Guo Yu, Wei Zairong, Zeng Kewei, Zhang Fengling, Deng Chengliang, Zhang Wenduo, Wang Dali
Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000, P.R.China.
Department of Burn and Plastic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563000,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2019 Feb 15;33(2):190-194. doi: 10.7507/1002-1892.201810025.
To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft.
Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly.
The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly.
Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.
探讨高频彩色多普勒超声（HFCDU）联合宽视野成像在前外侧大腿穿支皮瓣移植术前导航中的应用。
2017年1月至2018年3月，收治28例皮肤软组织缺损患者，其中男性22例，女性6例，平均年龄33.5岁（17 - 66岁）。致伤原因包括烫伤瘢痕2例、重物挤压伤7例、交通事故伤12例、摔伤4例、机器伤2例、感染性溃疡1例。损伤部位包括手部及腕部6例、小腿12例、足部10例。清创后创面面积为6.0 cm×3.5 cm至24.0 cm×9.0 cm，所有患者均行游离旋股外侧动脉穿支皮瓣移植术。术前采用HFCDU联合宽视野成像导航检测旋股外侧动脉穿支的起源、数量、走行、体表位置、血流动力学特征及其与体区的关系。根据源动脉宽视野成像显示的穿支信息，确定优势穿支作为设计皮瓣的蒂部。皮瓣大小为7.0 cm×4.5 cm至26.0 cm×7.0 cm。皮瓣供区直接缝合。
28例患者术前通过HFCDU联合宽视野成像成功检测到优势穿支。术中证实穿支存在，且定位准确。穿支走行特征与宽视野成像结果一致。术后27例患者皮瓣完全成活。1例患者皮瓣边缘出现坏死，经换药后愈合。所有患者随访3 - 12个月，平均9个月。所有皮瓣血运良好，弹性及外形佳。供区愈合良好。
应用HFCDU联合宽视野成像导航设计前外侧大腿穿支皮瓣，可清晰显示穿支特征、血流动力学信息及其与体区的关系，使术者能更准确、直观地了解穿支情况，提高皮瓣移植手术的成功率及效率。
