红外线热成像技术在游离股前外侧穿支皮瓣设计中的应用

目的:探讨采用红外线热成像技术在游离股前外侧穿支皮瓣移植术的临床应用。方法:自2014年6月至2018年6月,采用红外线热成像仪和多普勒血流探测仪对采用游离股前外侧穿支皮瓣移植术的31例四肢不同程度皮肤软组织缺损患者进行穿支动脉定位,其中男21例,女10例;年龄16～59(35.3±1.5)岁;病程2～4(1.8±0.6)周。根据多普勒血流探测仪数据及热成像图参数观察穿支数量、皮肤穿支点位置、穿支点活力以指导皮瓣设计,将检测结果与术中观察到的穿支动脉数据进行对比。结果:术中多普勒血流探测仪共发现设定范围内穿支动脉52支,术中证实穿支动脉38支,准确率为73.1%;术中红外线热成像仪共发现设定范围内穿支动脉38支,术中证实穿支动脉35支,准确率为92.1%;两组比较差异有统计学意义。多普勒血流探测仪发现最具活力穿支点通过术中证实,准确率为80.6%;红外线热成像仪发现的最具活力穿支点通过术中证实,准确率为100%;两组比较差异有统计学意义。31例皮瓣全部成活,均无血管危象发生。术后31例获得随访,时间6～18(10.7±1.2)个月。成活皮瓣质地柔软、血运良好,色泽与正常皮肤基本一致,肢体外观和功能恢复良好。结论:红外线热成像技术可作为一种新的技术应用于游离股前外侧穿支皮瓣移植术的穿支动脉定位实践中。

Application of infrared thermal imaging technology in the design of free anterolateral thigh perforator flap transplantation

Objective: To explore clinical effect of infrared thermal imaging technology for the treatment of free anterolateral thigh perforator flap transplantation. Methods: From June 2014 to June 2018,31 patients with skin defect at various degrees treated by free anterolateral thigh perforator flap transplantation,including 21 males and 10 females aged from 16 to 59 years old with an average age of(35.3±1.5) years old,the courses of disease ranged from 2 to 4 weeks with an average of (1.8±0.6) weeks. The number of perforating branch,the position of the perforating branch,the perforating branch vitality detected by Doppler blood stream detector and parameters of thermal imaging image in order to guide design of skin flap,and compared results with the data of perforator arteries observed during the operation. Results: Totally 52 branches of perforating arteries were detected by Doppler blood stream detector during operation,and 38 perforator branches were confirmed in operation,the accuracy rate was 73.1%. Thirty-eight branches of perforating arteries were detected by infrared thermography during operation,and 35 branches of perforating branches were confirmed in operation,the accuracy rate was 92.1%; there were statistical difference. The most dynamic perforating pivot found by Doppler blood stream detector was confirmed by intraoperative diagnosis,with an accuracy rate of 80.6%. The most dynamic perforating pivot found by infrared thermography is confirmed by intraoperative diagnosis,with an accuracy rate of 100%;there were statistical difference. Thirty-one flaps were survived without vascular crisis occurred. All patients were followed up from 6 to 18 months with an average of(10.7±1.2) months. The flaps survived with soft texture and good blood circulation,the defect was not bloated,the color of skin flap was basically the same as that of the normal skin,and the limbs appearance and function recovered well. Conclusion: Infrared infrared thermal imaging technology could be used as a new technology in localization of perforator artery in free anterolateral thigh perforator flap transplantation.