三维可视化重建展肌上缘动脉弓为蒂的可移植岛状皮瓣

Three-dimensional visualizational reconstruction of pedicled island skin flap with arterial arch at the superior border of abductor hallucis muscle

背景:目前以展肌上缘动脉弓为蒂的岛状皮瓣设计依赖于临床医生的抽象思维,难以定量分析和交流学习,使其在临床上的推广使用受限。目的:对展肌上缘动脉弓为蒂的岛状皮瓣进行三维可视化重建,建立该皮瓣动脉的可视化模型。方法:选取新鲜成人标本1具,经胫前动脉与胫后动脉行明胶-氧化铅混悬液灌注后,足部64排CT扫描,并通过mimics10.0软件重建内踝前动脉、跗内侧动脉、足底内侧动脉浅支及其吻合支,观察展肌上缘动脉弓的形成、走形与分布情况。根据解剖结构的特点,对皮肤及其血管进行重建,获得立体形态的动脉皮瓣结构。结果与结论:三维重建的各部位层次分明,展肌上缘动脉弓显示良好、实体感强、皮肤和动脉的相互关系一目了然,在三维重建的图像中清楚的观察各解剖结构的形态,特别是展肌上缘动脉弓的形成及其体表投影得到了很好的显示。结果表明展肌上缘动脉弓为蒂的岛状皮瓣三维重建对基础研究、临床试验及手术规划具有重要价值,为临床个性化手术方式的选择提供直观的参考,从而提高手术成功率。

BACKGROUND： At present, design of pedicled island skin flap with arterial arch at the superior border of abductor hallucis muscle mainly depends on clinician’s abstract thinking, which makes it difficult for quantitative analysis and exchange learning, and makes it limited in clinical application. OBJECTIVE： To perform the three-dimensional reconstruction of pedicled island skin flap with arterial arch at the superior border of abductor hallucis muscle, and to establish visible models of the flap. METHODS： One fresh adult cadaver specimen was collected and perfused with the mixture of lead oxide-gelatine through anterior tibial artery and posterior tibial artery, and then received spiral CT scanning. The branch of anterior medial malleolus artery, medial tarsal artery and the superficial branch of medial plantar artery as well as its anastomotic branch were reconstructed with mimics10.0 software, in order to observe the constitute, track-way and distribution of arterial arch at the superior border of abductor hallucis muscle. According to the feature of anatomical structures, reconstruction was conducted in skin and vessel to obtain three-dimensional arterial skin flap structure. RESULTS AND CONCLUSION： The layers of three-dimensional reconstruction were distinctively displayed, and the arterial arch at the superior border of abductor hallucis muscle was displayed well with strong physical sense and clear relationship between skin and arteries. The morphology of various anatomical structures could be observed clearly on the three-dimensional reconstruction image, especially the formation of arterial arch at the superior border of abductor hallucis muscle and its surface projection. Three-dimensional reconstruction of pedicled island skin flap with arterial arch at the superior border of abductor hallucis muscle may provide great value for basic research, clinical experiments and surgical planning, and provide visual reference for the individual operation design and can be able to enhance the successful rate of surgery.