增强现实技术导航辅助设计分叶股前外侧穿支皮瓣修复四肢软组织缺损8例

Augmented reality navigation assisted design of chimeric twin-paddled anterolateral thigh perforator flap in reconstruction of soft tissue defects in extremities:a report of 8 cases

目的:探讨增强现实(AR)技术导航辅助设计分叶股前外侧穿支皮瓣(ALTPF)修复四肢软组织缺损的可行性及临床效果。方法:2017年6月至2023年6月,贵港市人民医院手足显微外科应用AR导航辅助设计分叶ALTPF修复肢体软组织缺损8例;均为车祸伤或机器伤,缺损部位小腿3例,踝部2例,手部2例,足部1例,所有创面均为宽大或不规则,缺损大小14 cm×14 cm~25 cm×13 cm;术前CTA检查获取患者双侧大腿动脉图像,选择优势侧、优势穿支血管,应用Mimics软件进行三维重建,应用AR导航进行患者体表血管及穿支浅出点定位,指导分叶ALTPF的设计与切取,皮瓣面积15 cm×16 cm~26 cm×14 cm,供区直接缝合;分别于术后1、3、6、12个月门诊或通过微信图片、视频方法随访,记录皮瓣外形、颜色、质地、感染是否复发及皮瓣供区侧伸膝功能等。结果:8例均按术前设计完成分叶穿支皮瓣切取与移植,术中探查穿支血管浅出点与术前定位一致。术后所有皮瓣均顺利成活,皮瓣受区与供区均一期愈合。术后随访3~12(平均8.6)个月,皮瓣色泽、质地优良,皮瓣供、受区外形满意;2例手部损伤患者应用密歇根手功能简表(MHQ)评分,分别为43.74分、81.25分,6例下肢损伤患者应用Maryland足踝部功能评分,优2例,良3例,可1例。结论:应用AR导航可以有效辅助分叶ALTPF的设计,为临床开展分叶穿支皮瓣的个性化评估与设计提供有效的依据。

Objective To investigate the feasibility and clinical effects of the application of augmented reality(AR)navigation on assisted design of the chimeric twin-paddled anterolateral thigh perforator flap(ALTPF)in reconstruction of soft tissue defects in extremities.Methods From June 2017 to June 2023,8 patients with soft tissue defects in extremities received reconstruction of chimeric twin-paddled ALTPF designed with the assistance of AR navigation in Department of Hand&Foot Microsurgery Orthopaedics,Guigang City People’s Hospital.All of them were traffic accidents or machine injuries,with 3 cases of calf,2 cases of ankle,1 case of foot,and 2 cases of hand defects.All the wounds were wide or irregular(defect sized 14 cm×14 cm-25 cm×13 cm).The images of bilateral thighs were acquired by CT angiography preoperatively.The dominant side and dominant perforators were selected.Three dimensional reconstruction was performed by Mimics software.AR technology was applied to guide the design and harvest of the chimeric twin-paddled ALTPF.Flap area was 15 cm×16 cm to 26 cm×14 cm.The donor site was sutured directly.Follow-up with outpatient visits or WeChat images and videos at 1,3,6 and 12 months postoperatively to record the appearance,colour,texture,recurrence of infection,and knee extension function of the flap donor site.Results According to the preoperative design,the perforator flaps were harvested and transferred in all the 8 patients.All flaps survived and the recipient and donor sites healed in one stage.All patients entered postoperative follow-up for 3 to 12(mean,8.6)months.The colour and texture of the flaps were excellent,and the appearance of donor and recipient sites was satisfactory.Two patients with hand injuries were evaluated using the brief Michigan Hand Outcomes Questionnaire(MHQ),with scores of 43.74 and 81.25,respectively.Six patients with lower limb injuries were evaluated using the Maryland foot score,with scores of 2 excellent,3 good and 1 fair.Conclusion The application of AR navigation can effectively assist the design of a chimeric twin-paddled ALTPF.It also provides an effective basis for clinical personalised flap design.