现代影像学技术在修复体表软组织缺损中的应用(附15例报道)

Application of Modern Imageological Techniques in the Preoperative Assessment of the Reconstruction of Soft Tissue Defects

目的探讨借助现代影像学技术术前检查拟利用皮瓣的血供,以精确化修复体表软组织缺损,减少手术并发症,提高成功率。方法对拟用轴型皮瓣修复创面的15例患者术前行三维计算机断层扫描血管造影(three-dimensional computed tomography angiography,3D-CTA)或数字减影血管造影(digital subtraction angiography,DSA),并根据造影结果 ,选择手术方式及进行术前设计。结果 DSA及3D-CTA均能清楚地显示知名轴型动脉,本组15例中检查腹壁上下动脉6例、胸背动脉5例,颈横动脉2例,胸肩峰功能2例,其中14例血运通畅,据此设计皮瓣均完全成活,1例患者术前发现双侧胸廓内动脉及向下延伸的腹壁上动脉闭塞,遂改行游离皮瓣移植,避免了手术失败。结论借助于现代影像学技术可以更合理地制定轴型皮瓣切取的手术方式,简化手术步骤,节约时间,降低手术并发症,提高手术安全性。

Objective To evaluate the value of imageological techniques in the preoperative assessment of the reconstruction of soft tissue defects,and then to increase the successful rate and decrease the postoperative complications.Methods 15 patients with surface soft tissue defects were examined by three-dimensional computed tomography angiography（3D-CTA） or digital subtraction angiography（DSA）to assess the blood vessel of axial skin flaps before reconstruction operation.According to examinational result,operative designs and methods were determined.Results 3D-CTA and DSA can display axial blood vessel.Out of the 15 patients,superior/inferior epigastric artery was examined in 6,thoracodorsal artery in 5,transverse cervical artery in 2,and thoracoacromial artery in 2.The images showed that blood vessels of 14 cases were unobstructed,but 1 case was obstructed,so the therapeutic regimen was changed correspondingly to avoid complication.Conclusions Reasonable utilization of advanced imageological techniques can simplify the procedure,shorten operative duration,reduce operative complication rate and increase healing ratio.It is beneficial to the operative design in reconstruction of soft tissue defects.