数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣重建足跟软组织缺损  

Computer assisted design of lobulated perforator flap based on descending branch of lateral circumflex femoral artery in reconstruction of heel defects

作　　者：吴攀峰[1] 唐举玉[1] 卿黎明[1] 俞芳[1] 庞晓阳[1] 曾磊[1] 潘丁[1] 肖勇兵[1] 刘睿[1] WU Panfeng;TANG Juyu;QING Liming;YU Fang;PANG Xiaoyang;ZENG Lei;PAN Ding;XIAO Yongbing;LIU Rui

机构地区：[1]中南大学湘雅医院骨科-手显微外科,长沙410008

出　　处：《中华显微外科杂志》2022年第1期33-37,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871577,81901978,82072194)。

摘　　要：目的探讨应用数字化技术辅助以旋股外侧动脉降支(d-LCFA)为蒂的分叶穿支皮瓣重建足跟软组织缺损的可行性及临床效果.方法2014年10月至2016年11月,术前采用Mimics软件三维可视化构建d-LCFA及穿支血管,利用软件自带功能虚拟模拟d-LCFA分叶穿支皮瓣的设计、分离及切取的过程,运用该方法指导临床设计、切取d-LCFA分叶穿支皮瓣修复足跟大面积软组织缺损5例,其中1例患者系d-LCFA分叶穿支皮瓣与腹壁下动脉穿支皮瓣(DIEPF)组合移植,在修复创面的同时,Ⅰ期重建足跟外形和功能,皮瓣供区直接缝合.通过门诊随访其恢复效果.结果5例均成功建立d-LCFA体区血管的三维可视化模型,成功地指导了分叶穿支皮瓣的设计与切取.5例患者10叶皮瓣均顺利成活,1例DIEPF远端出现跨体区回流障碍,部分坏死,Ⅱ期植皮.术后随访6~12(平均8.7)个月,皮瓣色泽、质地优良,足跟外形满意,皮瓣供区线形瘢痕.结论数字化技术可以有效辅助d-LCFA分叶穿支皮瓣的设计,利用d-LCFA分叶穿支皮瓣在修复足跟大面积软组织缺损的同时,可Ⅰ期重建足跟外形,最大限度地恢复足跟的功能.Objective To investigate the feasibility and clinical effect of the computer assisted design of the lobulated perforator flap based on the descending branch of lateral circumflex femoral artery(d-LCFA)to reconstruct the soft tissue defects of heel.Methods From October 2014 to November 2016,a computer assisted virtual technology was used to simulate the process of pre-operative design,isolation,and harvest of d-LCFA perforating flaps.This method was used to guide the design and harvest of the flap of d-LCFA in the repair of large-area soft tissue defects of the heel in all of the 5 patients.One patient received a combine flap of the d-LCFA flap and the perforating branch of the inferior abdominal artery flap(DIEPF).Heel appearance and function were reconstructed in phase I together with the repair of the defect.Donor site was directly sutured.The recovery effect was followed-up in the clinic.Results The 3D visualised model of the vessels in the donor area for quadriceps artery was successfully established in all 5 patients,and the design and removal of the perforating flap were successfully guided.All the 10 flaps survived successfully in 5 patients,except 1 patient had a backflow disorder at the distal end of the inferior epigastric artery perforator flap,with partial necrosis and II grafting.After 6 to 12 months of follow-up(mean,8.7 months),the flap showed good in colour and texture,with satisfactory heel appearance.The donor site was left with a linear scar.Conclusion Computer assisted design technology can effectively help in the design of the polyfoliate perforator flap pedicled with d-LCFA,using this technique to assist the design and repair of large area soft tissue defect of heel could reconstruct the shape of heel in phase I and restore the function of the heel to the maximum extent.

关 键 词：旋股外侧动脉降支 分叶穿支皮瓣 足跟 软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]