基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究

THREE-DIMENSIONAL VISUALIZATION RECONSTRUCTION OF MEDIAL SURAL ARTERY PERFORATOR FLAP BASED ON DIGITAL TECHNOLOGY

目的探讨基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建可行性。方法以3名健康成年志愿者作为实验对象，采用CT血管造影技术获取双下肢二维断层图像数据，应用Mimics软件对腓肠内侧动脉结构进行三维可视化重建，利用软件白带测量工具记录腓肠内侧动脉的起始位置、起始部血管外径、血管走行、穿支穿深筋膜的位置、穿支数目及皮瓣血管蒂最大可切取长度。结果利用Mimics软件成功重建腓肠内侧动脉三维可视化重建模型，能清晰显示腓肠内侧动脉的分布、走行及穿支在体表皮肤穿出位置。6侧下肢均发现腓肠内侧动脉，起始于胭动脉，起始部外径为1．9～2．7mm，平均2．3mm。共观测到肌皮穿支13支，每侧1～3支，穿支集中出现在距胭窝皱褶以远6．2～15．0cm、距后正中线内侧2．5～4．2cm范围内。腓肠内侧动脉穿支皮瓣的血管蒂最大可切取长度为10．2～13．8cm，平均11．8cm。结论基于数字化技术可以提供腓肠内侧动脉三维动态解剖，为临床腓肠内侧动脉穿支皮瓣的个性化评估及皮瓣切取提供依据。

Objective To explore the feasibility of three-dimensional （3-D） visualization reconstruction of the medial sural artery perforator flap based on digital technology. Methods A series of Dicom images were obtained from three healthy adult volunteers by dual source CT angiography. Then the Mimics software was used to construct the medial sural artery model and measure the indexes, including the starting position of medial sural artery, external diameters of vascular pedicle, the number of perforators, location perforated deep fascia, and the maximum pedicle length of perforators based on medial sural artery perforator flap. Results The 3-D visualization reconstruction models were successfully finished with Mimics software, which can clearly display the distribution, travel, and perforating point. Thirteen perforators were found in 6 legs, which started at the popliteal artery with a mean external diameter of 2.3 mm （range, 1.9-2.7 mm）. Each specimen had 1-3 perforators, which located at the site of 6.2-15.0 cm distal to popliteal crease and 2.5-4.2 cm from posterior midline. The maximum pedicle lengthof medial sural artery perforator flap was 10.2-13.8 cm （mean, 11.8 cm）. Conclusion The 3-D visualization reconstruction models based on digital technology can provide dynamic visualization of the anatomy of the medial sural artery for individualized design of the medial sural artery perforator flap.