CTA三维可视化技术引导股前外侧 穿支皮瓣修复手及前臂创面

Clinical application of CTA three-dimensional visualization technique in anterolateral thigh perforator flap for repair of hand and forearm defects

目的探讨CTA三维可视化技术在股前外侧穿支皮瓣(Anterolateral thigh perforator flap,ALTPF)修复手及前臂创面的临床应用。方法2018年6月-2021年12月,在CTA三维可视化技术引导下行股前外侧穿支皮瓣修复前臂创面9例。术前将双下肢进行CT血管造影(CT angiography,CTA)检查,通过GE AW 4.3工作站获取双下肢动脉三维图像,初步明确股前外侧皮瓣穿支起源、类型及其源动脉走行、管径。将CTA数据导入Mimics软件进行重建,对照CTA横断面图像进行模拟皮瓣设计和模拟切取。根据测量穿支动脉位置进行体表绘制,术中结合三维图像进行皮瓣分离,供区一期闭合。结果9例皮瓣全部成活,供区均一期愈合。无血管危象发生。术后随访3~7个月(平均5个月),皮瓣质地柔软、血运良好,皮瓣无明显臃肿,色泽与正常皮肤基本一致。前臂旋转、肘及腕关节屈伸活动良好。供区切口愈合良好,皮肤感觉及肢体活动无明显异常。结论术前采用CTA三维可视化技术对股前外侧穿支皮瓣进行定位及设计,是一项较为可靠的方法,值得临床推广。

Objective To explore the clinical efficacy of CTA the three-dimensional visualization technique in anterolateral thigh perforator flap(ALTPF)transplantation.Methods Form June 2018 to December 2021,9 patients with hand and forearm defects were treated with ALTPF transplantation by the help of CTA three-dimensional visualization technique.Scanning both lower extremities with GE Revolution CT.We got the preliminary understanding of the origin,course,length,internal diameter and position of perforator by GE AW4.3 workstation,which were used to select the suitable perforator for ALTPF transplantation.To import CT angiography(CTA)data into Mimics software for reconstruction and proceeded the analogue design of flap according to cross sectional images.The operation was performed based the surface markers based on the three-dimensional measurement.Results After operation 9 flaps survived successfully without vascular crisis.All donor sites healed by first intention.All patients were followed-up for 3~7 months with an average of 5 months.The flaps were soft and a little corpulent with adequate blood supply,which their colors were same as the normal skin.The rotation of forearm and the flexion and extension activities of elbow and wrist were not limited.The sensations and activities of donor sites were normal.Conclusion Preoperative CTA three-dimensional visualization technique is a reliable method for the location of perforators and flap design of ALTPF,which is worthy of clinical application.