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.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Mar 15;34(3):367-372. doi: 10.7507/1002-1892.201908079.
To study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.
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.
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 ( >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 and 3 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 last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.
The digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.
探讨数字技术在腓动脉穿支螺旋桨皮瓣修复足跟创面中的应用效果。
2016年3月至2019年3月，采用腓动脉穿支螺旋桨皮瓣修复31例患者的足跟创面。其中男21例，女10例，平均年龄36岁（12～53岁）。17例为外伤后急诊入院，受伤至入院时间为6.0～12.5小时，平均8.5小时；14例为慢性感染性创面及溃疡。创面面积为5 cm×4 cm至12 cm×8 cm。皮瓣修复前，将下肢CT血管造影（CTA）数据导入Mimics19.0软件，对腓动脉穿支及皮肤模型进行三维重建，获得穿支的准确定位、穿支皮瓣的精确设计，并根据缺损范围及部位进行模拟手术。
基于三维模型确定了腓动脉穿支的起源、走行、穿支位置、穿支直径及穿支裸段最大长度。穿支定位点、穿支直径、穿支裸段最大长度术前与术中测量比较，差异均无统计学意义（P＞0.05）。31例腓动脉下穿支位于外踝尖后外侧（5～10 cm）。外踝尖10 cm范围内穿支的总发生率为96.9%，血管蒂长度为（3.44±0.65）cm。31例患者皮瓣切取及转移均顺利完成。平均手术时间为45分钟（30～65分钟）。术后4例发生静脉危象，3例出现部分坏死，经对症处理后均成活。所有皮瓣均成活，切口均一期愈合。所有患者均获随访，时间3～18个月，平均12个月。末次随访时根据美国足踝外科协会（AOFAS）评分：优17例，良11例，可3例，优良率为87.5%。
数字技术可提高穿支定位及腓动脉穿支螺旋桨皮瓣设计的准确性，降低手术难度及血管解剖变异带来的风险。
