3D-CTA assisted anterolateral thigh lobulated perforator flap in repairing soft tissue defect of limb: 11 cases report

中华显微外科杂志 Pub Date : 2019-12-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2019.06.008

Zhang Dexi, Z. Guohui, Zheng Guangcheng, Wang Yuanzheng, Song Kewei, Sun Luwei

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引用次数: 0

Abstract

Objective To investigate the effectiveness of preoperative 3D-CTA in assisting the preparation of free thinned anterolateral thigh lobulated perforator flap with nerve in repairing soft tissue defect of limb. Methods Between February, 2010 and May, 2018, free super-thin anterolateral thigh lobulated perforator flap with nerve was transferred to repair soft tissue defect of limbs in 11 cases. There were 8 males and 3 females with an average age of 35 (range, 22-56) years. The defect area was 8.0 cm×11.0 cm-9.0 cm×23.0 cm. Preoperation CT scan of the free flap donor site was performed to obtain 3D images of the region with arterial blood supply by digital 3D reconstruction CT, and to determine the origin, direction, classification, length, diameter and the position of pedicle perforator. Postoperative regular followed-up was carried according to the Upper Limb Function Evaluation Trial Standards of Chinese Medical Association of Hand Surgery and Enneking Evaluation System. Results All 11 flaps survived. No vascular crisis happened. All 11 cases were followed-up for 3 to 12 (average, 5) months. The flaps were supple and elastic with near normal color. There was no bulkiness. Sensory function was recovered well and two point discrimination was 3.0-6.0 mm. According to the Upper Limb Function Evaluation of Upper Limb of Chinese Medical Association of Hand Surgery, the results were excellent in 1 case, good in 3 cases and fair in 1 case. The Enneking system was used to assesse the lower limbs recovery. The average score was 21, an average of 70% of limb function restored. Conclusion The free super-thin anterolateral thigh lobulated perforator flap with nerve offers advantages to the traditional anterolateral thigh flap. The survived flaps are ideal in terms of covering limb defects and restoring functions. Preoperative 3D-CTA in the anterolateral thigh perforator flap transplantation is an accurate and useful method. It helps a safer and successful operation with optimal outcome. Key words: 3D-CTA; Anterolateral thigh perforator flap; Lobulated flap; Repair; Limb

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3D-CTA辅助股前外侧分叶穿支皮瓣修复四肢软组织缺损11例报告

目的探讨术前3D-CTA辅助制备带神经的游离薄股前外侧分叶穿支皮瓣修复肢体软组织缺损的效果。方法2010年2月~ 2018年5月，应用带神经的超薄股前外侧分叶穿支皮瓣修复肢体软组织缺损11例。男性8例，女性3例，平均年龄35岁，年龄范围22 ~ 56岁。缺损面积为8.0 cm×11.0 cm-9.0 cm×23.0 cm。术前对游离皮瓣供区进行CT扫描，通过数字三维重建CT获得动脉供血区域的三维图像，确定穿蒂的起源、方向、分类、长度、直径和位置。术后按照中华医学会手外科分会上肢功能评价试验标准及Enneking评价体系进行定期随访。结果11个皮瓣全部成活。没有发生血管危象。11例均随访3 ~ 12个月(平均5个月)。皮瓣柔软而有弹性，颜色接近正常。没有笨重。感觉功能恢复良好，两点辨别3.0 ~ 6.0 mm。根据中华手外科医学会上肢功能评定，优秀者1例，良者3例，一般者1例。采用Enneking系统评估下肢恢复情况。平均评分21分，平均70%肢体功能恢复。结论游离超薄股前外侧神经分叶穿支皮瓣优于传统的股前外侧皮瓣。存活的皮瓣在覆盖肢体缺损和恢复肢体功能方面是理想的。术前3D-CTA在股前外侧穿支皮瓣移植中是一种准确、有用的方法。它有助于更安全、更成功的手术，并获得最佳结果。关键词:3D-CTA;股前外侧穿支皮瓣;分瓣;修理;肢体

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来源期刊

中华显微外科杂志

CiteScore

0.50

自引率

0.00%

发文量

6448

期刊介绍： Chinese Journal of Microsurgery was established in 1978, the predecessor of which is Microsurgery. Chinese Journal of Microsurgery is now indexed by WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 1.731 in 2017, ranking the third among all journal of comprehensive surgery. The journal covers clinical and basic studies in field of microsurgery. Articles with clinical interest and implications will be given preference.