宽频线阵容积探头引导下三维超声技术在股前外侧穿支皮瓣术前穿支定位中的应用

Application of 3-D ultrasonography with a wide band linear matrix array volume transducer in preoperative localisation of perforating vessels of free anterolateral thigh perforator flap

目的:探讨宽频线阵容积探头引导下三维超声技术在游离股前外侧穿支皮瓣(ALTPF)术前穿支定位中的应用价值,更准确快速地指导切取ALTPF。方法:自2020年5月至2022年10月,回顾性分析无锡市第九人民医院足踝外科35例足踝部软组织缺损行游离ALTPF修复患者,其中足部创面25例,踝关节创面10例;年龄20~66岁,缺损面积11.0 cm×8.0 cm~28.0 cm×9.0 cm,皮瓣面积12.0 cm×9.0 cm~29.0 cm×10.0 cm。术前采用宽频线阵容积探头对ALTPF血管穿支进行探测,获得穿支三维图像,记录穿支数量、位置、分型,选择合适的穿支,精准设计皮瓣,指导术中皮瓣的切取,术中观察宽频线阵容积探头术前定位的准确性;术后患者均定期行门诊随访。结果:术前定位穿支70条,术中发现穿支72条,术前与术中相符穿支67条;67条相符穿支中,Kimura I型19例,Kimura Ⅱ型27例,Kimura Ⅲ型21例;二维超声技术术前探测敏感度为95.7%,阳性预测值为93.1%;25例皮瓣为筋膜下切取,10例为筋膜上切取超薄ALTPF,切取皮瓣面积平均大小17.7 cm×8.6 cm;所有皮瓣切取时显露的穿支与术前三维成像基本符合,术后所有皮瓣均完全成活,未出现血管危象情况。术后随访8~20个月,平均12.7个月。结论:宽频线阵容积探头引导下三维超声技术在ALTPF术前穿支定位准确,在超薄ALTPF切取中更有优势,值得在临床推广。

Objective To investigate the application of 3-D ultrasonography enabled by a wide band linear matrix array volume transducer in the localisation of perforating vessels of a free anterolateral thigh perforator flap(ALTPF)before surgery,and to guide microsurgeons in precise design and harvest of a ALTPF.Methods From May 2020 to October 2022,a retrospective study was carried out on 35 patients who had soft tissue defects and undertaken free ALTPF surgery in Department of Foot and Ankle Surgery,Wuxi No.9 People's Hospital Affiliated to Soochow University.ALTPFs were transfered for reconstruction of soft tissue defects of foot in 25 patients and of ankle in 10 patients.The age of patients were 20 to 66 years old.The defects were 11.0 cm×8.0 cm-28.0 cm×9.0 cm in size.The sizes of ALTPFs were at 12.0 cm×9.0 cm-29.0 cm×10.0 cm.Before surgery,ultrasound scans with a wide band linear matrix array volume transducer were performed to locate the perforating vessels.The 3-D ultrasound images showing the perforating vessels of ALTPFs were acquired and the number,location and classification of the perforating vessels were saved.After the appropriate perforating vessels had been determined,ALTPFs were designed for precisely intraoperative incision.The accuracy of preoperative location of perforating vessels by the linear matrix array volume ultrasound transducer was investigated in surgery.All patients received the scheduled postoperative follow-up at outpatient clinics.Results Of the 72 perforating vessels discovered in surgery,70 matched with those being located by ultrasound before surgery.It was found that a total of 67 perforating vessels located before surgery by ultrasonography were consistently mapped with the perforators discovered in surgery.Of the 67 consistently mapped perforating vessels,19 were Kimura type I,27 of Kimura type II and 21 of Kimura type III perforators.The rate of sensitivity and positive prediction were 95.7%and 93.1%,respectively,in the preoperative localisation of perforating vessels of ALTPFs with a wide band linear matrix array volume ultrasound transducer.Twenty-five ALTPFs were harvested subfascially and 10 superfascially.Average size of ALTPFs was 17.7 cm×8.6 cm.The perforating vessels revealed during the harvest of all ALTPFs were basically consistent with the preoperative 3-D ultrasound.All flaps survived after surgery without any incident.The postoperative follow-up lasted 8 to 20 months,with 12.7 months in average.Conclusion The 3-D ultrasonography with a wide band linear matrix array volume ultrasound transducer can accurately locate the perforating vessels of ALTPF before surgery.This technique has many advantages in the design and harvest of super-thin ALTPFs.