PDF(Pubmed)
Abstract：
BACKGROUND: Arteriovenous (AV) loops help to overcome absent or poor-quality recipient vessels in highly complex microvascular free flap reconstruction cases. There are no studies on blood flow and perfusion patterns. The purpose of this study was to evaluate and compare intraoperative hemodynamic characteristics of AV loops followed by free tissue transfer for thoracic wall and lower extremity reconstruction.
METHODS: this prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the assessment of blood flow volume, arterial vascular resistance and intrinsic transit time at the time of AV loop construction and on the day of free flap transfer.
RESULTS: A total of 11 patients underwent AV loop creation, of whom five required chest wall reconstruction and six required reconstruction of the lower extremities. In seven of these cases, the latissimus dorsi flap and in four cases the vertical rectus abdominis myocutaneous (VRAM) flap was used as a free flap. At the time of loop construction, the blood flow volume of AV loops was 466 ± 180 mL/min, which increased to 698 ± 464 mL/min on the day of free tissue transfer (p > 0.1). After free flap anastomosis, the blood flow volume significantly decreased to 18.5 ± 8.3 mL/min (p < 0.001). There was no significant difference in blood flow volume or arterial vascular resistance between latissimus dorsi and VRAM flaps, nor between thoracic wall and lower extremity reconstruction. However, a significant correlation between the flap weight and the blood flow volume, as well as to the arterial vascular resistance, was found (p < 0.05).
CONCLUSIONS: This is the first study to perform intraoperative blood flow and hemodynamic measurements of AV loops followed by free tissue transfer. Our results show hemodynamic differences and contribute to deeper understanding of the properties of AV loops for free flap reconstruction.
METHODS: this prospective clinical study combined Transit-Time Flowmetry and microvascular Indocyanine Green Angiography for the assessment of blood flow volume, arterial vascular resistance and intrinsic transit time at the time of AV loop construction and on the day of free flap transfer.
RESULTS: A total of 11 patients underwent AV loop creation, of whom five required chest wall reconstruction and six required reconstruction of the lower extremities. In seven of these cases, the latissimus dorsi flap and in four cases the vertical rectus abdominis myocutaneous (VRAM) flap was used as a free flap. At the time of loop construction, the blood flow volume of AV loops was 466 ± 180 mL/min, which increased to 698 ± 464 mL/min on the day of free tissue transfer (p > 0.1). After free flap anastomosis, the blood flow volume significantly decreased to 18.5 ± 8.3 mL/min (p < 0.001). There was no significant difference in blood flow volume or arterial vascular resistance between latissimus dorsi and VRAM flaps, nor between thoracic wall and lower extremity reconstruction. However, a significant correlation between the flap weight and the blood flow volume, as well as to the arterial vascular resistance, was found (p < 0.05).
CONCLUSIONS: This is the first study to perform intraoperative blood flow and hemodynamic measurements of AV loops followed by free tissue transfer. Our results show hemodynamic differences and contribute to deeper understanding of the properties of AV loops for free flap reconstruction.
摘要：
背景：动静脉（AV）环有助于克服高度复杂的微血管游离皮瓣重建病例中缺失或质量差的受体血管。没有关于血流和灌注模式的研究。这项研究的目的是评估和比较AV环的术中血流动力学特征，然后进行游离组织转移以进行胸壁和下肢重建。
方法：这项前瞻性临床研究结合了传输时间流速法和微血管吲哚菁绿血管造影来评估血流量，AV环构建时和游离皮瓣转移当天的动脉血管阻力和固有通过时间。
结果：共有11名患者接受了房室环创建，其中5人需要胸壁重建，6人需要下肢重建。在其中七个案例中，背阔肌皮瓣和4例垂直腹直肌肌皮瓣（VRAM）用作游离皮瓣。在循环构建时，房室循环血流量为466±180毫升/分钟，在游离组织转移当天增加到698±464毫升/分钟(p>0.1)。游离皮瓣吻合术后,血流量显著下降至18.5±8.3mL/min(p<0.001)。背阔肌和VRAM皮瓣的血流量或动脉血管阻力无显著差异,胸壁和下肢重建之间也没有。然而,皮瓣重量和血流量之间的显著相关性，以及动脉血管阻力，发现（p<0.05）。
结论：这是第一项进行术中血流和血流动力学测量的房室环，然后进行游离组织转移的研究。我们的结果显示了血液动力学差异，并有助于更深入地了解用于游离皮瓣重建的AV环的特性。
方法：这项前瞻性临床研究结合了传输时间流速法和微血管吲哚菁绿血管造影来评估血流量，AV环构建时和游离皮瓣转移当天的动脉血管阻力和固有通过时间。
结果：共有11名患者接受了房室环创建，其中5人需要胸壁重建，6人需要下肢重建。在其中七个案例中，背阔肌皮瓣和4例垂直腹直肌肌皮瓣（VRAM）用作游离皮瓣。在循环构建时，房室循环血流量为466±180毫升/分钟，在游离组织转移当天增加到698±464毫升/分钟(p>0.1)。游离皮瓣吻合术后,血流量显著下降至18.5±8.3mL/min(p<0.001)。背阔肌和VRAM皮瓣的血流量或动脉血管阻力无显著差异,胸壁和下肢重建之间也没有。然而,皮瓣重量和血流量之间的显著相关性，以及动脉血管阻力，发现（p<0.05）。
结论：这是第一项进行术中血流和血流动力学测量的房室环，然后进行游离组织转移的研究。我们的结果显示了血液动力学差异，并有助于更深入地了解用于游离皮瓣重建的AV环的特性。
