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  • Title: [Indocyanine green angiography technique assisted brachial artery perforator propeller flap to repair soft tissue defects of trunk and upper limb].
    Author: Xie T, Liu Y, Han T, Zhu S, Zang M, Chen B, Li S.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2021 Feb 15; 35(2):200-205. PubMed ID: 33624474.
    Abstract:
    OBJECTIVE: To explore the feasibility of using indocyanine green (ICG) angiography to detect brachial artery perforators, and the clinical application of brachial artery perforator propeller (BAPP) flaps to repair soft tissue defects of the trunk and upper limbs. METHODS: Between August 2016 and February 2019, ICG angiography was used to detect the perforating vessels of the brachial artery muscle septum, and the BAPP flaps were cut out with the detected perforating vessels as the pedicle to repair 19 cases of trunk and upper limb soft tissue defects. There were 12 males and 7 females, with an average age of 28.6 years (range, 5-66 years). Etiologies included the post-burn scar in 10 cases, soft-tissue sarcoma in 5 cases, congenital melanocytic nevi in 2 cases, chronic chest wall ulcer in 1 case, and malignant melanoma in 1 case. Defects located in axilla in 8 cases, chest wall in 4 cases, elbow in 5 cases, and shoulder in 2 cases. The area of the defect ranged from 15 cm×3 cm to 20 cm×8 cm. Pre-transfer tissue expansion was used in 11 patients. Thirteen flaps were pedicled with 1 perforator vessel, and 6 flaps were pedicled with 2 perforator vessels. The length of the vascular pedicle was 2.5-4.5 cm, with an average of 3.08 cm. The area of the skin flap ranged from 11 cm×5 cm to 22 cm×10 cm. The flap rotation angle was 110° in 1 case, 120° in 1 case, and 180° in 17 cases. Except for one donor site repaired by skin graft, the other donor sites were directly sutured. RESULTS: A total of 24 perforating vessels of the brachial artery muscle septum were detected by ICG angiography, 26 were identified during the operation, with an accuracy rate of 92.31%. Eighteen flaps survived without arteriovenous crisis. Venous congestion was observed in the distal 3-cm of one flap and the flap survived after conservative management. Intraoperative analysis showed that the blood perfusion of the distal 4-cm of one flap was poor, the relative value was less than 32%, the flap survived after removing the poor perfusion area. All the patients were followed up 3 to 23 months (mean, 8.6 months). The color and texture of the flap were similar to those of the recipient area. Flap debulking was not needed in all patients owing to the thinness of the flap. The contracture symptoms of patients with scar contracture on the medial of the elbow joint and axilla were significantly improved; a patient with malignant melanoma underwent tumor resection at 1 year and 5 months after operation due to tumor recurrence, and additional surgery was done to remove the recurrent tumor. No tumor recurrence was found in other patients. CONCLUSION: The ICG angiography technique can be used to explore the perforating vessels of the brachial artery muscle septum. The BAPP flap pedicled with the perforating vessels can be used for the repair of skin and soft tissue defects in the chest wall, axilla, shoulder, and elbow joint. 目的: 探讨应用吲哚菁绿(indocyanine green,ICG)血管造影技术探测肱动脉穿支血管的可行性,以及应用肱动脉穿支螺旋桨(brachial artery perforator propeller,BAPP)皮瓣修复躯干和上肢软组织缺损的临床效果。. 方法: 2016 年 8 月—2019 年 2 月,应用 ICG 血管造影技术探测肱动脉肌间隔穿支血管,并以探测到的穿支血管为蒂切取 BAPP 皮瓣,修复躯干和上肢软组织缺损 19 例。其中男 12 例,女 7 例;年龄 5~66 岁,平均 28.6 岁。病因:烧伤后瘢痕挛缩 10 例,软组织肉瘤 5 例,先天性黑色素痣 2 例,慢性胸壁溃疡 1 例,恶性黑色素瘤 1 例。部位:腋窝 8 例,胸壁 4 例,肘部 5 例,肩部 2 例。软组织缺损范围为 15 cm×3 cm~20 cm×8 cm。11 例于皮瓣转移前行扩张手术。13 个皮瓣以 1 支穿支血管为蒂,6 个皮瓣以 2 支穿支血管为蒂,血管蒂长度为 2.5~4.5 cm,平均 3.08 cm。皮瓣切取范围为 11 cm×5 cm~22 cm×10 cm。皮瓣旋转角度分别为 110° 1 例、120° 1 例、180° 17 例。除 1 个皮瓣供区植皮修复外,其他皮瓣供区均直接拉拢缝合。. 结果: ICG 血管造影技术共探测到 24 支肱动脉肌间隔穿支血管,术中找到 26 支,准确率为 92.31%。术后所有皮瓣全部成活,无动、静脉危象发生。术中 1 个皮瓣远端 4 cm 处血液灌注不良,相对值低于 32%,切除灌注不良区域后皮瓣顺利成活;术后 1 个皮瓣远端 3 cm 处出现静脉淤血,经针刺放血、按摩等保守治疗后成活。19 例均获随访,随访时间 3~23 个月,平均 8.6 个月。所有皮瓣菲薄,颜色、质地与受区相似,无需二次手术去脂修薄。肘关节内侧和腋窝瘢痕挛缩患者术后挛缩症状明显改善;1 例恶性黑色素瘤患者术后 1 年 5 个月因肿瘤复发再次行肿瘤切除术,其他肿瘤患者未见复发。. 结论: ICG 血管造影技术可用于探测肱动脉肌间隔穿支血管,以该穿支血管为蒂的 BAPP 皮瓣可用于胸壁、腋窝、肩部和肘关节内侧皮肤软组织缺损的修复。.
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