Duan Jiazhang, He Xiaoqing, Xu Yongqing, Fan Xinyu, Luo Haotian, Wang Teng, Dong Kaixuan, Yu Kaifu
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2015 Jul;29(7):807-11.
To investigate the effectiveness of digital technology in repairing wounds of the hand and foot with anterolateral thigh flap.
Between September 2013 and September 2014, 16 cases of wounds of the hand and foot were treated with the anterolateral thigh flap. There were 10 males and 6 females, with an average age of 31 years (range, 20-52 years). The causes included traffic accident injury in 8 cases, crushing injury by machine in 6 cases, burning injury in 1 case, and animal biting injury in 1 case. The locations of soft tissue defect were the dorsum of the foot in 5 cases, the ankle in 4 cases, the planta pedis in 1 case, and the hand and forearm in 6 cases. The time was 2 hours to 45 days from injury to hospitalization (mean, 14.3 days). All defects were associated with exposure of bone and tendon. The size of wound was from 9.0 cmx4.0 cm to 29.0 cmx8.5 cm. CT angiography (CTA) was performed before operation, and the appropriate perforator as well as the donor site was selected. Then the Mimics l5.0 software was used to reconstruct the data of CTA so as to locate the main perforators, design the three-dimensional models of the anterolateral thigh flap, and simulate operation. The flap was obtained according to preoperative plan during operation. The size of flaps varied from 11 cm x 5 cm to 31 cm x 10 cm. The donor sites were sutured directly in 14 cases and were repaired by free skin graft in 2 cases.
The lateral femoral circumflex artery identified by Mimics l5.0 software before operation, as well as the starting position of its descending branch, the blood vessel diameter at start site, vascular distribution, the maximum cutting length of the vascular pedicle were consistent with the actual observation during operation. All flaps were harvested and were used to repair defect smoothly. Vascular crisis occurred in 1 flap after operation, and the other flaps survived successfully. The wounds and the incisions obtained healing by first intention, and grafted skin survived completely. All cases were followed up 6-17 months (mean, 9 months). Fifteen flaps had good shape; but a second- stage operation was performed to make the flap thinner in 1 case. At last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case according to total active motion (TAM) in 6 cases of hand and forearm injury; the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) in 10 cases of foot injury. The total excellent and good rate was 81.25%.
The preoperative individualization design of the flap can be realized through CTA digital technology and Mimics 15.0 software; it can reduce the operation risk.
探讨数字技术在股前外侧皮瓣修复手足创面中的应用效果。
2013年9月至2014年9月，采用股前外侧皮瓣修复16例手足创面。男10例，女6例，平均年龄31岁（20～52岁）。致伤原因：交通事故伤8例，机器挤压伤6例，烧伤1例，动物咬伤1例。软组织缺损部位：足背5例，踝部4例，足底1例，手及前臂6例。受伤至入院时间为2小时至45天（平均14.3天）。所有缺损均伴有骨与肌腱外露。创面大小为9.0 cm×4.0 cm至29.0 cm×8.5 cm。术前行动脉CT血管造影（CTA），选择合适的穿支血管及供区。然后应用Mimics 15.0软件对CTA数据进行重建，定位主要穿支血管，设计股前外侧皮瓣三维模型并模拟手术。术中按术前设计切取皮瓣。皮瓣大小为11 cm×5 cm至31 cm×10 cm。供区14例直接缝合，2例游离植皮修复。
Mimics 15.0软件术前显示的旋股外侧动脉及其降支起始位置、起始处血管直径、血管分布、血管蒂最大可切取长度与术中实际观察一致。所有皮瓣均顺利切取并用于修复缺损。术后1例皮瓣发生血管危象，其余皮瓣均成活。创面及供区切口均一期愈合，植皮完全成活。所有病例随访6～17个月（平均9个月）。15例皮瓣外形良好，1例二期手术修薄皮瓣。末次随访时，6例手及前臂损伤患者按总主动活动度（TAM）评定：优3例，良2例，可1例；10例足部损伤患者按美国足踝外科协会（AOFAS）评分评定：优5例，良3例，可2例。总优良率为81.25%。
通过CTA数字技术及Mimics 15.0软件可实现皮瓣术前个体化设计，降低手术风险。
