数字三维成像技术在颌面部软组织整复术前的皮瓣设计应用

Application of digital 3D imaging technique in flap design before maxillofacial soft tissue reconstruction

目的:采用数字化技术对口腔颌面部软组织缺损行术前皮瓣设计,指导手术操作,为制作个性化股前外侧皮瓣提供依据。方法:选取7例患有口腔颌面部恶性肿瘤患者,行下肢薄层CT扫描,对CT血管造影检查结果进行数据分析,测量出旋股外侧动脉降支穿支的管径、走形、血管蒂长度,选取合适的穿支做为皮瓣血供来源,在皮肤上标记穿支位置,模拟皮瓣切取范围。术中根据术前标记,画线并标出皮瓣大小,皮瓣制备完毕后,供区直接拉拢缝合,内置负压引流管。将皮瓣移植到组织缺损处,分别行动静脉吻合,皮瓣与缺损创面严密缝合,颈部内置负压引流管,术后严密观测皮瓣及全身状况。结果:所有重建的旋股前外侧动脉降支穿支皮瓣均能显示皮肤、肌肉、血管及其毗邻关系,并根据缺损区域大小,利用Mimics 17.0软件模拟切取皮瓣,与缺损范围基本一致。7例皮瓣主要穿支及主干与术前检查一致,皮瓣全部成活,创面及供区均Ⅰ期愈合。术后随访1~6个月,皮瓣外形、质地和功能均恢复良好。结论:利用数字化技术可以准确定位旋股外侧动脉降支穿支位置,显示皮肤、肌肉、血管与骨骼之间空间关系,结合Mimics17.0软件实现股前外侧皮瓣三维化及精确化设计,减少供区损伤,提高皮瓣成功率。

Objective：Using digital technique to design the preoperative flap of oral and maxillofacial soft tissue defect,to instruct the operation and to provide the basis for making the individual femoral flap.Method：We chosed 7 patients with oral and maxillofacial malignancies to undergo thin-line CT scans of lower extremities and analyzed the data of CTA examination to measure the diameter,shape and length of vascular pedicle.Then selected the appropriate perforation as the source of blood supply for flap.The location of perforation was marked on the skin to simulate flap removal range.During the surgery according to the preoperative mark,draw lines and mark flap size.After flap preparation is completed,suture the donor area directly and build in negative pressure drainage tube.Result：All reconstruction of the anterolateral femoral artery descending perforator flap can show the skin,muscle,blood vessels and their adjacent relationship,and according to the size of the defect area,using Mimics 17.0 software simulation to cut flap which should be the same as the defect area.The main perforating branches and trunks of seven skin flaps were consistent with pre-operative examination and all skin flaps survived;the wound surface and the donor were all in stageⅠhealing.After operation,patients were followed up for 1-6 months and the form,quality and function of skin flaps all recovered well.Conclusion：The location of lateral femoral circumflex artery descending limb and perforating branch were accurately located by digital technique threedimensional reconstruction technology,showing the spatial relationship among skin,muscle,blood vessels and bones.By combining with Mimics 17.0 software,it can achieve three-dimensional and accurate design of anterolateral thigh flap,reduce the donor injury and improve the successful rate of skin flap.