Wu Zhipeng, Ding Jian, Chen Xinglong, Chen Mingming, Hong Zipu, Yan Hede
Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou Zhejiang, 325000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 Jun 15;39(6):748-753. doi: 10.7507/1002-1892.202504035.
To investigate the application of three-dimensional (3D) reconstruction technology in preoperative planning for anterolateral thigh flap transplantation.
A retrospective analysis was performed on the clinical data of 11 patients with skin and soft tissue defects treated with free anterolateral thigh flap transplantation between January 2022 and January 2024, who met the selection criteria. There were 8 males and 3 females, aged 34-70 years (mean, 50.8 years). Causes of injury included traffic accidents (4 cases), machine trauma (3 cases), heavy object crush injury (3 cases), and tumor (1 case). The time from injury to flap repair ranged from 7 to 35 days (mean, 23 days). Preoperatively, the patients' CT angiography images were imported into Mimics21.0 software. Through the software's segmentation, editing, and reconstruction functions, 3D visualization and measurement of the vascular pedicle, perforators, wound size, and morphology were performed to plan the flap harvest area, contour, vascular pedicle length, and anastomosis site, guiding the implementation of flap transplantation.
The length of the vascular pedicle needed by the recipient site was (9.1±0.9) cm, and the maximum length of vascular pedicle in the donor area was (10.6±0.6) cm, with a significant difference ( =4.230, <0.001). The operation time ranged from 220 to 600 minutes (mean, 361.9 minutes). One patient had poor wound healing at the recipient site, which healed after dressing changes. All 11 flaps survived well without necrosis. All patients were followed up 6-19 months (mean, 11 months). Four flaps showed bulkiness and underwent secondary debulking; the remaining flaps had good contour and soft texture. The donor sites healed well, with no sensory disturbance around the incision or complications such as walking impairment.
Preoperative planning using CT angiography data and 3D reconstruction software can effectively determine the flap area, contour, required vascular pedicle length, anastomosis site, and whether vascular grafting is needed, thereby guiding the successful execution of anterolateral thigh flap transplantation.
探讨三维（3D）重建技术在股前外侧皮瓣移植术前规划中的应用。
回顾性分析2022年1月至2024年1月期间11例符合入选标准的采用游离股前外侧皮瓣移植治疗皮肤软组织缺损患者的临床资料。其中男性8例，女性3例，年龄34 - 70岁（平均50.8岁）。受伤原因包括交通事故（4例）、机器外伤（3例）、重物挤压伤（3例）和肿瘤（1例）。从受伤至皮瓣修复的时间为7至35天（平均23天）。术前，将患者的CT血管造影图像导入Mimics21.0软件。通过该软件的分割、编辑和重建功能，对血管蒂、穿支血管、创面大小和形态进行三维可视化和测量，以规划皮瓣切取面积、轮廓、血管蒂长度和吻合部位，指导皮瓣移植的实施。
受区所需血管蒂长度为（9.1±0.9）cm，供区血管蒂最大长度为（10.6±0.6）cm，差异有统计学意义（ =4.230，<0.001）。手术时间为220至600分钟（平均361.9分钟）。1例患者受区伤口愈合不佳，经换药后愈合。11块皮瓣全部顺利存活，无坏死。所有患者均获随访6至19个月（平均11个月）。4块皮瓣出现臃肿，行二期减容手术；其余皮瓣外形良好，质地柔软。供区愈合良好，切口周围无感觉障碍，无行走障碍等并发症。
利用CT血管造影数据和3D重建软件进行术前规划，可有效确定皮瓣面积、轮廓、所需血管蒂长度、吻合部位以及是否需要血管移植，从而指导股前外侧皮瓣移植手术的成功实施。
