数字重建技术辅助设计分叶腹壁下动脉穿支皮瓣修复下肢远端巨大创面  

Digital reconstruction technology in assisted design of lobulated deep inferior epigastric perforator flap for reconstruction of large defect in lower extremity

作　　者：杨曦 徐永清 段家章 刘武华 石岩 方翔 徐月仙 何晓清 YANG Xi;XU Yongqing;DUAN Jiazhang;LIU Wuhua;SHI Yan;FANG Xiang;XU Yuexian;HE Xiaoqing(Department of Orthopaedics,the 920th Hospital of Joint Logistic Support Force of Chinese PLA,Kunming 650032,China;Department of Emergency Surgery,the Second People’s Hospital of Yunnan Province,Kunming 650021,China)

机构地区：[1]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650032 [2]云南省第二人民医院急诊外科,昆明650021

出　　处：《中华显微外科杂志》2023年第5期527-533,共7页Chinese Journal of Microsurgery

基　　金：云南省科技厅科技计划项目(202102AA310068)。

摘　　要：目的探讨数字重建技术辅助设计分叶腹壁下动脉穿支皮瓣(DIEPF)修复下肢远端巨大创面的疗效。方法回顾分析中国人民解放军联勤保障部队第九二〇医院骨科于2017年1月至2022年1月收治的8例下肢远端巨大创面患者,缺损面积16.0 cm×12.0 cm~28.0 cm×22.0 cm。术前行腹主动脉至双下肢动脉CTA检查,利用Mimics软件对DIEPF血管蒂进行三维可视化重建。根据创面形状和大小,利用三维图像筛选目标穿支,直角坐标系定位穿支,设计分叶皮瓣。术中按照设计切取分叶皮瓣修复创面,供区直接缝合。术后通过门诊、电话、微信的方式随访观察皮瓣成活和肢体恢复情况。采用Maryland足踝部功能评分标准对术后恢复情况进行评定。结果所有病例均完成供区的三维重建,并成功辅助分叶DIEPF的切取。8例患者的15叶皮瓣全部成活,1例中单叶皮瓣远端静脉危象后局部坏死,二期清创再次缝合后愈合;术后4例行二期皮瓣修薄。供、受区创面均一期愈合。随访时间15~27个月,平均20个月。末次随访时所有病例骨折愈合,皮瓣外形满意,供区仅遗留线形瘢痕。Maryland足踝部功能评分,其中优5例,良2例,可1例。结论数字重建技术能准确定位穿支血管,辅助合理设计分叶皮瓣;分叶DIEPF切取面积大,供区均一期闭合。两者联合可有效修复下肢远端巨大创面,具有临床应用价值。Objective To investigate the efficacy of digital reconstruction technology in assisted design of lobulated deep inferior epigastric perforator flap(DIEPF)for surgical reconstruction of large defect in lower extremity.Methods From January 2017 to January 2022,a study was carried out to retrospectively analyse 8 patients who had massive soft tissue defects in lower extremities were admitted in the Department of Orthopaedic Surgery of the 920 Hospital of Joint Logistic Support Force of Chinese PLA.The size of defects varied from 16.0 cm×12.0 cm-28.0 cm×22.0 cm.CTA scans were performed over abdominal aorta and the arteries of lower extremities.Three-dimensional model of DIEPF and vascular pedicles were reconstructed by Mimics software.According to the shape and size of the wound,targeted perforators were determined on the 3D images,and precisely mapped in a digitised rectangular coordinate system.The lobulated flap was then digitally designed in the 3D coordinate system.Flaps were harvested according to preoperative digital designs for the reconstruction of large defects in the lower extremities.The donor site was sutured directly.The flaps and recovery of lower extremities were observed though postoperative follow-ups and were conducted through visits of outpatient clinics and distance interviews via telephone and WeChat.Recoveries of lower extremities were evaluated using Maryland ankle-foot function scoring system.Results The 3D reconstructed models of the vessels in donor sites were successfully completed for all patients.The harvests of lobulated DIEPF were successfully guided by the digital designs.Fifteen lobes of lobulated DIEPF survived successfully in all 8 patients.All donor sites were closed in the stage-I.Necrosis occurred at the distal tip of a lobulated flap due to a local venous occlusion,and healed after debridement and re-suture.Four patients received further flap debulking surgery.Time of postoperative follow-ups had ranged 15-27 months,with an average of 20 months.At the last follow-up,all the f

关 键 词：腹壁下动脉穿支皮瓣 分叶穿支皮瓣 下肢 软组织缺损 穿支定位 数字医学技术 

分 类 号：R687.3[医药卫生—骨科学]