,2016,137(2):731-741.DOI: 10.1097/01.prs.0000475765.83901.80.
[24]	MoyerHR,LoskenA.Predicting mastectomy skin flap necrosis with indocyanine green angiography: the gray area defined[J].Plast Reconstr Surg,2012,129(5):1043-1048.DOI: 10.1097/PRS.0b013e31824a2b02.
[25]	薛兵建,刘元波,臧梦青,等.吲哚菁绿SPY成像技术在皮瓣外科中的应用[J].中华整形外科杂志,2017,33(5):339-344.DOI: 10.3760/cma.j.issn.1009-4598.2017.05.004.
[26]	NewmanMI,JackMC,SamsonMC.SPY-Q analysis toolkit values potentially predict mastectomy flap necrosis[J].Ann Plast Surg,2013,70(5):595-598.DOI: 10.1097/SAP.0b013e3182650b4e.
[27]	AzumaR,MorimotoY,MasumotoK,et al.Detection of skin perforators by indocyanine green fluorescence nearly infrared angiography[J].Plast Reconstr Surg,2008,122(4):1062-1067.DOI: 10.1097/PRS.0b013e3181858bd2.
[28]	杨林,柳志锦,程俊楠,等. 以肌内主干型旋股外侧动脉斜支为蒂股前外侧穿支皮瓣的临床应用[J]. 中国修复重建外科杂志,2022,36(12):1512-1518. DOI: 10.7507/1002-1892.202207012.
[29]	杨林,柳志锦,程俊楠,等.以肌间隔主干型旋股外侧动脉斜支为蒂的股前外侧穿支皮瓣解剖特点与临床应用[J].中华烧伤与创面修复杂志,2022,38(12):1133-1139.DOI: 10.3760/cma.j.cn501225-20220227-00039.
[30]	孙丰文,杨林,程俊楠,等.股前外侧皮瓣术中“降支陷阱”的识别和处理策略[J].中国美容整形外科杂志,2024,35(3):140-144,156.DOI: 10.3969/j.issn.1673-7040.2024.03.004.
[31]	刘族安,黄志锋,马亮华,等.股前外侧皮瓣斜支血管的认识及斜支“陷阱”的处理[J].中华显微外科杂志,2021,44(2):146-151.DOI: 10.3760/cma.j.cn441206-20200724-00299.
[32]	孙丰文,杨林,程俊楠,等.股前外侧皮瓣术中“静脉陷阱”的类型及处理策略[J].中华手外科杂志,2024,40(3):193-198.DOI: 10.3760/cma.j.cn311653-20231229-00120.
[33]	李科,章一新.吲哚菁绿荧光造影技术在皮瓣外科中的应用[J].中华显微外科杂志,2016,39(5):520,插页5-1-插页5-3.DOI: 10.3760/cma.j.issn.1001-2036.2016.05.035.
[34]	杨锴,穆籣,刘岩,等. 吲哚菁绿血管造影在皮瓣手术中的应用价值[J]. 中国修复重建外科杂志,2015,29(9):1113-1116. DOI: 10.7507/1002-1892.20150241.
[35]	杨成鹏,唐林峰,柳志锦,等.以股内侧穿支为血供来源的股前外侧区皮瓣修复四肢创面的疗效[J].中华烧伤与创面修复杂志,2023,39(9):842-848.DOI: 10.3760/cma.j.cn501225-20220726-00310.
[36]	薛明宇,芮永军,寿奎水,等.以股内侧穿支为蒂的皮瓣修复股前外侧皮瓣供区的临床应用[J].中华手外科杂志,2014,30(2):90-92.DOI: 10.3760/cma.j.issn.1005-054X.2014.02.004.

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图 1 应用高选择性动脉吲哚菁绿造影辅助设计的游离股前外侧皮瓣修复患者交通伤致左足创面的效果。1A.行清创术后患者左足背皮肤软组织缺损,跖骨外露；1B.术前根据穿支定位及创面大小预设计皮瓣；1C.术中经旋股外侧动脉降支主干行高选择性动脉吲哚菁绿造影,荧光显影图像显示降支的皮肤供血范围；1D.术中根据造影结果将皮瓣切取位置向肢体远端移动8 cm；1E.术中结合创面大小、形状与降支的荧光显影范围切取皮瓣；1F.术后14 d,患者出院时皮瓣外形稍显臃肿,皮瓣存活良好

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