Koban Konstantin Christoph, Kuhlmann Constanze, Wachtel Nikolaus, Hirschmann Maximilian, Hellweg Marc, Karcz Konrad Wojcieck, Giunta Riccardo Enzo, Ehrl Denis
Division of Hand, Plastic and Aesthetic Surgery University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany.
Department of Plastic, Reconstructive and Hand Surgery, Burn Centre for Severe Burn Injuries, Nuremberg Clinics, University Hospital Paracelsus Medical University, 90419 Nuremberg, Germany.
J Clin Med. 2024 Aug 15;13(16):4811. doi: 10.3390/jcm13164811.
The use of free gracilis muscle flaps in reconstructive surgery of the lower leg is common practice to cover defects. However, there is still a lack of understanding of the morphometric changes that occur in the transferred muscle and area of interest over time, particularly the characteristic volume decrease that is observed over the course of the first year. This study aimed to assess volume changes in patients with free gracilis muscle flap reconstruction following infection, trauma, or malignancies of the lower extremity. Three-dimensional surface imaging was performed intraoperatively after 2 weeks, 6 months, and 12 months with the Vectra H2 system. A total of 31 patients were included in this study and analyzed. There was an average volume increase of 146.67 ± 29.66% 2 weeks after reconstruction. Compared to this volume increase, there was a reduction of 108.44 ± 13.62% after 12 months ( < 0.05). Overall, we found a shrinkage to 85.53 ± 20.14% of the intraoperative baseline volume after 12 months. The use of non-invasive 3D surface imaging is a valuable tool for volume monitoring after free flap reconstruction of the lower extremity. The free gracilis muscle flap undergoes different phases of volume change over the first year, with the greatest influence on overall change being the development and decongestion of edema. Precise initial surgical tailoring is crucial for optimal long-term functional and cosmetic results.
在小腿重建手术中使用游离股薄肌皮瓣来覆盖缺损是常见的做法。然而，对于转移肌肉和感兴趣区域随时间发生的形态测量变化，尤其是在第一年期间观察到的特征性体积减小，仍缺乏了解。本研究旨在评估因下肢感染、创伤或恶性肿瘤而接受游离股薄肌皮瓣重建的患者的体积变化。在术后2周、6个月和12个月时，使用Vectra H2系统在术中进行三维表面成像。本研究共纳入31例患者并进行分析。重建后2周平均体积增加146.67±29.66%。与这一体积增加相比，12个月后体积减少了108.44±13.62%（P<0.05）。总体而言，我们发现12个月后体积缩小至术中基线体积的85.53±20.14%。使用非侵入性三维表面成像技术是下肢游离皮瓣重建术后体积监测的一项有价值的工具。游离股薄肌皮瓣在第一年经历不同阶段的体积变化，对总体变化影响最大的是水肿的形成和消退。精确的初始手术剪裁对于获得最佳的长期功能和美容效果至关重要。
