三维扫描在扩张皮瓣术前设计中的应用  

3D Scanning for Pre Operative Design for Expanded Flap

作　　者：孙映菲 夏文政 高雅姗 李周骁 李海洲[1] 毛佳怡 昝涛[1] 李青峰[1] SUN Yingfei;XIA Wenzheng;GAO Yashan;LI Zhouxiao;LI Haizhou;MAO Jiayi;ZAN Tao;LI Qingfeng(Department of Cerebral Sursery,Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medcine,Shanghai 200023,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,200023

出　　处：《临床外科杂志》2024年第12期1246-1249,共4页Journal of Clinical Surgery

摘　　要：目的评估三维扫描技术在扩张皮瓣术前设计中的价值,通过此方法对病人二期扩张皮瓣转移手术时机进行客观和准确地判断,避免扩张皮瓣面积不足或过量。方法2024年4月~2024年9月收治的拟计划接受局部扩张皮瓣修复病人10例,借助Vectra WB360三维成像仪对病人的创面缺损面积、扩张器底座面积及扩张皮面积进行测算,并与术中结果进行比较,评估此技术用于指导扩张皮瓣手术的准确性。结果10例病人采用Vectra WB360三维成像仪测量扩张器表面积(扩张皮面积)、扩张器底座面积、病灶面积分别为(539.3±268.4)cm^(2)、(157.0±78.13)cm^(2)、(252.8±141.6)cm^(2),术中实际测量分别为(470.7±230.4)cm^(2)、(159.9±83.2)cm^(2)、(241.7±134.1)cm^(2),其中仪器测量的扩张器底座面积、病灶面积与术中实际测量的相比,差异均无统计学意义(P>0.05),仪器测量的扩张皮面积大于术中皮瓣面积,差异有统计学意义(P<0.05),与扩张器取出后扩张皮回缩有关。术中皮瓣均可完整覆盖创面,术后皮瓣全部存活,1~6个月的随访显示,术区外形和功能恢复良好,病人满意度高。结论Vectra WB360三维成像仪能显著提高术前皮瓣面积估算的准确性,优化手术计划,提高扩张皮瓣手术的成功率。Objective To evaluate the value of three-dimensional scanning technology in the preoperative design of tissue expansion procedures,with the expectation of making objective and accurate judgments regarding the timing of the second-stage expanded flap transfer surgery for patients,in order to avoid insufficient or excessive expanded flap areas.Methods From April 2024 to September 2024,we treated 10 patients who planned to undergo local tissue expansion for head and neck reconstruction.We utilized the Vectra WB360 three-dimensional imaging device to measure the wound defect area,the base area of the expander,and the expanded flap area in these patients,and compared these measurements with intraoperative results to assess the accuracy of this technology in guiding tissue expansion surgery.Results In 10 cases,the surface area of the expander(expansion skin area),the base area of the expander,and the lesion area were measured using the Vectra WB3603D imaging device,with average measurements of(539.3±268.4)cm^(2),(157.0±78.13)cm^(2),and(252.8±141.6)cm^(2).Intraoperative actual measurements were(470.7±230.4)cm^(2),(159.9±83.2)cm^(2),and(241.7±134.1)cm^(2).Statistical analysis revealed no significant differences between the device-measured base area of the expander and lesion area compared to the intraoperative actual measurements(P>0.05).The device-measured expanded skin area was greater than the intraoperative flap area(P<0.05),which is associated with the retraction of the expanded skin after the removal of the expander.During the opearation,the flaps were able to completely cover the wound,and all flaps survived postoperatively.Follow-up at 1 to 6 months indicated good recovery of the surgical site’s appearance and function,with a high level of patient satisfaction.Conclusion The Vectra WB360 three-dimensional imaging device significantly improves the accuracy of preoperative flap area estimation,optimizes surgical planning,and thereby enhances the success rate of expanded skin flap surgery.

关 键 词：三维扫描 组织扩张 皮瓣外科 

分 类 号：R47[医药卫生—护理学]