光通过缺血皮瓣的模拟评估
Simulated assessment of light transport through ischaemic skin flaps
摘要：
目前，游离皮瓣和带蒂皮瓣在术后护理中使用颜色、毛细血管再充盈、温度、纹理和多普勒信号（如果可用）评估再灌注。虽然这些技术是有效的，但由于其定性性质，它们容易出错。在这项研究中，我们探索使用不同波长的光来量化缺血组织的反应。该评估为我们提供了指标，这些指标对于我们开发能够定量观察灌注减少的即时诊断设备的目标至关重要。我们建立了一个详细的皮肤层的光学模型。模型的各层被赋予组织的适当光学特性，并适当考虑黑色素和血红蛋白浓度。我们模拟了24个健康的模型，灌注组织和灌注剥夺组织，以评估可见光和近红外波长的光照射时的反应。除了详细的光子传播的注量图，我们提出了一个简单的数学模型来评估的差分传播的光子在组织中的光学再灌注因子（ORF）。我们的研究结果表明，使用较长波长（红色，近红外）的光具有明显的优势，并且从模拟中得出的推论具有重要的临床意义。模拟的场景和结果巩固了多波长、即时诊断设备的信念，并为其量化移植组织中血流的设计提供了信息。建模方法适用于当前研究之外，其中可以研究可以在皮肤中数学表示的其他医学状况。通过这些，可以实现对其他护理点设备的附加推断和方法。
英文摘要：
Currently, free flaps and pedicled flaps are assessed for reperfusion in post-operative care using colour, capillary refill, temperature, texture and Doppler signal (if available). While these techniques are effective, they are prone to error due to their qualitative nature. In this research, we explore using different wavelengths of light to quantify the response of ischaemic tissue. The assessment provides us with indicators that are key to our goal of developing a point-of-care diagnostics device, capable of observing reduced perfusion quantitatively. We set up a detailed optical model of the layers of the skin. The layers of the model are given appropriate optical properties of the tissue, with due consideration of melanin and haemoglobin concentrations. We simulate 24 models of healthy, perfused tissue and perfusion-deprived tissue to assess the responses when illuminated with visible and near-infrared wavelengths of light. In addition to detailed fluence maps of photon propagation, we propose a simple mathematical model to assess the differential propagation of photons in tissue; the optical reperfusion factor (ORF). Our results show clear advantages of using light at longer wavelengths (red, near-infrared) and the inferences drawn from the simulations hold significant clinical relevance. The simulated scenarios and results consolidate the belief of a multi-wavelength, point-of-care diagnostics device and inform its design for quantifying blood flow in transplanted tissue. The modelling approach is applicable beyond the current research, wherein other medical conditions that can be mathematically represented in the skin can be investigated. Through these, additional inferences and approaches to other point-of-care devices can be realised.
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