数字化辅助技术在股前外侧分叶皮瓣修复前中足脱套伤中的应用  

Application of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degioved injury of foot

作　　者：何晓清[1] 段家章 徐永清[1] 朱跃良[1] 李国栋[1] 杨曦[1] 冯凡哲[1] 刘帅 

机构地区：[1]成都军区昆明总医院全军创伤骨科研究所,650032

出　　处：《中华创伤杂志》2017年第10期868-872,共5页Chinese Journal of Trauma

基　　金：全军后勤科研计划重大专项（AWS14C003）;全军后勤科研计划面上项目（CCD14J003）

摘　　要：目的探讨数字化辅助技术在股前外侧分叶皮瓣修复前中足脱套伤中的初步疗效。方法采用回顾性病例系列研究分析2013年3月～12015年12月收治的8例前中足脱套伤患者临床资料，其中男7例，女1例；年龄18～51岁，平均34．5岁。足部缺损面积18cm×12cm～13cm×10cm。患者均在数字化技术辅助下应用股前外侧分叶皮瓣完成修复。术前均行下肢CT血管造影（CTA），将CTA数据以DICOM格式导入Mimics 15．0软件。根据旋股外动脉降支穿支情况和足部皮肤缺损面积，选择一侧大腿进行股前外侧皮瓣数字化三维重建。皮瓣面积24cm×9cm～19cm×7cm。患者均为Ⅱ期修复。术后1个月内观察皮瓣成活情况、皮瓣供区愈合情况。记录皮瓣修薄次数。术后3个月观察皮瓣外观、穿鞋情况、行走步态、相关并发症。结果患者均获随访10～21个月，平均15．5个月。8例皮瓣均成活良好，所有皮瓣供区均直接缝合。术后2次皮瓣修薄3例，1次皮瓣修薄3例，无须修薄2例。末次随访时患者皮瓣色泽、质地均良好；均能正常穿鞋；2例步态轻度异常；1例前足内侧表浅溃疡形成。结论股前外侧分叶皮瓣修复前中足脱套伤可促进伤口愈合，减少并发症；数字化辅助技术能实现皮瓣的术前精确设计和术中精准切取。Objective To assess preliminary clinical efficacy of digital assisted technology in double skin paddle anterolateral thigh flap reconstructing degloved injury of forefoot or midfoot. Methods From March 2013 to December 2015, eight patients with degloved injury of forefoot or midfoot were retrospectively analyzed by case series study. They were seven males and one female, with age range of 18-51 years （mean, 34.5 years）. The foot skin defect area ranged from 18 cm × 12 cm to 13 cm × 10 cm. All patients underwent computed tomography angiography （CTA） in lower extremities preoperatively. The CTA data were entered into Mimics 15. 0 software in DICOM format. Based on perforating condition of descending branch of lateral femoral cireundlex artery and the size of foot defect, one thigh was chosen for three dimensional reconstruction of anterolateral thigh flap. The flap size ranged from 24 cm × 9 cm to 19 cm × 7 cm. All reconstructive surgeries were performed secondarily. Patients were all at Ⅱ stage recovery. The survival of flaps and healing status of flap donor sites were observed in one month after surgery. The number of debulking flaps was recorded. The appearance of flaps, shoe wearing, gait and related complications were recorded. Results The follow-up was 10-21 months （ mean, 15.5 months）. All flaps survived uneventfully, and all donor sites were sutured directly. Three patients had twice debulking procedures, three patients had one debulking procedure, and two patients had no debulking. At the last visit in follow-up, the color and texture of flaps were good. All patients were able to wear shoes normally, two patients remained mild abnormal gait, and one patient presented superficial ulcer at the medial of the forefoot. Conclusions Double skin paddle anterolateral thigh flap for reconstruction of degloved injury of forefoot or midfoot can prompt wound healing and decrease complications. Digital assisted technology is an excellent supplementary method in double skin paddle anterolateral thigh f

关 键 词：足损伤 软组织损伤 外科皮瓣 计算机辅助设计 

分 类 号：R658.3[医药卫生—外科学]