3D—CTA技术在足趾组织移植修复拇手指缺损中的应用

The application of 3D-CTA technology in toe-to-hand transfers

目的探讨3D-CTA技术在足趾组织移植修复拇手指缺损中的临床意义。方法自2009年8月至2015年6月，采取足趾组织移植修复拇手指部分缺损患者33例41指。术前通过3D-CTA技术扫描双足，使用计算机软件构建三维图像，确定供区动静脉血管走向、分型等参数，制定与各个病例手指缺损数量、长度和受区皮肤缺损范围、形状相适应的手术设计。结果33例移植修复的41指均存活，经3个月至1年随访，根据中华医学会手外科学会上肢部分功能评定试用标准评价：优17指，良20指，可3指，差1指；优良率为90．2％。修复后的拇手指外观、功能满意。结论3D-CTA技术为拇手指缺损修复设计了个性化及精确化的手术方案，极大地降低了手术风险，提高了修复成活率，有较高的临床价值。

Objective： To investigale the clidical significance of the application of 3D-CT angiogram （CTA） in toe-to-hand transplantation for thumb and finger reconstruction. Methods From August 2009 to June 2015, 41 partial thumb and finger defects in 33 cases were treated with toe to hand transfer. Preoperativdy both feet were scanned using the 3D-CTA technique to establish three-dimensional images of the vasculature. The courses of the arteries and veins at the donor site and their branching patterns were visualized which allowed harvesting of the donor toe tailored to the number of missing fingers, the length of the defect and the size and shape of the skin defects. Results All 41 toe-to-hand transplants in the 33 cases survived. Postoperative follow-up ranged from 3 months to 1 year. According to the upper extremity functional evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 17 digits, good in 20 digits,fair in 3 digits and poor in 1 digit. The overall satisfactory rate was 90.2%. The appearance and function of the reconstructed thumb and fingers were satisfactory. Conclusion The 3D-CTA technique can help us formulate individualized and more accurate stn.gical design in toe-to-hand transfer. It greatly reduces surgical risk and improves the survival rate. It has practical and clinical significance in microsurgical reconstruction of the thumb and fingers.