中国修复重建外科杂志

中国修复重建外科杂志

数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用研究

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目的 探讨数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用价值。 方法 2013 年 8 月—2016 年 10 月,应用外侧腓肠浅动脉穿支皮瓣修复手部中小创面 10 例。男 6 例,女 4 例;年龄 19~47 岁,平均 31.2 岁。致伤原因:机器绞伤 6 例,交通事故伤 3 例,电烧伤 1 例。伤后至入院时间 4 h~10 d,平均 3.5 d。创面部位:虎口 2 例,拇指指腹 3 例,示指指腹 1 例,掌背 3 例,指背 1 例。创面范围 4 cm×3 cm~8 cm×7 cm,均伴骨骼或肌腱外露。术前首先常规行腹主动脉至双侧胫前、后动脉 CT 血管造影(CT angiography,CTA),初步观察双侧肢体膝关节周围外侧腓肠浅动脉穿支血管情况,并挑选合适一侧肢体作为供区;然后,将 CTA 数据导入 Mimics15.0 软件三维重建穿支血管、骨骼、皮肤,并根据创面大小动态模拟皮瓣设计、切取过程。术中根据术前设计切取皮瓣,皮瓣切取范围 5 cm×4 cm~10 cm×8 cm。9 例供区直接缝合,1 例供区游离植皮修复。 结果 除 3 例患者外侧腓肠浅动脉较细,术中改为内侧腓肠浅动脉穿支皮瓣修复外,其余患者均顺利切取皮瓣修复创面。术后 24 h 1 例皮瓣发生静脉危象,经对症处理后成活;其余皮瓣均顺利成活,创面及供区均Ⅰ期愈合。患者均获随访,随访时间 3~18 个月,平均 10 个月。皮瓣外形良好,末次随访时按关节总活动度(TAM)评价标准评定手部功能,优 6 例,良 3 例,可 1 例。 结论 CTA 结合 Mimics15.0 软件能实现术前外侧腓肠浅动脉穿支皮瓣的个体化、精确化设计,降低了手术风险。

Objective To investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap. Methods Between August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case. Results Superficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM). Conclusion The preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.

关键词: 外侧腓肠浅动脉穿支皮瓣; 数字化技术; CT 血管造影; 手部创面

Key words: Superficial lateral sural artery perforator flap; digital technology; CT angiography; hand wound

引用本文: 李国栋, 徐永清, 何晓清, 罗浩天, 董凯旋, 王腾. 数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用研究. 中国修复重建外科杂志, 2017, 31(5): 564-569. doi: 10.7507/1002-1892.201612088 复制

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