摘要
目的分析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有效性。方法采用回顾性病例系列研究分析2019年8月至2022年10月华北医疗健康集团邢台总医院收治的26例采用游离穿支皮瓣修复四肢软组织缺损患者的临床资料, 其中男21例, 女5例;年龄20~59岁[(39.5±4.1)岁]。创面大小为2.0 cm×5.0 cm~12.0 cm×16.0 cm。受伤至手术时间为5~30 d[(16.2±1.9)d]。术中采用吲哚菁绿血管造影技术分别于游离穿支皮瓣完全切取但血管蒂未切断之前、游离穿支皮瓣与受区血管吻合通血并与周围组织缝合后即刻, 评估皮瓣区血液灌注情况。对两次吲哚菁绿血管造影技术显示皮瓣血液灌注程度进行一致性检验, 判断皮瓣移植后吻合口是否通畅。术后14 d观察第2次吲哚菁绿血管造影技术显示血液灌注充足患者的皮瓣成活状况, 比较吲哚菁绿血管造影技术显示皮瓣区血液灌注差的部分与该部分实际坏死发生状况有无差异, 计算吲哚菁绿血管造影技术评估皮瓣区血液灌注方面的灵敏度、特异度、准确率、阴性预测值及阳性预测值。结果患者均获随访14~21 d[(17.4±3.5)d]。两次吲哚菁绿血管造影技术显示皮瓣区血液灌注情况一致性程度均很强, 差异无统计学意义(Kappa系数均为1.00, P<0.01)。所有患者皮瓣移植后吻合口通畅。术后14 d, 第2次吲哚菁绿血管造影技术皮瓣区全部显影为1级11例, 显影最差部分为2级7例, 3级5例, 4级3例。对于皮瓣全部显影为1级及显影最差部分为2级的患者, 皮瓣全部成活;对于皮瓣显影最差部分为3级和4级的患者, 皮瓣血运差的区域全层或表浅部分皮瓣坏死者5例, 皮瓣成活良好者3例。吲哚菁绿血管造影技术评估皮瓣区血液灌注方面的灵敏度为100%(95%CI 0.46, 1.00), 特异度为85.71%(95%CI 0.63, 0.96), 准确率为88.46%(95%CI 0.76, 1.00), 阴性预测值为100%(95%CI 0.78, 1.00), 阳性预测值为62.50%(95%CI 0.26, 0.90)。结论吲哚菁绿血管造影技术实时显影效果好, 敏感度、特异度及准确率较高, 是一种了解四肢软组织缺损修复术中皮瓣血运状况、预测皮瓣坏死情况的客观监测方法。
Objective To analyze the effectiveness of indocyanine green angiography in monitoring blood perfusion of free perforator flap during repair surgery of limb soft tissue defect.Methods A retrospective case series study was conducted to analyze the clinical data of 26 patients who underwent free perforator flap repair of soft tissue defects in the limbs in Xingtai General Hospital of North China Medical and Health Group from August 2019 to October 2022.The patients included 21 males and 5 females,aged 20-59 years[(39.5±4.1)years].The wound size ranged from 2.0 cm×5.0 cm to 12.0 cm×16.0 cm.The time from injury to surgery was 5-30 days[(16.2±1.9)days].During the surgery,indocyanine green angiography was used to evaluate the blood perfusion in the flap area after the free perforator flap was completely cut but before the vascular pedicle was not cut off,and immediately after the free perforator flap was anastomosed with the recipient area′s blood vessels and sutured with surrounding tissues.Consistency testing was performed on the degree of blood perfusion of the skin flap displayed by two indocyanine green angiography tests to determine whether the anastomosis of the skin flap was unobstructed after transplantation.On 14 days after surgery,the second indocyanine green angiography technique was applied to measure the survival of flaps in patients with sufficient blood perfusion.The difference between the poor blood perfusion in the flap arearevealed by indocyanine green angiography technique and the actual necrosis occurrence in this part was compared.The sensitivity,specificity,accuracy,negative predictive value,and positive predictive value of indocyanine green angiography were calculated for evaluating blood perfusion in the flap area.Results All the patients were followed up for 14-21 days[(17.4±3.5)days].Two indocyanine green angiography tests showed strong consistency in blood perfusion in the flap area,with no statistically significant difference(Kappa coefficients of 1.00,P<0.01).All the patients had unobstructed anastomosis after flap transplantation.On 14 days after surgery,the second indocyanine green angiography test showed all skin flap areas as grade 1 in 11 patients,with the worst developed areas as grade 2 in 7 patients,grade 3 in 5,and grade 4 in 3.All the flaps survived in the 18 patients with flaps showing grade 1 development and the worst part showing grade 2 development;among the 8 patients with the worst developed areas being grade 3 and grade 4,5 patients were found with skin flap necrosis(full thickness or superficial)in the areas with poor blood supply,and the skin flap survived well in 3 patients.Indocyanine green angiography in evaluating blood perfusion in the flap area showed the sensitivity of 100%(95%CI 0.46,1.00),the specificity of 85.71%(95%CI 0.63,0.96),the accuracy of 88.46%(95%CI 0.76,1.00),the negative predictive value of 100%(95%CI 0.78,1.00),and the positive predictive value of 62.50%(95%CI 0.26,0.90).Conclusion Indocyanine green angiography has good real-time imaging effect,with high sensitivity,specificity and accuracy,making it an objective method for monitoring the blood flow status of skin flaps and predicting skin flap necrosis.
作者
高文华
赵书明
张路
李栋
樊安未
Gao Wenhua;Zhao Shuming;Zhang Lu;Li Dong;Fan Anwei(Third Department of Orthopedics,Xingtai General Hospital of North China Medical and Health Group,Xingtai 054000,China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2023年第10期919-924,共6页
Chinese Journal of Trauma
基金
河北省重点研发计划自筹项目(182777243)。
作者简介
通信作者:樊安未,Email:848906630@qq.com,电话:15131901088。
