基于多层CT血管成像的穿支皮瓣设计和切取的三维导航流程的建立及其临床应用效果  

Establishment and clinical application effects of a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography

作　　者：尹其翔[1] 糜菁熠 蔡华忠[1] 周峰[1] 姚群 华雍 Yin Qixiang;Mi Jingyi;Cai Huazhong;Zhou Feng;Yao Qun;Hua Yong(Department of Emergency,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;Department of Sports Medicine,Wuxi No.9 People's Hospital,Wuxi 214062,China)

机构地区：[1]江苏大学附属医院急诊中心,镇江212001 [2]无锡市第九人民医院运动医学科,无锡214062

出　　处：《中华烧伤与创面修复杂志》2025年第2期171-179,共9页Chinese Journal of Burns And Wounds

基　　金：上海市周围神经显微外科重点实验室/卫健委手功能重点实验室(20DZ2270200);镇江市科技创新资金(SH2021051,SH2023033);无锡市卫生健康委重大科研项目(Z202108);2023年无锡市太湖人才计划“顶尖医学团队”无锡市卫生健康委员会推广应用项目(T202346);无锡市科技发展基金项目面上项目(Y20232020);镇江市科技计划(SH2024043)。

摘　　要：目的 建立基于多层CT血管成像(MDCTA)的穿支皮瓣设计和切取的三维导航流程,探讨其临床应用效果.方法 该研究为回顾性观察性研究.2021年1月-2023年10月,江苏大学附属医院收治7例、无锡市第九人民医院收治6例符合入选标准的创伤后四肢皮肤软组织缺损患者,其中男8例、女5例,年龄21~68岁.创面位于手部者9例、足部者4例.清创后创面面积为8.0 cm×6.0 cm~18.0 cm×17.0 cm.通过基于MDCTA的三维导航流程,设计并切取14块穿支皮瓣,包括11块游离股前外侧穿支皮瓣、3块含腓肠神经营养血管链的腓动脉穿支带蒂皮瓣,皮瓣面积9.0 cm×6.0cm~20.0 cm×15.0 cm.6块皮瓣供区创面直接缝合,8块皮瓣供区创面行皮片移植.比较术前导航显示的穿支位置、类型及其来源动脉同术中实际探查的一致性.术后即刻,按照自定义标准评价皮瓣覆盖创面情况.观察术后皮瓣成活情况.观察并记录随访期间并发症发生情况.末次随访时,观察皮瓣外观,参照中华医学会手外科学会上肢部分功能评定试用标准评定皮瓣血运和9例手部创伤者手部功能,采用美国矫形足踝外科协会踝-后足评分系统评定4例足部创伤者足部功能.结果 术前导航显示的穿支位置、类型及其来源动脉与术中实际探查结果一致.术后即刻,11块皮瓣覆盖创面情况为优、3块为中.术后,13块皮瓣完全成活;1块皮瓣部分坏死,经移植大腿全厚皮后愈合.患者术后获得4~24个月随访,1例患者发生皮瓣下血肿、1例患者发生局部感染.末次随访时,所有患者皮瓣色泽、质地均良好,5例术后皮瓣臃肿者行修薄手术后外观良好;12块皮瓣血运为优、2块皮瓣血运为良;手部创伤者中手部功能为优者2例、良者4例、差者3例,足部创伤者中足部功能为优者3例、良者1例.结论 基于MDCTA的穿支皮瓣设计和切取的三维导航流程,实现了对皮瓣供区穿支血管及受区皮肤软组织缺损的�ObjectiveTo establish a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography(MDCTA)and to explore its clinical application effects.MethodsThis study was a retrospective observational study.From January 2021 to October 2023,7 patients and 6 patients with post-traumatic skin and soft tissue defects in extremity and conformed to the inclusion criteria were admitted to the Affiliated Hospital of Jiangsu University and Wuxi No.9 People's Hospital,respectively.There were 8 males and 5 females,aged 21 to 68 years.Nine patients had wounds on the hand and 4 patients had wounds on the foot.The wound area after debridement ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm.Through the three-dimensional navigation process based on MDCTA,14 perforator flaps were designed and resected,including 11 free anterolateral thigh perforator flaps and 3 pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain,with flap size ranging from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm.Six wounds in the flap donor sites were directly sutured,and eight wounds in the flap donor sites were transplanted with skin grafts.The consistency of the location,type,and source of the perforators was compared between the preoperative navigation display and actual intraoperative detection.Immediately after surgery,the coverage of wound by the flap was evaluated according to the self-made criteria.The postoperative flap survival was observed.The occurrence of complications was observed during follow-up.At the last follow-up,the appearance of the flaps was observed,the blood supply of the flaps and the hand function of the 9 patients with hand trauma were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association,and the foot function of the 4 patients with foot trauma was assessed using the American Orthopaedic Foot&Ankle Society Ankle-Hindfoot Scoring System.Result

关 键 词：穿支皮瓣 血管造影术 成像 三维 术前导航流程 创面修复 

分 类 号：R47[医药卫生—护理学]