红外血管成像技术在动脉化静脉皮瓣游离移植中的临床应用

Clinical application of infrared vascular imager in the transplantation of free arterialized venous flaps

目的探讨红外血管成像技术应用于动脉化静脉皮瓣游离移植中的可行性及其临床效果。方法回顾性分析2019年3月至2020年11月温州医科大学附属第二医院手显微外科采用动脉化静脉皮瓣游离移植修复手部创面的患者资料。在红外血管成像仪辅助下,根据Goldschlager分型中的Ⅲ型设计合适的静脉皮瓣血管走行,放大镜辅助下切取皮瓣,将游离的静脉皮瓣移植于受区创面。术后观察皮瓣修复情况,包括皮瓣血运、颜色、质地、成活情况,患指屈、伸活动度和前臂供区外观。采用中华医学会手外科学会上肢部分功能评定试用标准评价手功能。结果共纳入17例患者,男性11例,女性6例,年龄19~68岁,平均34.6岁。共设计切取18个皮瓣,皮瓣大小为2.0 cm×3.0 cm~8.0 cm×9.0 cm。术后随访3~12个月,平均6个月,8个皮瓣术后2 d出现水疱,予抬高患肢保持水疱完整性,术后1周皮瓣水疱消退;7个皮瓣术后2 d出现淤血情况,经抬高患肢、拆除部分缝线等常规处理2周后逐渐自行消退;1个皮瓣术后1周出现渐进性低灌注状态,经保温、抗凝、扩血管及高压氧对症处理后无明显改善,最终坏死。完全成活17个皮瓣,完全坏死1个皮瓣。所有成活皮瓣无臃肿,外观佳,2例植皮区色素沉着,患指屈、伸活动度良好。16例(除去1例完全坏死皮瓣)成活皮瓣的患者手部功能评价结果:优11例,良5例。结论红外血管成像技术具有非接触、无创、操作简单、直观精确等优点,可实现直视下快速设计静脉皮瓣,是动脉化静脉皮瓣移植的得力辅助工具。

Objective To explore the feasibility and clinical effect of the infrared vascular imager in the transplantation of free arterialized venous flaps.Methods A retrospective analysis was conducted with patient data of hand microsurgery using free arterialized venous flaps to repair hand wounds in the Second Affiliated Hospital of Wenzhou Medical University from March 2019 to November 2020.An arterialized venous flap was designed according to the Goldschlager’s TypeⅢflap design with the aid of a magnifying glass following the venous course.The flap was transfer to cover the wound of the recipient area.The reconstructive effect was observed postoperatively,including the blood supply,color,texture,survival of the flap,the flexion and extension of the affected finger,and the appearance of the forearm donor site.The hand function was evaluated by the Chinese Medical Association Hand Surgery Society’s upper limb function evaluation trial standard.Results A total of 17 patients were included,including 11 males and 6 females,ranging in age from 19 to 68 years old,with an average age of 34.6 years.A total of 18 skin flaps were designed and elevated,and the flap size ranged from 2.0 cm×3.0 cm to 8.0 cm×9.0 cm.The patients were followed up 3 to 12 months after the operation,with an average follow-up of 6 months.Blisters appeared on the second day after the operation in 8 flaps,and the affected limbs were raised to maintain the integrity of the blisters.The blisters of the flaps subsided one week after the operation.Congestion occurred on the second day after operation in 7 flaps,which subsided after two weeks after routine treatment,such as raising the affected limb and removing some sutures.One flap developed progressive hypoperfusion one week after the operation,and eventually necrosis.Seventeen flaps survived,and one flap failure was observe.All the surviving skin flaps were free of bloat and had a good appearance.In two cases,the skin graft area was pigmented,and the flexion and extension activities of the affected fingers were suitable.Using the Chinese Medical Association Society of Hand Surgery’s upper limb function evaluation trial standard,16 patients(excluding one flap failure)were evaluated for hand function,showing 11 cases were excellent and 5 cases were good.Conclusions Infrared vascular imaging technology enables free arterialized venous flap transplantation to realize non-contact,non-invasive,simple operation,intuitive and accurate,and truly realizes rapid flap design under direct vision.Infrared vascular imaging technology is an effective auxiliary tool for free arterialized venous flap transplantation.