- 期刊
Preliminary Outcome of Free Flap Monitoring by Laser Doppler Imager
雷射都卜勒微流影像儀監測自由皮瓣─初期報告
摘要
背景：自由皮瓣的監測，尤其是在外傷後肢體重建，目前仍是一大考驗。雖然傳統的監測方式如皮膚溫度、顏色、飽滿度及微血管回流是簡單及非侵襲性的，但是卻缺乏客觀性而且容易因監測的人不同而判斷不同。雷射都卜勒微流影像儀已經廣為用於監測表皮血流情形，本文試著探討其在皮瓣監測的角色。目的及目標：本文討論雷射都卜勒微流影像儀在自由皮瓣的監測經驗以及討論其對臨床判讀的輔助角色。材料及方法：在2011四月至2011七月，26位病患接受自由皮瓣肢體重建，術後我們使用雷射都卜勒微流影像儀來監測皮瓣血液循環。除皮瓣血循測量值外，周遭皮膚血循測量值也一併測量。血循指數定義為皮瓣血循測量值除周遭皮膚血循測量值以避免周遭因素影響測量值。結果：26位病患當中，有兩塊皮瓣發生靜脈回流不良而需要回開刀房進行探查手術，手術前血循指分別是數0.165及0.168。其中一塊皮瓣完全存活另一塊皮瓣有部分皮膚壞死。兩塊肌肉皮辦發生皮膚壞死但肌肉部分是存活的。總體來說有22塊皮瓣是完整的。血循指數的範圍從0.5到0.9。手術後第一天平均血循指數0.68±0.08（0.55－0.85），術後第二天平均血循指數是0.68±0.09（0.52－0.87），術後第三天平均血循指數是0.73±0.08（0.59－0.89）。結論：在臨床面對有問題的皮瓣時，雷射都卜勒微流影像儀可以提供一個輔助的測量。若血循指數在0.5到0.9之間的皮瓣可以確認其血循完整性。
關鍵字
無資料並列摘要
Background:Monitoring of the viability of free flap after reconstruction in traumatic extremities remained a challenge issue. Although traditional methods assessed by temperature, color, capillary refilling and turgor of skin are easy and non-invasive, they are not objective and varied from person to person. Laser Doppler imager (LDI) has been widely used as an objective tool in determination of the cutaneous blood flow. This instrument may be useful in free flap monitor.Aim and Objectives:In this article we presented our experiences in free tissue monitor with LDI and reviewed its application in microsurgical reconstructive surgery.Materials and Methods:Between April 2011 and July 2011, 26 patients who received extremities reconstruction with free tissue transfer were included in this study. LDI was used to monitor the microcirculation while staying in our intensive care center. The blood flow statistics were captured and compared with the surrounding skin. Perfusion index (PI) was defined as the perfusion unit of flap divided by the perfusion unit of surrounding skin in order to eliminate the surrounding factors that may influence the assessment.Results:Of the 26 patients, two flaps experienced venous congestion and underwent exploration surgery. Pre-exploration PI level was 0.165 and 0.168 respectively. One flap had total flap survival and another flap had partial skin loss after exploration.Two musculocutaneous flaps developed total skin loss with intact perfusion of muscle flap. Of the 26 flaps, 22 flaps were intact and well survived with the range of PI from 0.5 to 0.9. The mean PI of the uneventful 22 flaps was 0.68 ± 0.08 (0.55-0.85) on the first post operation day, 0.68 ± 0.09 (0.52-0.87) on the second post operation day and 0.73 ± 0.08 (0.59-0.89) on the third post operation day.Conclusion:When facing compromised flap with difficulty in clinical judgment, LDI may provide an objective measurement. Perfusion index ranged from 0.5 to 0.9 could represent the integrity of the flap perfusion.