数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣设计的初步应用  

Application of computer assisted technique to desgin polyfoliate perforator flappedicled on the descending branch of the circumflex femoral lateral artery

作　　者：唐举玉[1] 卿黎明[1] 贺继强[1] 吴攀峰[1] 周征兵[1] 梁捷予[1] 俞芳[1] 李文政[2] 易小平[2] 

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008 [2]中南大学湘雅医院放射科

出　　处：《中华显微外科杂志》2016年第2期123-126,共4页Chinese Journal of Microsurgery

基　　金：中南大学临床科研基金资助项目（2014L06）;国家自然科学基金项目（81472104）

摘　　要：目的探讨应用数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣移植的可行性及临床效果。方法2014年10月至2015年7月，选取12例合并有宽大或不规则皮肤软组织缺损的患者，术前采用数字减影血管造影（DSA）结合CT血管造影技术（CTA）获取一侧下肢的二维断层图像数据，应用Mimics软件对旋股外侧动脉降支及其分支进行三维可视化重建，根据软件的自带工具虚拟模拟分叶穿支皮瓣的设计及其分离切取的手术过程。临床实际运用该方法指导旋股外侧动脉降支分叶穿支皮瓣的术中设计与皮瓣的切取12例，皮瓣供区直接缝合。结果12例均成功建立旋股外侧动脉降支体区血管的三维可视化模型，清晰的显示出旋股外侧动脉降支穿支血管的分布、走行及穿支在体表皮肤穿出位置，成功的指导了分叶穿支皮瓣的设计与切取。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1～5个月（平均3．6个月），皮瓣色泽、质地优良，皮瓣供、受区外形满意。结论基于数字化技术可以有效辅助旋股外侧动脉降支分叶穿支皮瓣的设计，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 explore the feasibility of three-dimensional visualizational reconstruction and vir- tualization simulated operation of polyfoliate perforator flap pedicled on the descending branch of the circumflex femoral lateral artery. Methods Between October, 2014 and July, 2015, a series of DICOM images were obtained from 12 patients by DSA and dual source CTA. Then the mimics 16.0 was been used to reconstruct the descending branch of the circumflex femoral lateral artery and its perforator vessels. The procedure of free polyfoliate perforator flap pedicled on the descending branch of the circumflex femoral lateral artery had been simulated in personal computer. According to design in the computer, the polyfoliate perforator flaps were designed and dissected for 12 patients who had combined with the huge or irregular wound. Results The 3D reconstruction models could provide perfectly dynamic visualization of the anatomy of the descending branch of the circumflex femoral lateral artery and clearly display three-dimensional relations of blood vessels, skin and adjacent tissue. The procedure of the free polyfoliate perforator flap transfer could be virtually simulated through the mimics soft in the personal computer. Twelve polyfoliate perforator flaps pedicled on the descending branch of the circumflex femoral lateral artery had been transfered with the methods all of flaps were successful survival and donor sites had been directly closed. All patients were followed-up with 1-5 months （mean 3.6 month）. The appearance of flaps were satisfactory. Conclusion The 3D reconstruction models can provide a perfect dynamic visualization of the anatomy of the descending branch of the circumflex femoral lateral artery and its perforator vessels which can be used for individualized design of the Polyfoliate perforator flap pedicled on the descending branch of the circumflex femoral lateral artery.

关 键 词：旋股外侧动脉 穿支皮瓣 三维可视化 放射造影 显微外科手术 

分 类 号：R622[医药卫生—整形外科]