摘要
目的探讨数字化技术在腓动脉穿支蒂螺旋桨皮瓣修复足跟部创面中的应用价值。方法2016年3月-2019年3月,采用腓动脉穿支蒂螺旋桨皮瓣修复足跟部创面31例。男21例,女10例;年龄12~53岁,平均36岁。外伤后急诊入院17例,受伤至入院时间为6.0~12.5 h,平均8.5 h;慢性感染及溃疡创面14例。创面范围5 cm×4 cm^12 cm×8 cm。皮瓣修复术前基于下肢CT血管造影(CT angiography,CTA)数据,通过Mimics19.0软件三维重建腓动脉穿支血管及皮肤模型,精确定位穿支点,并根据创面缺损范围和位置设计腓动脉穿支蒂螺旋桨皮瓣和模拟切取操作。结果基于术前重建的穿支血管及皮肤三维模型,明确腓动脉穿支来源及走行,术前测量的穿支定位点、穿支血管外径、穿支最大可裸化长度与术中实际测量结果差异无统计学意义(P>0.05)。31例腓动脉动脉低位穿支于小腿后外侧外踝尖上5~10 cm区域分布较为恒定,外踝尖上10 cm以内的穿支总出现率为96.9%,穿支血管蒂长(3.44±0.65)cm。31例患者均顺利完成皮瓣切取及转位。手术时间30~65 min,平均45 min。术后4例皮瓣出现静脉危象、3例皮瓣部分坏死,经对症处理后成活;其余皮瓣及植皮均顺利成活,创面Ⅰ期愈合。患者均获随访,随访时间3~18个月,平均12个月。皮瓣外形良好,末次随访时患者足踝部功能根据美国矫形足踝协会(AOFAS)评分,获优17例、良11例、可3例;优良率为87.5%。结论数字化技术能提高腓动脉穿支定位及腓动脉穿支蒂螺旋桨皮瓣设计的准确性,降低了血管解剖变异导致的皮瓣切取困难和手术风险。
Objective To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.Methods Between March 2016 and March 2019,the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps.There were 21 males and 10 females,with an average age of 36 years(range,12-53 years).Seventeen patients were admitted to hospital in emergency after trauma,the time from injury to admission was 6.0-12.5 hours,with an average of 8.5 hours;14 patients were chronic infectious wounds and ulcer.The wound area ranged from 5 cm×4 cm to 12 cm×8 cm.Before flap repair,CT angiography(CTA)data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model,accurate location of perforator,accurate design of perforator flap,and simulated operation according to the defect range and location were obtained.Results The origin and course of peroneal artery perforator,the position of perforator,the diameter of perforator,and the maximum length of the naked perforator were determined based on the three-dimensional model.There was no significant difference in locating point of perforator,diameter of perforator,maximum length of naked perforator between the pre-and intra-operative measurements(P>0.05).The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip(5-10 cm)in 31 cases.The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%,and the length of vascular pedicle was(3.44±0.65)cm.The flap removal and transposition in 31 patients were successfully completed.The average operation time was 45 minutes(range,30-65 minutes).After operation,vein crisis and partial necrosis occurred in 4 cases and3 cases,respectively,which were survived after symptomatic treatment.All the grafts survived and the incisions healed by first intention.All the patients were followed up 3-18 months,with an average of 12 months.At
作者
赵万秋
徐永清
何晓清
罗浩天
许育健
ZHAO Wanqiu;XU Yongqing;HE Xiaoqing;LUO Haotian;XU Yujian(Department of Orthopedics,the 920th Hospital of Joint Logistic Support Force of Chinese PLA,Kunming Yunnan,650032,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第3期367-372,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
2015年钟世镇院士工作站项目(2015IC030)
云南省临床医学中心基金。
关键词
螺旋桨皮瓣
腓动脉穿支
数字化技术
足跟
创面修复
Propeller flap
peroneal artery perforator
digital technology
heel
wound repair
