3D-CTA辅助股前外侧分叶穿支皮瓣修复四肢软组织缺损11例

3D-CTA assisted anterolateral thigh lobulated perforator flap in repairing soft tissue defect of limb:11 cases report

目的探讨术前3D--CTA辅助修薄的含神经的游离股前外侧分叶穿支皮瓣修复四肢软组织缺损的临床价值。方法2010年2月至2018年5月,应用修薄的含神经的游离股前外侧分叶穿支皮瓣修复11例四肢软组织缺损创面,男8例,女3例;年龄22-56岁,平均35岁;创面位于下肢6例,其中小腿4例,足底2例;创面位于上肢5例,其中臂1例,前臂2例,手背2例。创面缺损面积11.0 cmx8.0 em-23.0 emx9.0 cm。术前CT扫描皮瓣供区,通过CTA三维重建技术取得供区血管三维图像,明确穿支皮瓣血供的起始,走行、血管蒂长度、管径及穿支点位置等,依据图像结果设计皮瓣。术后定期随访,依照中华医学会手外科学分会上肢功能评定试用标准及Enneking评价系统制定随访内容。结果本组11例皮瓣全部成活,没有血管危象发生,所有患者均获随访,随访时间3个月~1年,平均5个月,术后皮瓣有弹性,质地较好,无臃肿,颜色和周围正常皮肤近似,两点辨别觉达3.0-6.0 mm。依照中华医学会手外科学分会功能评定试用标准评估上肢恢复情况:优1例,良3例,可1例;Enneking系统评估下肢恢复情况:平均为21分,平均恢复了肢体功能的70%。结论修薄的含神经的游离股前外侧分叶穿支皮瓣是修复四肢软组织缺损创面的理想方案,疗效满意,术前3D-CTA技术可有效提高皮瓣修复术的成活率及安全性。

Objective To investigate the effctiveness of preoperative 3D-CTA in assisting the preparation of free thinned anterolateral thigh lobulated perforator flap with nerve in repairing soft tissue defect of limb.Methods Between February,2010 and May,2018,free super--thin anterolateral thigh lobulated perforator flap with nerve was transferred to repair soft tissue defect of limbs in 11 cases.There were 8 males and 3 females with an average age of 35(range,22--56)years.The defect area was 8.0 cmx11.0 cm-9.0 cmx23.0 cm.Preoperation CT scan of the free flap donor site was performed to obtain 3D images of the region with arterial blood supply by digital 3D reconstruction CT,and to determine the origin,direction,classification,length,diameter and the position of pedicle perforator.Postoperative regular followed-up was carried according to the Upper Limb Function Evaluation Trial Standards of Chinese Medical Association of Hand Surgery and Enneking Evaluation System.Results All 11 flaps survived.No vascular crisis happened.All 11 cases were followed--up for 3 to 12(average,5)months.The flaps were supple and elastic with near normal color.There was no bulkiness.Sensory function was recovered well and two point discrimination was 3.0-6.0 mm.According to the Upper Limb Function Evaluation of Upper Limb of Chinese Medical Association of Hand Surgery,the results were excellent in 1 case,good in 3 cases and fair in I case.The Enneking system was used to assesse the lower limbs recovery.The average score was 21,an average of 70%of limb funetion restored.Conclusion The free super-thin anterolateral thigh lobulated perforator flap with nerve offers advantages to the traditional anterolateral thigh flap.The survived flaps are ideal in terms of covering limb defects and restoring functions.Preoperative 3D-CTA in the anterolateral thigh perforator flap transplantation is an accurate and useful method.It helps a safer and successful operation with optimal outcome.