数字三维成像技术在颌面部软组织整复术前的皮瓣设计应用

发布时间：2018-03-23 06:00

本文选题：股前外侧皮瓣　切入点：CT血管造影　出处：《临床耳鼻咽喉头颈外科杂志》2017年24期 　论文类型：期刊论文

【摘要】：目的:采用数字化技术对口腔颌面部软组织缺损行术前皮瓣设计,指导手术操作,为制作个性化股前外侧皮瓣提供依据。方法:选取7例患有口腔颌面部恶性肿瘤患者,行下肢薄层CT扫描,对CT血管造影检查结果进行数据分析,测量出旋股外侧动脉降支穿支的管径、走形、血管蒂长度,选取合适的穿支做为皮瓣血供来源,在皮肤上标记穿支位置,模拟皮瓣切取范围。术中根据术前标记,画线并标出皮瓣大小,皮瓣制备完毕后,供区直接拉拢缝合,内置负压引流管。将皮瓣移植到组织缺损处,分别行动静脉吻合,皮瓣与缺损创面严密缝合,颈部内置负压引流管,术后严密观测皮瓣及全身状况。结果:所有重建的旋股前外侧动脉降支穿支皮瓣均能显示皮肤、肌肉、血管及其毗邻关系,并根据缺损区域大小,利用Mimics 17.0软件模拟切取皮瓣,与缺损范围基本一致。7例皮瓣主要穿支及主干与术前检查一致,皮瓣全部成活,创面及供区均Ⅰ期愈合。术后随访1~6个月,皮瓣外形、质地和功能均恢复良好。结论:利用数字化技术可以准确定位旋股外侧动脉降支穿支位置,显示皮肤、肌肉、血管与骨骼之间空间关系,结合Mimics17.0软件实现股前外侧皮瓣三维化及精确化设计,减少供区损伤,提高皮瓣成功率。
[Abstract]:Objective: to design the preoperative flap for oral and maxillofacial soft tissue defects by digital technique, and to provide the basis for making individualized anterolateral femoral flap. Methods: seven patients with oral and maxillofacial malignant tumor were selected. Thin slice CT scanning of lower extremity was performed, and the data of CT angiography were analyzed. The diameter, shape and length of the perforating branch of descending branch of lateral circumflex femoral artery were measured. The appropriate perforating branch was selected as the blood supply source of the flap. The position of perforating branch was marked on the skin, and the range of skin flap was simulated. According to the mark before operation, the line was drawn and the size of the flap was marked. After the preparation of the flap, the donor area was closed and sutured directly, and the negative pressure drainage tube was built in. The flap was transplanted to the site of tissue defect. The flap was sutured to the defect wound, the negative pressure drainage tube was built in the neck, the flap and the whole body were observed closely after operation. Results: all the reconstructed perforators of the descending branch of anterolateral circumflex femoral artery could show the skin and muscle. According to the size of the defect area and the size of the defect area, the flap was simulated by Mimics 17.0 software. The results showed that the main perforating branch and trunk of the flap were consistent with the defect area, and all the flaps survived. The wound and donor area were healed in the first stage. The skin flap was followed up for 1 ~ 6 months. The shape, texture and function of the flap recovered well. Conclusion: the location of the descending branch of lateral femoral circumflex artery can be accurately located by digital technique, and the skin and muscle can be displayed. The three-dimensional and accurate design of anterolateral femoral flap was realized by using Mimics17.0 software to reduce the injury of donor area and improve the success rate of the flap.
【作者单位】：上海交通大学医学院附属苏州九龙医院口腔颌面外科;西南医科大学附属医院整形外科;苏州市立医院介入科;
【基金】：江苏省青年医学人才项目(No:QNRC2016232)
【分类号】：R782.2

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