ABSTRACT
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 indocyanine 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.
ABSTRACT
Objective To carried out rat as deep inferior epigastic perforator (DIEP) flap necrosis model,to reveal the continuous blood fluid change in process of flap necrosis.Methods Seven SpragueDawley rats of male were used.The designed DIEP flap model was pedicled on the right-sided cranial perforator.Near-infrared fluorescent angiography was performed using SPY imaging system pre-and-aft operation and all angiography videos were compared and analyzed.Results Using SPY imaging system could observe the process of the blood fluid scattered from perforator through choke anastomoses to next vascular territories in living body.The study could clearly observe sequence change of blood fluid pr-and-aft operation,which could give the important information in revealing the reason of necrosis in DIEP flap.Cross-midline traffic vascular sparse and eventually could no longer wear through the contralateral abdominal wall vessel area and open in the region of lateral thoracic vascular occlusion of blood vessels to reach the flap to the far left side,and showed no blood flow in the dark zone.Conclusion The reasons of necrosis of contralateral distal zone of the flap model,are the choke anastomoses across the midline to the contralateral side appeared small,less intensity and the blood supply to contralatral distal zone should through twice choke anastomoses.