摘要
目的探讨术前定位膜联合CTA辅助设计股前外侧穿支皮瓣(ALTPF)修复足和踝关节周围软组织缺损的可行性和临床疗效。方法2018年5月至2021年12月,宁波大学附属第一医院整形修复外科收治的足和踝关节周围软组织缺损患者共18例,男11例,女7例,年龄32~78岁,平均57.5岁。其中慢性溃疡创面10例,外伤创面6例,恶性肿瘤术后创面2例。创面面积为6.0 cm×8.0 cm~9.0 cm×13.0 cm,皮瓣面积为8.0 cm×10.0 cm~11.0 cm×15.0 cm,术前应用定位膜联合CTA三维重建,以数字化的形式标记出拟采用穿支血管的穿出点,同时描记血管走行,计算血管蒂长度,根据重建图像精准设计ALTPF,并以此修复踝关节软组织缺损创面,供区均直接拉拢缝合。术后门诊定期随访,观察皮瓣成活情况,并按照美国足踝外科学会(AOFAS)踝-后足评分评定功能恢复情况。结果术后18例皮瓣全部成活,供区与受区创面顺利愈合。术后18例患者均获得随访,随访时间5~36个月,平均13个月,末次随访患者受区皮瓣质地较好,外形无臃肿,供区恢复良好,无明显瘢痕增生,患足功能根据AOFAS踝-后足评分,结果优10例,良6例,可2例。结论定位膜联合CTA三维重建能以数字化的形式标记穿支血管的穿出点及走行,是术前精准定位穿支血管的有效手段,其辅助设计ALTPF修复足和踝关节周围软组织缺损有效缩短了手术时间,降低手术风险,术后皮瓣成活率高,具有较好的临床价值。
Objective To explore the feasibility and clinical effectiveness of preoperative positioning grid combined with CTA assisted design of anterolateral thigh perforator flap(ALTPF)in reconstruction of soft tissue defects around foot and ankle.Methods From May 2018 to December 2021,a total of 18 cases with soft tissue defects around foot and ankle were admitted to the Department of Plastic and Reconstructive Surgery,First Affiliated Hospital of Ningbo University.The patients were 11 males and 7 females,aged from 32 to 78 years old,with an average age of 57.5 years old.Among them,10 had chronic ulcer wounds,6 had traumatic wounds,and 2 had postoperative wounds after malignant tumor resection.The sizes of soft tissue defect ranged from 6.0 cm×8.0 cm to 9.0 cm×13.0 cm,and the flap sizes ranged from 8.0 cm×10.0 cm to 11.0 cm×15.0 cm.Preoperative positioning grid combined with CTA three-dimensional reconstruction were used to mark the exit point of the perforator vessels in digital format,in order to restore the course of vessels and calculate the length of the vascular pedicles.ALTPFs were accurately designed based on the digitally reconstructed images,and then the ALTPFs were used to repair the soft tissue defects around the ankle.The flap donor sites were directly closed in stageⅠ.After the operation,all the patients were included in scheduled follow-ups at the outpatient department to observe the appearance of the recipient flaps and donor sites.The functional evaluation of the affected feet were assessed according to the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hindfoot score.Results All 18 flaps survived,and the wounds in both the recipient and donor sites healed in stageⅠ.Postoperative follow-up for the 18 patients were 5 to 36 months,with an average of 13 months.At the last follow-up,the appearances of the flaps were good without swelling,the donor sites had good recovery,and there was no obvious scar hypertrophy.The function evaluation of the affected feet were found at excellent in 10 cases,good in 6 cases,and fair in 2 cases.Conclusion Preoperative position grid combined with CTA three-dimensional reconstruction can digitally mark the exit points and running courses of the perforator vessels.It is an effective method for accurate position of perforator vessels before surgery.It can effectively reduce the operation time,lower the surgical risks,and achieve a high survival rate of the flap,thus holding considerable clinical value.
作者
陈芝武
林光豪
於恩兴
陈林海
宋庆华
魏鹏
蔡利兵
CHEN Zhiwu;LIN Guanghao;YU Enxing;CHEN Linhai;SONG Qinghua;WEI Peng;CAI Libing(Department of Plastic and Reconstructive Surgery,First Affiliated Hospital of Ningbo University,Ningbo,Zhejiang Province 315000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第6期625-630,共6页
Chinese Journal of Microsurgery
基金
浙江省自然科学基金(BY23H180015)
宁波市科技局基金(2023Z193)。
关键词
定位膜
股前外侧穿支皮瓣
三维重建
踝关节
修复
Positioning grid
Anterolateral thigh perforator flap
Three-dimensional reconstruction
Ankle
Reconstruction
