基于术前CT血管造影的股前外侧皮瓣修复口腔颌面部缺损

Anterolateral thigh flap for repairing oral and maxiUofacial defects based on preoperative CT angiography

目的探讨基于术前cT血管成像（CTA）三维重建技术设计的股前外侧皮瓣在口腔颌面部软组织缺损修复中的应用价值。方法对12例拟行股前外侧皮瓣修复口腔颌面部缺损患者术前行CTA检查，利用Philips IntelliSpace Portal软件进行图像分割与三维重建，确定旋股外侧动脉的大小、走行与周围组织的三维空间关系。根据图像显示结果于供区皮肤描记股前外侧皮瓣的点线面。术中校对旋股外侧动脉的降支及其穿支的走行，按照缺损形态大小制备皮瓣，并移植于受区修复缺损。结果CTA能直观的显示旋股外侧动脉降支、穿支等血管的起始、走行与周围组织的三维空间关系。术中所见皮瓣血管主干穿支位置及形态与术前检查相符合。术后随访6～24个月，12例皮瓣完全存活，受区外形、功能恢复良好。结论CTA三维重建技术可显示股前外侧皮瓣血管主干及穿支分支的三维解剖关系，对皮瓣的切取和移植有指导意义。

Objective To investigate the clinical application value of anterolateral thigh flap based on computer tomography angiography （CTA） and three-dimensional reconstruction in repair of oral and maxillofacial defects. Methods Preoperative CTA examination was performed on 12 cases of patients with oral and maxillofacial defect which was going to be repaired by anterolateral thigh flap. Image segmentation and 3D reconstruction were preformed by IntelliSpace Portal Philips software to determine the size, distribu- tion, and three-dimensional anatomic relationship of the lateral femoral artery with the peripheral tissues. Point and area of anterolateral thigh flap was signed on the donor skin according to the image. The distribu- tion of descending and perforating branches of lateral circumflex femoral artery was checked in operation, and individual flap based on size and shape of defected area was transplanted to the recipient site to repair the defect. Results The origination, structure of descending and perforating branches of lateral circumflex femoral artery as well as the three-dimensional anatomic relationship with its peripheral tissues can be displayed well by the CTA. During operation, the position and structure of perforator flaps were consistent with the result of pre-operative examination, the vessel position of recipient site was consistent with the result of pre-operative examination. The patients were followed up for 6 -24 months. Twelve flaps survived completely and the shape and function of recipient site was good. Conclusions CAT and three-dimension- al reconstruction can display three-dimensional anatomic structure of flap vessel and its branches, which is a guidence for cutting and transplanting flap.