数字化技术辅助游离ALTPF在四肢大面积软组织缺损重建中的应用

Application of digital technology assisted free ALTPF in reconstruction of large-area soft tissue defect of limbs

目的探讨数字化技术在ALTPF游离移植修复四肢大面积软组织缺损的应用价值。方法选择2017年4月-2020年4月收治的四肢大面积软组织缺损实施游离ALTPF移植修复创面的患者13例,其中男9例,女4例;年龄39~58(42.75±1.94)岁,皮瓣面积为16 cm×10 cm~27 cm×18 cm。术前将供区及受区进行CTA,通过三维重建技术获得供区动脉血供三维图像,明确ALTPF血供的起源、走向、分型、血管蒂长度、管径以及穿支点位置,根据三维图像参数实用Mimics软件重建设计受区缺损及数字化三维设计皮瓣并术中精准规范修复。结果 13例患者皮瓣全部成活,均无血管危象发生,术后门诊结合微信随访6~24(平均16)个月,末次随访成活皮瓣质地柔软,血运良好,修复缺损外形、色泽与正常皮肤基本一致,肢体功能恢复良好。按照中华医学会上肢功能评定关节总活动度(TAM)法及Maryland足踝部功能评分法评定:优8例,良3例,可2例。结论术前利用数字化技术辅助游离ALTPF在四肢大面积软组织缺损重建中,具有较高的精准度及规范性,能够提高游离皮瓣修复质量及成功率,该方法可靠且实用,具有临床应用价值。

Objective To explore the application value of digital technology in free transfer of ALTPF to repair large-area soft tissue defect of limbs.Methods A total of 13 patients with large-area soft tissue defects of limbs treated from April 2017 to April 2020 were selected in the study,including 9 males and 4 females,aged 39-58 years old.The average age was(42.75±1.94)years old.The area of flap was 16 cm×10 cm-27 cm×18 cm.Before operation,CTA was performed on the donor and recipient areas,and the 3-dimensional image of arterial blood supply in the donor area was obtained by 3-dimensional digital reconstruction technology of CT angiography,so as to clarify the origin,course,classification,length vascular pedicle,of diameter and location of perforating fulcrum of the blood supply of ALTPF.According to the image parameters 3-dimensional,of the defect of the recipient area was reconstructed and designed with Mimics software,and the 3-dimensional digital designed flap was used accurately and standardized during the operation.Results All the 13 flaps survived without a vascular crisis.The patients entered the follow-up for 6 to 24(mean 16)months by outpatient clinic visits combined with WeChat reviews.At the last follow-up,the surviving flaps had soft texture and good blood supply,the shape and colour of the flap were basically the same as those of normal skin.The limb function recovered well.According to Chinese Medical Association Upper Limb Function Evaluation(TAM)method and Maryland ankle function evaluation method:8 cases were in excellent,3 cases were in good and 2 cases were in fair.Conclusion The preoperative application of digital technology to assist the reconstruction of large-area soft tissue defects of limbs with free ALTPF has high accuracy and standardisation.It improves the quality and success rate of free flap repair.This method is reliable,practical and with clinical value.