MDCTA三维重建在穿支皮瓣可视化研究与设计中的应用

Clinical application of MDCTA for visualization and design of perforator flaps

目的：评价MDCTA三维重建技术对穿支皮瓣血管可视化定位方法及设计的指导意义。方法：2011年6月至20i3年8月，对23例皮肤软组织缺损的病例行穿支皮瓣修复术，术前在拟设计皮瓣区域采用MDCTA扫描及三维重建，根据重建的皮瓣穿支血管的位置及供血范围设计皮瓣，比较术前穿支血管定位与术中实际位置的差异。并根据三维重建后的3D图象观察穿支分布及彼此吻合情况，以此结果指导术中皮瓣设计，旋转方式等。结果：本组23例，其中胫后动脉穿支皮瓣9例，腹壁下动脉穿支皮瓣4例，臀上动脉穿支皮瓣6，腓肠肌穿支皮瓣2例，背阔肌肌穿支皮瓣2例。所有皮瓣经MDCTA扫描，均能清楚分辨皮瓣穿支以及其二级血管的位置走向，三维重建能清楚分辨穿支血管与其周围血管的解剖关系。MDCTA术前定位与术中解剖相符率达100％。23个皮瓣除2例远端1／3发绀经处理后无好转，II期植皮修复外，其余均I期愈合。随访1～10个月，皮瓣色泽，质地良好。皮瓣两点感觉大于0．3cm。结论：MDCTA三维重建能三维直观精确定位穿支血管及显示皮瓣血流灌注范围，术前用于指导皮瓣设计，能明显提高手术安全性，降低手术风险。

Objective The article is directed to evaluate the instructive significance of MDCTA 3- dimensional reconstruction for visual localization and design of the vessels of perforator flaps. Methods 23 cases of skin and soft tissue defects had been treated with prosthetics of perforator flaps from June 2011 to August 2013,during which MDCTA scanning and 3-dimensional reconstruction were conducted in the regions before operation and intended to design flaps designed according to the location of reconstructed perforator vessels and the scope of blood supply.It is aimed to compare the differences between localization of perforator vessel before operation and the real position in the operation.The distribution and anastomosis of perforator branches were observed by the 3D pictures after 3-dimensional reconstruction as a way to direct the design and rotating manner of flaps. Results Among the 23 cases,9 were posterior tibial artery perforator flaps,4 were DIEP flaps,6 were superior gluteal artery perforator flaps, 2 were gastrocnemius myocutaneous perforator glaps and the other 2 were latissimus dorsi perforator flaps. The location and direction of perforator flaps and the second branches can be clearly distinguished by MDCTA scanning.What＇s more,the anatomic relationship between perforator vessels and the surrounding vessels can be also differentiated by 3D reconstruction. 21 cases had been cured primarily except that 2 cases had been with cyanosis in the distal one-third underwent skin grafting in the second stage after ineffective treatment.After 1-10 months＇ follow-up,the color and texture of the flaps were fine and the distance of two points perfusion of reconstruction rate of risk wil was longer than 0.3cm. Conclusions Perforator vessels and the extent of blood flaps could be localized intuitively and precisely by MDCTA 3-dimensional By using this method to direct the design of flaps, the operation will be safer and the be largely reduced.