PDF(Pubmed)
Abstract：
UNASSIGNED: Although major amputations can often be avoided due to evolving methods of endovascular and surgical revascularizations techniques, in patients with chronic limb-threatening ischemia, it is still necessary in some cases. Aim of this study was the detection of wound healing disorders through intraoperative microcirculation measurements in major limb amputations.
UNASSIGNED: In this single-center clinical study, patients with an indication for major amputation were enrolled prospectively. Cause of amputation, patients\' comorbidities including cardiovascular risk profile were assessed. Macrocirculation, as well as microcirculation were assessed. Microcirculation measurements were performed by fluorescence angiography with the administration of indocyanine green. A preoperative measurement was obtained at the amputation level, followed by three additional measurements of the amputation stump postoperatively. Wound healing was monitored and correlated with the microcirculatory findings, based on the perfusion parameters ingress and ingress rate, calculated in the indocyanine green fluorescence video sequences of the amputation stumps.
UNASSIGNED: Forty-five patients were enrolled, including 19 (42%) below-the-knee amputations and 26 (58%) above-the-knee amputations. When considering the need for revision, a change in the microperfusion parameters was observed postoperatively. The mean value for ingress was significantly lower directly postoperatively in stumps requiring revisions (5 ± 0 A.U. versus 40.5 ± 42.5 A.U., p < 0.001). The mean value of ingress rate behaved similarly (0.15 ± 0.07 A.U./s versus 2.8 ± 5.0 A.U./s, p = 0.005). The evaluation of indocyanine green measurements when wound healing disorders occurred also showed nonsignificant differences in the mean values.
UNASSIGNED: Fluorescence angiography after major lower limb amputations appears to be an option of depicting microperfusion. Especially, the early postoperative detection of reduced perfusion can indicate a subsequent need for revision. Therefore, this method could possibly serve as a tool for intraoperative quality control after major limb amputation.
UNASSIGNED: In this single-center clinical study, patients with an indication for major amputation were enrolled prospectively. Cause of amputation, patients\' comorbidities including cardiovascular risk profile were assessed. Macrocirculation, as well as microcirculation were assessed. Microcirculation measurements were performed by fluorescence angiography with the administration of indocyanine green. A preoperative measurement was obtained at the amputation level, followed by three additional measurements of the amputation stump postoperatively. Wound healing was monitored and correlated with the microcirculatory findings, based on the perfusion parameters ingress and ingress rate, calculated in the indocyanine green fluorescence video sequences of the amputation stumps.
UNASSIGNED: Forty-five patients were enrolled, including 19 (42%) below-the-knee amputations and 26 (58%) above-the-knee amputations. When considering the need for revision, a change in the microperfusion parameters was observed postoperatively. The mean value for ingress was significantly lower directly postoperatively in stumps requiring revisions (5 ± 0 A.U. versus 40.5 ± 42.5 A.U., p < 0.001). The mean value of ingress rate behaved similarly (0.15 ± 0.07 A.U./s versus 2.8 ± 5.0 A.U./s, p = 0.005). The evaluation of indocyanine green measurements when wound healing disorders occurred also showed nonsignificant differences in the mean values.
UNASSIGNED: Fluorescence angiography after major lower limb amputations appears to be an option of depicting microperfusion. Especially, the early postoperative detection of reduced perfusion can indicate a subsequent need for revision. Therefore, this method could possibly serve as a tool for intraoperative quality control after major limb amputation.
摘要：
■尽管由于血管内和外科血运重建技术的不断发展，通常可以避免严重的截肢，在慢性威胁肢体缺血的患者中，在某些情况下仍然是必要的。这项研究的目的是通过术中微循环测量来检测四肢截肢手术中的伤口愈合障碍。
■在这项单中心临床研究中，我们前瞻性纳入了有大截肢指征的患者.截肢的原因,我们评估了患者的合并症,包括心血管风险.宏观循环，以及微循环进行了评估。微循环测量通过给予吲哚菁绿的荧光血管造影术进行。在截肢水平获得了术前测量，术后再进行三次截肢残端测量。监测伤口愈合情况，并与微循环结果相关，基于灌注参数入口和入口速率，在截肢树桩的吲哚菁绿荧光视频序列中计算。
■纳入45名患者，包括19例（42%）膝下截肢和26例（58%）膝上截肢。当考虑修改的需要时，术后观察到微灌注参数的变化.在需要修正的树桩中，术后直接进入的平均值显着降低（5±0A.U.与40.5±42.5A.U.，p<0.001)。入口速率的平均值表现相似(0.15±0.07A.U./s与2.8±5.0A.U./s,p=0.005)。当发生伤口愈合障碍时，对吲哚菁绿测量的评估也显示平均值无显着差异。
■下肢截肢后的荧光血管造影似乎是描绘微灌注的一种选择。尤其是,术后早期发现灌注减少可能表明随后需要进行翻修.因此,这种方法有可能成为截肢术后术中质量控制的工具.
■在这项单中心临床研究中，我们前瞻性纳入了有大截肢指征的患者.截肢的原因,我们评估了患者的合并症,包括心血管风险.宏观循环，以及微循环进行了评估。微循环测量通过给予吲哚菁绿的荧光血管造影术进行。在截肢水平获得了术前测量，术后再进行三次截肢残端测量。监测伤口愈合情况，并与微循环结果相关，基于灌注参数入口和入口速率，在截肢树桩的吲哚菁绿荧光视频序列中计算。
■纳入45名患者，包括19例（42%）膝下截肢和26例（58%）膝上截肢。当考虑修改的需要时，术后观察到微灌注参数的变化.在需要修正的树桩中，术后直接进入的平均值显着降低（5±0A.U.与40.5±42.5A.U.，p<0.001)。入口速率的平均值表现相似(0.15±0.07A.U./s与2.8±5.0A.U./s,p=0.005)。当发生伤口愈合障碍时，对吲哚菁绿测量的评估也显示平均值无显着差异。
■下肢截肢后的荧光血管造影似乎是描绘微灌注的一种选择。尤其是,术后早期发现灌注减少可能表明随后需要进行翻修.因此,这种方法有可能成为截肢术后术中质量控制的工具.
