吲哚菁绿血管造影辅助下设计切取扩张皮瓣整复瘢痕的临床效果

胡雅楠; 谢婷珺; 刘元波; 朱珊; 杨增杰; 田佳; 甘承; 焦虎; 李杉珊; 陈子翔; 周璐; 韩兵; 晋圣阳; 曾妍; 汪淼; 臧梦青

doi:10.3760/cma.j.cn501225-20250108-00013

吲哚菁绿血管造影辅助下设计切取扩张皮瓣整复瘢痕的临床效果

doi: 10.3760/cma.j.cn501225-20250108-00013

中国医学科学院北京协和医学院整形外科医院瘢痕与创面治疗中心,北京　　100144

基金项目:

中国医学科学院医学与健康科技创新工程项目 2023-I2M-C&T-B-104

详细信息

通讯作者:
臧梦青,Email：zangmengqing@sina.com

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出版历程
- 收稿日期: 2025-01-08

Clinical effect of indocyanine green angiography-assisted design and harvest of expanded flaps for scar reconstruction

Scar and Wound Treatment Center, Plastic Surgery Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100144, China

Funds:

Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences 2023-I2M-C&T-B-104

More Information

Corresponding author: Zang Mengqing, Email: zangmengqing@sina.com

摘要

摘要: 目的探讨在吲哚菁绿血管造影（ICGA）辅助下设计、切取扩张皮瓣整复瘢痕的临床效果。方法该研究为回顾性观察性研究。2019年4月—2023年8月,中国医学科学院北京协和医学院整形外科医院收治19例符合入选标准的瘢痕患者,其中男8例、女11例,年龄3~38岁,瘢痕分布于头面部、躯干及四肢。Ⅰ期手术：于瘢痕周围选择合适区域埋置皮肤软组织扩张器行皮肤软组织扩张术。Ⅱ期手术：切除瘢痕组织（形成创面面积100~210 cm²）并设计扩张皮瓣,行ICGA确定扩张皮瓣的目标穿支及其伴行静脉,调整皮瓣设计确保包含完整动静脉轴,使用单侧回切法切取面积为120~240 cm²扩张皮瓣并转移至受区。直接缝合供区创面。记录扩张皮瓣设计过程中ICGA的动脉期和静脉期持续时间。统计不同部位回切皮瓣的长宽比。Ⅱ期术后,观察皮瓣的血流灌注及成活情况、供区创面愈合情况及并发症发生情况。随访时,观察患者皮瓣外观、色泽和质地。结果 ICGA的动脉期持续时间为10~27（18±5）s,静脉期持续时间为78~116（100±10）s。头面部、躯干和四肢的回切皮瓣长宽比分别为1.22±0.32、1.63±0.12和1.15±0.21。Ⅱ期术后,1例患者皮瓣存在大面积血流灌注不足,通过比较转移皮瓣前后的ICGA图像,行松开口角处的缝线处理,皮瓣血运得以恢复；其余患者皮瓣血流灌注良好。皮瓣均完全成活；供区创面愈合良好,无并发症发生。随访0.5~14.0个月显示,所有患者皮瓣外观良好,色泽和质地与周围皮肤相近。结论 ICGA作为浅表血流可视化手段,不仅可以清晰呈现术前扩张皮瓣的微血管分布,辅助优化皮瓣设计,还能够评估术后皮瓣的血流灌注情况,减少并发症的发生,为扩张皮瓣的切取提供全程导航,提高该皮瓣转移整复瘢痕手术的安全性。
- 瘢痕 /
- 血管造影术 /
- 穿支皮瓣 /
- 吲哚菁绿血管造影 /
- 皮肤软组织扩张术 /
- 皮瓣设计 /
- 创面修复
Abstract: Objective To investigate the clinical effect of indocyanine green angiography (ICGA)-assisted design and harvest of expanded flaps for scar reconstruction. Methods This study was a retrospective observational study. From April 2019 to August 2023, 19 patients with scars (8 males, 11 females; aged 3-38 years) treated at the Plastic Surgery Hospital of Peking Union Medical College and Chinese Academy of Medical Sciences met the inclusion criteria. The scars were distributed on the head, face, trunk, and extremities. In stage Ⅰ surgery, skin soft tissue expanders were implanted in suitable areas around the scars for skin soft tissue expansion. In stage Ⅱ surgery, the scar tissue was excised, resulting in wound areas ranging from 100 to 210 cm², and expanded flaps were designed. ICGA was used to identify target perforators and their accompanying veins, and the flap design was adjusted to ensure the inclusion of complete arterial and venous axes. The expanded flap with an area of 120 to 240 cm² was harvested using unilateral back-cut technique and transferred to the recipient site, and the donor site wound was sutured directly. The durations of the arterial and venous phases of ICGA during flap design were recorded. The length-to-width ratios of the back-cut flaps were calculated for different regions. After stage Ⅱ surgery, the blood perfusion and survival of the flap, the wound healing at the donor site, and the occurrence of complications were observed. During follow-up, the appearance, color, and texture of the patient's flap were observed. Results The arterial phase of ICGA lasted 10-27 (18±5) s, and the venous phase lasted 78-116 (100±10) s. The length-to-width ratios of the back-cut flaps were 1.22±0.32, 1.63±0.12, and 1.15±0.21 for the head and neck, trunk, and limb regions, respectively. After stage Ⅱ surgery, one patient had a large area of insufficient blood perfusion in the flap. By comparing ICGA images before and after flap transfer, the sutures at the oral commissure were loosened, the blood flow of the flap was restored. The blood perfusion of the flaps in other patients was good. All flaps survived completely, with well-healed donor site wounds and no complications. During 0.5-14.0 months of follow-up, all flaps of patients demonstrated excellent appearance, with color and texture matching the surrounding skin. Conclusions As a means of superficial blood flow visualization, ICGA can not only clearly show the microvascular distribution of the expanded flap before operation, assist in optimizing the design of the flap, but also evaluate the blood perfusion of the flap after operation, reduce the occurrence of complications, and provide a full-process navigation for the harvesting of expanded flaps, thereby improving the safety of flap transfer for scar reconstruction.
- Cicatrix /
- Angiography /
- Perforator flap /
- Indocyanine green angiography /
- Skin and soft tissue expansion /
- Flap design /
- Wound repair
胡雅楠：采集资料、分析数据、撰写文章；谢婷珺、刘元波、朱珊、杨增杰、田佳、甘承、焦虎、李杉珊：实施手术、分析数据、修改文章；陈子翔、周璐、韩兵、晋圣阳、曾妍、汪淼：实施手术、采集资料、分析数据；臧梦青：酝酿和设计研究、实施手术、采集资料、修改文章

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图 1 吲哚菁绿血管造影（ICGA）辅助下设计切取扩张皮瓣修复例1患者右腿瘢痕切除后形成的创面的效果。1A.Ⅱ期术前,瘢痕及扩张皮瓣情况；1B.Ⅱ期术前,扩张皮瓣的ICGA动脉期显像,其中红色箭头指示动脉穿支,白色虚线为回切设计线,白色箭头指示回切终点；1C.Ⅱ期术前,扩张皮瓣的ICGA静脉期显像,黄色箭头指示浅表静脉,白色虚线和白色箭头指示内容同图1B；1D.Ⅱ期术前皮瓣设计,红色箭头指示回切终点；1E.转移皮瓣后再次行ICGA检查,血流灌注情况良好；1F.皮瓣转移术后即刻

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图 2 吲哚菁绿血管造影（ICGA）辅助下设计切取扩张皮瓣修复例2患者面部瘢痕切除后形成的创面的效果。2A.Ⅱ期术前,瘢痕情况及扩张皮瓣设计；2B.Ⅱ期术前,扩张皮瓣的ICGA动脉期显像,红色箭头指示穿支及其分支；2C.Ⅱ期术前,扩张皮瓣的ICGA静脉期显像,黄色箭头指示图2B中穿支及其分支的伴行浅表静脉；2D.Ⅱ期术中,首次ICGA检查显示回切皮瓣血流灌注可；2E.皮瓣与创面切口完全缝合后,第2次ICGA检查显示皮瓣血流灌注情况,白色虚线圈内区域（患者下唇部）存在动脉血流灌注不足；2F.松开口角处缝线后,第3次ICGA检查显示白色虚线圈内下唇区域血流灌注改善；2G.术后12.0个月随访,皮瓣外观良好,色泽和质地与周围皮肤相近

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