摘要
目的探讨数字化与3D打印技术辅助旋髂浅动脉皮瓣接力修复股前外侧皮瓣(ALTF)供区的临床疗效。方法自2017年4月至2021年10月,无锡市第九人民医院手外科收治8例手部创面患者,其中男6例,女2例;平均年龄45.8(29~59)岁。损伤原因:碾轧伤3例,热压伤2例,机器绞伤3例。损伤部位:手背侧创面5例,掌侧创面3例,创面均存在不同程度污染伴软组织缺损,缺损面积为11 cm×10 cm~22 cm×14 cm,其中合并掌、指骨开放性骨折4例,肌腱缺损3例。均利用游离ALTF移植修复,并设计旋髂浅动脉皮瓣接力修复继发供区创面,腹股沟处供区直接缝合。术前采用CTA联合CDU对皮瓣穿支血管进行定位及验证,并利用3D打印技术,制作患肢创面3D打印模型,精准指导皮瓣的设计。术后定期门诊复诊或网络随访,了解皮瓣质地、外形、感觉恢复以及邻近关节运动情况。结果术中发现创面形状及面积与术前模拟设计基本一致,皮瓣选择与术前模拟一致。术后皮瓣均顺利成活,8例均获随访,时间8~24(平均17.5)个月。ALTF供区皮瓣质地柔软,未见明显臃肿、色素沉着及瘢痕增生,且邻近髋、膝关节活动未受影响。腹部供区仅残留线状瘢痕,颜色及外观轮廓自然。结论术前利用数字化与3D打印技术可准确定位穿支血管位置,指导个性化的皮瓣设计,使患肢创面及ALTF供区达到精准修复,提高手术效率,术后皮瓣外形及功能恢复良好。
ObjectiveTo explore the efficacy of digital and 3D printing technologies on design of superficial iliac circumflex artery flap for coverage the donor site of anterolateral thigh flap(ALTF).MethodsClinical data of 8 patients were studied retrospectively for treatment of soft tissue defects of hand in the Department of Hand Surgery,Wuxi NO.9 People's Hospital Affiliated to Soochow University,from April 2017 to October 2021.The patients were 6 males and 2 females,aged from 29 to 59 years(mean,45.8 years).Cause of injury:3 patients were crushed,2 by hot pressing,and 3 by machine strangulation.Site of injury included:5 cases were dorsal hand defects and 3 cases were palm defects.All the wounds were contaminated to varying degrees with soft tissue defects.The areas of soft tissue defect ranged from 11 cm×10 cm to 22 cm×14 cm.Four patients had combined injuries of open fracture of metacarpals and phalanges and 3 with tendon defects.All wounds were repaired by free ALTF transplantation.And the donor sites in the thigh were repaired by superficial iliac circumflex artery flaps.The secondary wounds caused by flap harvesting on abdominal wall were closed directly.The targeted perforator vessels were detected preoperatively by CTA combined with CDU.3D printed models of the affected hand were obtained before operation for individualised repairs according to the shape and area of the wounds.After the operation,all patients entered scheduled follow-ups at the outpatient clinic and via internet by observing the flap shape and testing the recovery of sensory and movement of adjacent joint.ResultsThe shapes and sizes of the wounds and the flaps were found basically in accordance with those in the preoperative simulative designs.All flaps in 8 patients survived and the wounds healed completely.All patients entered follow-ups for 8 to 24(average,17.5)months.The donor thighs presented good appearance and colour,pliability without bloating.The range of motion of the hips and knees was not affected.Only linear scars remained in the abdominal donor sites,with natural colour and appearance.ConclusionDigital and 3D printing technologies in preoperative design of flaps can help to locate the perforator vessels intraoperatively and guide the individualised design of the flaps with improved operation efficiency and satisfactory appearance of the flaps.
作者
陆浩
薛明宇
王进
高丽婷
周晓
LU Hao;XUE Mingyu;WANG Jin;GAO Liting;ZHOU Xiao(Department of Hand Surgery,Wuxi NO.9 People's Hospital Affiliated to Soochow University,Wuxi,Jiangsu Province 214062,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第2期168-173,共6页
Chinese Journal of Microsurgery
基金
无锡市卫计委适宜推广项目(T201731)。
关键词
旋髂浅动脉皮瓣
3D打印
精准设计
股前外侧皮瓣
供区
修复
Superficial iliac circumflex artery flap
3D printing
Precision design
Anterolateral thigh flap
Donor site
Repair
作者简介
通讯作者:周晓,Email:zhouxiaowuxi@sohu.com,电话:+8613812058166。
