数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用研究

发布时间：2018-03-16 09:33

本文选题：外侧腓肠浅动脉穿支皮瓣　切入点：数字化技术　出处：《中国修复重建外科杂志》2017年05期 　论文类型：期刊论文

【摘要】：目的探讨数字化技术在外侧腓肠浅动脉穿支皮瓣修复手部中小创面中的应用价值。方法 2013年8月—2016年10月,应用外侧腓肠浅动脉穿支皮瓣修复手部中小创面10例。男6例,女4例;年龄19~47岁,平均31.2岁。致伤原因:机器绞伤6例,交通事故伤3例,电烧伤1例。伤后至入院时间4 h~10 d,平均3.5 d。创面部位:虎口2例,拇指指腹3例,示指指腹1例,掌背3例,指背1例。创面范围4 cm×3 cm~8 cm×7 cm,均伴骨骼或肌腱外露。术前首先常规行腹主动脉至双侧胫前、后动脉CT血管造影(CT angiography,CTA),初步观察双侧肢体膝关节周围外侧腓肠浅动脉穿支血管情况,并挑选合适一侧肢体作为供区;然后,将CTA数据导入Mimics15.0软件三维重建穿支血管、骨骼、皮肤,并根据创面大小动态模拟皮瓣设计、切取过程。术中根据术前设计切取皮瓣,皮瓣切取范围5 cm×4 cm~10 cm×8 cm。9例供区直接缝合,1例供区游离植皮修复。结果除3例患者外侧腓肠浅动脉较细,术中改为内侧腓肠浅动脉穿支皮瓣修复外,其余患者均顺利切取皮瓣修复创面。术后24 h 1例皮瓣发生静脉危象,经对症处理后成活;其余皮瓣均顺利成活,创面及供区均Ⅰ期愈合。患者均获随访,随访时间3~18个月,平均10个月。皮瓣外形良好,末次随访时按关节总活动度(TAM)评价标准评定手部功能,优6例,良3例,可1例。结论 CTA结合Mimics15.0软件能实现术前外侧腓肠浅动脉穿支皮瓣的个体化、精确化设计,降低了手术风险。
[Abstract]:Objective to evaluate the application of digital technique in the repair of small and middle wounds of the hand with the perforating branch flap of the lateral superficial sural artery. Methods from August 2013 to October 2016, 10 patients (6 males) were treated with the perforating branch flap of the lateral superficial sural artery. Four cases were female, the age was 1947 years old (mean 31.2 years). The causes of injury were: mechanical wound in 6 cases, traffic accident in 3 cases, electric burn in 1 case. The time from injury to admission was 4 hours and 10 days, with an average of 3.5 days. Wound site: Tiger mouth in 2 cases, thumb finger in 3 cases. There were 1 case of finger abdomen, 3 cases of dorsal metacarpal and 1 case of dorsal finger. The wound area was 4 cm 脳 3 cm~8 cm 脳 7 cm, with bone or tendon exposure. Before operation, abdominal aorta was performed to bilateral tibia. Ct angiography of the posterior artery was performed to observe the perforating branch of lateral superficial sural artery around the knee joint of bilateral limbs, and to select a suitable limb as donor area. Then, the CTA data were imported into Mimics15.0 software to reconstruct perforating vessels and bones. The skin was designed according to the size of the wound, and the skin flap was designed according to the size of the wound. The range of flap was 5 cm 脳 4 cm~10 cm 脳 8 cm.9. One case was repaired by direct suture of donor area with free skin graft. Results except for 3 cases, the lateral superficial sural artery was thin and the flap was replaced by medial superficial sural artery perforating branch flap during the operation. After 24 hours of operation, venous crisis occurred in 1 case of the flap and survived after symptomatic treatment. All the other flaps survived successfully and the wounds and donor areas were healed in the first stage. All the patients were followed up for 3 ~ 18 months. The average was 10 months. The skin flap had a good shape. At the last follow-up, the hand function was evaluated according to the assessment criteria of total motion of joint (TAM), excellent in 6 cases, good in 3 cases, excellent in 6 cases and good in 3 cases. Conclusion CTA combined with Mimics15.0 software can individualize the perforating branch flap of lateral superficial sural artery and reduce the risk of operation.
【作者单位】：成都军区昆明总医院骨科;
【基金】：全军后勤科研计划面上项目(CCD14J003)~~
【分类号】：R658.2

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