通过测量微循环检测大截肢后的伤口愈合障碍:前瞻性单中心研究。

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL
SAGE Open Medicine Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI:10.1177/20503121241263244
Katharina Zetzmann, Nikolaos Papatheodorou, Eva Rühl, Shatlyk Yagshyyev, Briain Haney, Oxana Moosmann, Yi Li, Alexander Meyer, Ferdinand Knieling, Christian-Alexander Behrendt, Werner Lang, Ulrich Rother
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引用次数: 0

摘要

导言:尽管由于血管内再通术和外科再通术技术的不断发展,大截肢手术通常可以避免,但对于慢性肢体缺血患者来说,在某些情况下仍有必要进行大截肢手术。本研究的目的是通过术中微循环测量检测大截肢患者的伤口愈合障碍:在这项单中心临床研究中,对有大截肢指征的患者进行了前瞻性登记。对截肢原因、患者的合并症(包括心血管风险状况)进行了评估。评估了大循环和微循环。微循环测量是通过使用吲哚菁绿荧光血管造影术进行的。术前在截肢处进行一次测量,术后对截肢残端再进行三次测量。根据截肢残端吲哚菁绿荧光视频序列计算出的灌注参数入口和入口率,监测伤口愈合情况并将其与微循环结果联系起来:结果:45 名患者入选,其中包括 19 名(42%)膝下截肢者和 26 名(58%)膝上截肢者。考虑到翻修的需要,术后观察到微灌注参数发生了变化。在需要翻修的残肢中,术后直接侵入的平均值明显降低(5 ± 0 A.U. 对 40.5 ± 42.5 A.U., p p = 0.005)。对伤口愈合障碍时的吲哚菁绿测量结果进行评估后发现,平均值之间也无显著差异:结论:下肢大截肢术后荧光血管造影似乎是描述微灌注的一种选择。特别是,术后早期发现灌注减少可预示随后需要进行翻修。因此,这种方法可作为大肢截肢术后术中质量控制的一种工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Detection of wound healing disorders after major amputations by measurements of the microcirculation: A prospective single-center study.

Introduction: 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.

Materials and methods: 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.

Results: 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.

Conclusion: 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.

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来源期刊
SAGE Open Medicine
SAGE Open Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
3.50
自引率
4.30%
发文量
289
审稿时长
12 weeks
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