CTA联合增强现实技术实施股前外侧穿支皮瓣游离移植舌再造九例

The use of CTA combined augmented reality navigation in free anterolateral thigh perforator flap for tongue reconstruction: 9 cases report

目的探讨CTA联合增强现实(AR)技术在游离股前外侧穿支(ALTP)皮瓣移植舌再造的应用价值。方法2016年12月至2018年12月,对9例舌癌患者,术前进行CTA检查选择优势穿支血管,应用AR技术导航对旋股外侧动脉降支的穿支血管进行定位并体表标记,实施ALTP皮瓣游离移植进行舌再造9例。切取皮瓣面积6 cm×8 cm^8 cm×12 cm,供区创面全部直接缝合。术后随访3~6个月,评价皮瓣成活和再造舌的功能情况。结果全部病例术前应用AR技术导航定位的穿支血管,在术中均探查证实定位准确,术后移植再造舌全部成活,无血管危象发生。供区一期线形瘢痕愈合,再造舌体丰满,术后语音、吞咽及咀嚼功能恢复良好。结论CTA联合AR技术导航在ALTP舌再造术中定位准确,操作简便,临床效果较好,有一定的实用价值。

Objective To explore the value of CTA combined augmented reality(AR) navigation in tongue reconstruction with free anterolateral thigh perforator (ALTP) flaps. Methods From December, 2016 to December, 2018, 9 cases of tongue cancer patients were treated with lingual reconstruction with the free ALTP flap. The dominant perforator was selected according to CTA before operation. The origin, course, locations at the level passing through the fascia lata of the perforators and digital flaps were located and marked under the guidance of AR navigation technology. The flaps area were 6 cm×8 cm-8 cm×12 cm, and the donor sites were closed directly. The effect of the AR navigation was explored intraoperatively. The function of reconstructed tongue and donor site were followed-up 3 to 6 months post-operatively. Results All navigation-positioned perforators were confirmed by AR preoperatively. Intraoperative exploration showed that the perforators were accurately located. All flaps survived, and no vascular crisis occurred. The donor sites healed primarily with linear scars. The tongue was plump, and the function of voice and swallowing were favorable. Conclusion CTA combined AR navigation has the advantages of accurate location, easy to use and low cost in tongue reconstruction with free ALTP flaps. It is a worthy method to be popularized.