Hyperspektralimaging zum postoperativen Lappenmonitoring von lokoregionären Lappenplastiken.

Zusammenfassung

Hintergrund Seit der Erstbeschreibung einer lokoregionären Lappenplastik zur Nasenrekonstruktion im 6. Jahrhundert v. Chr. durch den indischen Arzt Sushruta Samhita sind diese ein fester Bestandteil in der Wiederherstellungschirurgie geworden. Neben der konsequenten Weiterentwicklung chirurgischer Operationsmethoden wurden die zu Grunde liegenden physikalischen Messmethoden des Lappenmonitoring in den letzten Dekaden stetig weiterentwickelt. Das Hyperspektralimaging (HSI) stellt eine neue quantitative Messmethode zur Beurteilung der Gewebeperfusion dar.

Ziel Das Ziel dieser Arbeit ist die Evaluation des HSI als Monitoringverfahren nach lokoregionärer Defektdeckung.

Patienten und Methode Bei insgesamt 16 Patienten wurde nach gefäßgestieltem Gewebetransfer die Sauerstoffsättigung, der Hämoglobingehalt sowie der Wassergehalt von Haut, Monitorinsel und nekrotischen Lappenarealen am 1. bis 7. postoperativen Tag gemessen. Die erhobenen Daten wurden statistisch deskriptiv ausgewertet und grafisch ausgearbeitet.

Ergebnisse Das HSI zeigte einen erhöhten Hämoglobingehalt, eine Abnahme der Sauerstoffsättigung sowie des Wassergehaltes in den nekrotischen Lappenarealen im Vergleich zur vitalen Monitorinsel und zur gesunden Haut. Monitorinsel und vitale Hautareale wiesen eine nahezu identische Werteverteilung auf.

Schlussfolgerung HSI erlaubt die sichere, kontaktfreie und sofortige Bestimmung der Gewebeperfusion von transferierten Gewebearealen bei Patienten nach lokoregionärer Defektdeckung. Daher erscheint die Verwendung von HSI im Rahmen des postoperativen Lappenmonitorings sinnvoll.

Abstract

Background Since pedicle flaps were first described by the Indian physician Sushruta Samhita in the 6th century B. C., they have become an integral part of reconstructive surgery. As more and more research has been conducted into the underlying physical principles, flap monitoring has developed steadily in the last few decades. Hyperspectral Imaging (HSI) is a new quantitative measuring method for assessing the perfusion of the underlying tissue.

Objective This study aims to evaluate HSI as a monitoring method for pedicle flaps.

Patients and Methods In 16 patients who had undergone reconstructive surgery, oxygen saturation, haemoglobin and water concentration of the locoregional flap, necrotic flap areas as well as intact skin were measured on postoperative days 1 to 7. Subsequently, the data were statistically described and graphically illustrated.

Results HSI revealed increased haemoglobin concentration and decreased oxygen and water concentration in necrotic flap areas compared with the monitor island and healthy skin. The distribution of the values collected from the vital skin areas and the monitor island was almost identical.

Conclusion HSI allows for safe, immediate, non-contact measurement of tissue perfusion of transferred tissue areas in patients after pedicle flap surgery. The use of HSI may improve postoperative flap monitoring.

Schlüsselwörter

Gestielte Lappenplastiken - Hyperspektralimaging - Gewebeoxymetrie - Lappenmonitoring - Durchblutungsstörung

Key words

Pedicle flaps - hyperspectral imaging - perfusion disorder - tissue oximetry

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