吲哚菁绿SPY成像技术在皮瓣外科中的应用

Application of indocyanine green SPY imaging in flap surgery

目的探讨吲哚菁绿SPY成像技术评估术中移植皮瓣血供的有效性。方法回顾性分析2016年7月至2017年3月连续收治的35例患者，术中应用吲哚菁绿SPY成像技术评估45个皮瓣血运，其中44个带蒂皮瓣，1个游离皮瓣，切取皮瓣大小2．0cm×1．5cm-34．0cm×17．0cm，在皮瓣掀起后、转移或移植至受区后进行2次SPY检查，记录并统计分析SPY显示皮瓣灌注情况和皮瓣预后的相关性。结果SPY显示皮瓣灌注良好者29个，均未发生坏死。16个SPY提示皮瓣远端部分灌注不佳者，结合医师临床经验，2个进行术中干预处理，全部成活；14个予以保留观察，其中9个皮瓣出现表浅或全层坏死，经换药或清创后二期愈合，5个未发生坏死。预测皮辨坏死的敏感性为100％（9／9），特异性为85．3％（29／34），准确性为88．4％（38／43）。结论吲哚菁绿SPY成像技术在整形外科尤其在皮瓣与重建外科领域是一客观有效的、辅助外科医师评估皮瓣血运、预测皮瓣坏死的手段。

Objective To evaluate the efficacy of indocyanine green SPY imaging in flap surgery. Methods Between July 2016 and March 2017, forty-five flaps of thirty-five consecutive patients were retrospectively analyzed, among which forty-four were pedicled flaps and one was free flap, measuring from 2. 0 cm × 1.5 cm to 34. 0 cm ×17.0 cm. SPY imaging was performed twice for each flap, after the elevation of flap and after flap insertion respectively. The correlation of the flap perfusion detected by SPY and the prognosis of each flap were recorded and analyzed. Results Twenty-nine flaps demonstrated good perfusion on SPY healed uneventfully. Sixteen flaps were demonstrated poor perfusion in the distal part of flap. Two flaps underwent surgical intervention intraoperatively and totally survived. Fourteen flaps were preserved conservatively and nine suffered partial- or full-thickness necrosis. None of the remaining five flaps sustained necrosis. Secondary healing was achieved through regular dressing change or operative debridement. The sensitivity, specificity and accuracy were 100% （9/9）, 85.3% （29/34） and 88.4% （ 38/43 ） respectively. Conclusions Intraoperative indoeyanine green SPY imaging is a useful adjuvant to evaluate flap perfusion and predict necrosis in plastic surgery, enhancing a surgeon＇ s clinical judgment of flap viability.