MD-CT造影检查在整形外科穿支皮瓣术前设计中的应用研究

Preoperative MDCT angiography in the planning of perforator flap surgery

目的:探讨和评价多层螺旋CT(MDCT)造影检查在整形外科穿支皮瓣术前设计中的临床应用价值。方法:术前利用MDCT造影检查探查供区穿支血管情况,然后用特定的软件对数据进行分析与筛选,标记最理想的穿支。手术中用多普勒测定穿支血管的穿出点,解剖穿支,观察穿支血管位于的层次及走行,并与测定图像进行对比,以探讨MDCT的检查准确率及精确性,并根据受区组织缺损情况,设计穿支皮瓣或扩张预制的穿支皮瓣。结果:术中观察到27条穿支血管,其位置均与术前测定相符,准确率100%,除一根穿支直径与术前显示不符,其余穿支的直径均与术前测定基本相符,精确度96.3%。皮瓣最大旋转角度可达180°,除1例皮瓣远端坏死,余成活良好,供区一期闭合,无继发畸形。结论:将MDCT造影检查应用于穿支皮瓣术前设计,相对于其他检查有明显优势,术前可提供准确而直观的影像,能显示出穿支血管的穿出点、管径及行程,大大提高了手术的效率、安全性与灵活性,且供区损伤小,可满足不同修复重建的需要,具有广泛的临床应用前景。

Objective To investigate and evaluate the effectiveness of MDCT analysis for the planning of perforator flap surgery. Methods We used specific software for data analysis and screening which obtained from MDCT angiography,get the images which is available to helping preoperative planning. Through the MDCT angiography,we find the optimal perforator to design a flap which can cure the defect safely and perfectly.Using Doppler to measure the perforator vessels piercing point during operation, observing the perforator＇s location and branches,then compared with MDCT angiography,then design the perforator flap according to the recipient site. Results The authors presented 27 perforators explored with MDCT angiography,and observed the piercing point of them intro-operations with the accuracy of 100% .The operation also leads to a good result.Only 1 perforator was not matched in its diameter and showed the match of 96.3% for diameters.The operation also leads to a good result.All the cases were satisfied with survived which can rotated even 180° ,except one case of distal necrosis,but with both good function and appearance.The donor site also closed at the meantime without deformity. Conclusion Compared with other methods,the MDCT angiography is more accurate and audio-visually. It can facilitate the operation process and decrease the complications very well.In this paper,we will discuss about the effectiveness of MDCT analysis for the planning of perforator flap surgery.It allows appropriate selection of the sizable perforator with the shortest intramuscular and suprafascial course preoperatively leading to safer and easier operation with optimal outcome in clinical applications.