红外热成像结合高频彩色多普勒超声定位浅筋膜穿支在超薄股前外侧皮瓣切取中的应用  

Infrared thermography combined with high frequency colour Doppler ultrasound to locate superficial fascia perforators in harvest of super-thin anterolateral thigh flaps

作　　者：李贤海 周建东 郑杰 何仕辉 胡起文 张宇轩 陈学民 LI Xianhai;ZHOU Jiandong;ZHENG Jie;HE Shihui;HU Qiwen;ZHANG Yuxuan;CHEN Xuemin(Department of Orthopaedics,Zhoushan Hospital,Zhoushan 316021,China;Department of Foot and Ankle Surgery,Wuxi No.9 People's Hospital,Wuxi 214062,China)

机构地区：[1]舟山医院骨科,舟山316021 [2]无锡市第九人民医院足踝外科,无锡214062

出　　处：《中华显微外科杂志》2024年第6期635-640,共6页Chinese Journal of Microsurgery

基　　金：浙江省医药卫生科技计划(2022KY1368)。

摘　　要：目的探讨红外热成像(IRT)结合高频彩色多普勒超声(HFCDU)定位浅筋膜穿支指导切取超薄股前外侧皮瓣(ALTF)的效果。方法2022年1月至2023年7月,舟山医院骨科和无锡市第九人民医院足踝外科选取患者共15例,其中男11例,女4例,年龄26~64岁,平均48.3岁,其中足部创面14个,手部创面1个,前臂创面1个,踝部创面1个,软组织缺损大小5 cm×3 cm~23 cm×7 cm,共计切取17个游离超薄ALTF修复创面,切取皮瓣面积6 cm×4 cm~25 cm×8 cm,供区均直接拉拢缝合。术前均采用HFCDU对ALTF穿过深筋膜进入浅筋膜的穿支进行定位,手术室内采用IRT对皮肤浅筋膜浅层穿支进行定位,根据两种方式定位的穿支连线确定浅筋膜内穿支走行,进行超薄ALTF切取并验证穿支准确性,使用SPSS 23.0统计学软件进行数据分析,对热成像对浅筋膜穿支定位数据与手术发现浅筋膜内穿支数据进行秩和检验,以P<0.05为差异有统计学意义。术后采用门诊及微信随访,观察皮瓣的成活和功能恢复情况。结果HFCDU定位穿支30条,IRT定位穿支30条,术中共发现31条浅筋膜穿支。真阳性率为93.3%,假阳性为6.7%,假阴性为9.7%。对IRT定位穿支数量与术中发现穿支数量采用秩和检验,结果差异无统计学意义(P=0.853)。术后皮瓣14块无并发症;部分坏死1块,换药后创口愈合;发生静脉危象1块,探查后情况改善;发生浅表感染1块,抗感染治疗后改善。术后随访3~12个月,皮瓣质地良好,肢体外观及功能满意。供区愈合良好,无瘢痕增生。结论采用IRT结合HFCDU进行ALTF浅、深结合定位穿支,效果可靠,有利于超薄皮瓣的穿支探查及皮瓣切取。Objective To investigate the effect of combination of infrared thermography(IRT)and high frequency colour Doppler ultrasound(HFCDU)in location of superficial fascia perforating vessels and to guide the design and harvest of super-thin anterolateral thigh flap(ALTF).Methods A total of 15 patients who received medical treatment in the Department of Orthopaedics,Zhoushan Hospital and Department of Foot and Ankle Surgery,Wuxi No.9 People’s Hospital from January 2022 to July 2023 were selected to participate the study.The patients were 11 males and 4 females,aged 26 to 64 years with an average age of 48.3 years.A total of 14 wounds of foot,1 of hand,1 of forearm and 1 of ankle were reconstructed with 17 free super-thin ALTFs.The sizes of soft tissue defect were 5 cm×3 cm-23 cm×7 cm.The flaps were 6 cm×4 cm to 25 cm×8 cm in size.The donor sites were directly pulled together and sutured.Before surgery,HFCDU was applied to locate the perforator vessels across deep fascia into superficial fascia of the ALTF.IRT was further employed to locate the superficial perforator vessels on the superficial fascia in operating room.The running course of a perforating branch in the superficial fascia was determined by the running courses of the perforating branch located by the two location methods.Super-thin ALTFs were harvested and the precise locations of the perforating vessels were verified in surgery.SPSS 23.0 software was used for data analysis.Rank sum test was performed on the location data of superficial fascial perforating branches found by IRT and the data in surgery.P<0.05 was considered a statistically significant difference.All patients were included in the postoperative follow-up by means of visit of outpatient clinic and via WeChat reviews,where the survival and functional recovery of the flaps were observed.Results A total of 30 perforating vessels had been located by HFCDU and 30 by IRT,and a total of 31 perforating vessels were found in superficial fascia in surgery.The true positive rate was 93.3%,with a fals

关 键 词：红外热成像 高频彩色多普勒超声 股前外侧皮瓣 超薄皮瓣 穿支定位 

分 类 号：R445.1[医药卫生—影像医学与核医学] R658.3[医药卫生—诊断学]