| Objective: With the rapid development of medical technology,the popularity and application of flap surgery are also becoming more and more extensive.The types and applications of flaps are also increasing rapidly in recent years.In the past,surgeons used to observe the color,finger pressure response,edge bleeding and temperature of flaps to determine the blood flow of flaps during surgery.In recent years,many auxiliary imaging examinations have also been used to determine the blood flow of flaps during surgery,but the sensitivity and specificity have not been agreed by experts.Indocyanine green(ICG)is a fluorescent contrast agent widely used in clinical.It is injected into blood vessels through peripheral veins,and 3.6 mm of subcutaneous tissue and skin can be observed by infrared fluorescence positioning camera,so it can be used to observe the blood flow of intraoperative skin flap.In this study,indocyanine green angiography(ICGA)was used to assist in the design of the preoperative flap and the blood supply of the flap during the operation,so as to observe whether this method can increase the skin flap graft survival and reduction of postoperative complications after flaps.Methods: The clinical data of 78 patients admitted to the Department of Burn and Plastic Surgery of Xi’an Central Hospital from March 2019 to March 2021 were randomly selected and divided into control group of 40 cases according to the order of admission,including 5 cases of trapezius island myocutaneous flaps,4 cases of facial artery perforator flaps,3 cases of anterolateral femoral flaps,1 cases of latissimus dorsi flaps,2 cases of toenail flaps,4 cases of inferior epigastric artery perforator flaps,and 2 cases of peroneal artery perforator flaps.Superiorulnar accessory artery perforator flaps in 3 cases and random flaps in 16 cases.There were 38 patients in the experimental group,including 4 cases of trapezius island myocutaneous flaps,6 cases of facial artery perforator flaps,5 casesof anterolateral femoral flaps,3 cases of inferior epigastric artery perforator flaps,4 cases of latissimus dorsi flaps,3 cases of radial collateral artery perforator flaps and 13 cases of random flaps.The control group underwent traditional flap transplantation,and the experimental group underwent ICGA before and during the operation to evaluate the blood supply of the flap and adjust the surgicalplan based on the results of the angiography.The survival and complications ofskin flap in the experimental group and the control group were compared by test.Age,albumin and blood sugar were compared by t test.Results:The condition of patients in both groups was stable during hospitalization.The mean age of patients in the experimental group was 35.3±15.4 years,blood glucose was 5.2±1.1 mmol/L,albumin was 41.2±6.8 g/L;The average age of patients in control group was 42.0±17.6 years,blood glucose was 5.7±1.3 mmol/L,albumin was 41.6±6.3 g/L.Data comparison showed that the age,blood glucose and albumin P values of patients in the two groups were all greater than 0.05,with no significant statistical differences,so the groups were comparable.Patients in the two groups received surgical treatment respectively,and none of the 38 patients in the experimental group had angiography related complications after ICGA.In the experimental group,3 cases were adjusted according to the results of ICGA and the operation was successfully completed.The other 35 cases were successfully completed according to the preoperative design.In the control group,40 cases were treated with traditional flap surgery,among which 8 cases had blood circulation disorder at the tip of flap,and the operation was ended after corresponding treatment.The other 32 cases were successfully completed according to the preoperative design.Patients in both groups were followed up six months after discharge.There were 1 cases in the experimental group and 3 cases in the control group.The tip of the flap was necrotic after surgery,and the wound healed after dressing change.Postoperative complications were found in 5 cases of flaps,including 1 case of fat liquefaction in theexperimental group,2 cases of fat liquefaction or necrosis in the control group,and the other 2 cases of poor incision healing,which healed after dressing change.The results showed that there was no significant difference in the incidence of abnormal blood supply and flap-related complications between the experimental group and control group(= 0.212,P = 0.645)and(= 0.749,P = 0.387).Conclusion:1.ICGA imaging results can be used to assist in preoperative flap design during flap repair surgery,and the region with strong fluorescence intensity should be selected as the flap donor region as far as possible.2.ICG angiography can be used to evaluate the blood perfusion of the flap in real time during flap surgery,which is helpful to timely adjust the surgical plan of the flap.3.There was no significant difference in the incidence of flap-related complications and abnormal blood supply of the flap between the experimental group guided by the ICGA results and the control group under the traditional operation method. |
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