中国修复重建外科杂志

中国修复重建外科杂志

高频彩色多普勒超声联合宽景成像在股前外侧穿支皮瓣术前导航中的应用

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目的 探讨高频彩色多普勒超声(high frequency color Doppler ultrasound,HFCDU)联合宽景成像在股前外侧动脉穿支皮瓣术前导航中的应用价值。 方法 2017 年 1 月—2018 年 3 月,收治 28 例皮肤软组织缺损患者。男 22 例,女 6 例;年龄 17~66 岁,平均 33.5 岁。致伤原因:烫伤瘢痕 2 例,重物砸伤 7 例,交通事故伤 12 例,摔伤 4 例,机器绞伤 2 例,感染溃疡 1 例。损伤部位:手、腕部 6 例,小腿 12 例,足 10 例。清创后创面范围为 6.0 cm×3.5 cm~24.0 cm×9.0 cm,均行游离旋股外侧动脉穿支皮瓣修复术。术前利用 HFCDU 结合宽景成像探测旋股外侧动脉穿支血供来源、数量、走行、体表位置、血流动力学特点及与体区关系等,根据源动脉的宽景成像显示的穿支信息确定优势穿支作为血管蒂设计皮瓣。皮瓣切取范围为 7.0 cm×4.5 cm~26.0 cm×7.0 cm。供瓣区直接拉拢缝合。 结果 28 例患者术前利用 HFCDU 结合宽景成像均成功探测到优势穿支,术中证实该穿支存在,定位准确,走行特点与宽景成像结果一致。术后 27 例皮瓣完全成活;1 例皮瓣边缘局部坏死,经换药后愈合。患者均获随访,随访时间 3~12 个月,平均 9 个月。皮瓣血运佳、弹性好,供区及受区外形、功能均良好。 结论 股前外侧皮瓣术前利用 HFCDU 结合宽景成像导航,可显示其穿支特点、血流动力学信息及与体区关系,使术者能更加准确、直观了解穿支情况,提高了皮瓣切取的成功率及手术效率。

Objective To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft. Methods Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crush injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly. Results The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good lasticity and shape. The donor areas healed perfectly. Conclusion Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.

关键词: 高频彩色多普勒超声; 宽景成像; 创面修复; 股前外侧皮瓣

Key words: High frequency color Doppler ultrasound; wide-field imaging; wound repair; anterolateral thigh flap

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