Volume 39 Issue 4
Apr.  2023
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Fang J,Zhao GZ,Li HZ,et al.Effects of three-dimensional computed tomography angiography-assisted free medial sural artery perforator flap in repairing foot wounds[J].Chin J Burns Wounds,2023,39(4):343-349.DOI: 10.3760/cma.j.cn501225-20220930-00430.
Citation: Fang J,Zhao GZ,Li HZ,et al.Effects of three-dimensional computed tomography angiography-assisted free medial sural artery perforator flap in repairing foot wounds[J].Chin J Burns Wounds,2023,39(4):343-349.DOI: 10.3760/cma.j.cn501225-20220930-00430.

Effects of three-dimensional computed tomography angiography-assisted free medial sural artery perforator flap in repairing foot wounds

doi: 10.3760/cma.j.cn501225-20220930-00430
Funds:

Bethune Medical Science Research Foundation 72AN

Medical Science Research Foundation of Beijing Medical and Health Public Welfare Foundation B187018

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  •   Objective   To investigate the effects of three-dimensional computed tomography angiography (3D-CTA)-assisted free medial sural artery perforator flap in repairing foot wounds.   Methods   A retrospective observational study was conducted. From May 2018 to August 2021, 18 patients with foot soft tissue defects who met the inclusion criteria were admitted to the Department of Spine and Trauma Orthopedics of the Yidu Central Hospital of Weifang, including 13 males and 5 females, aged 19 to 55 years, with a wound area of 4.0 cm×3.0 cm-9.0 cm×8.0 cm at admission. Before the operation, CT scanner was used to scan the area from the supracondylar femur to the middle segment of the fibula of patients, and the obtained data were extracted into the Mimics16.0 software and analyzed to determine the pre-selected perforator, and then the image data of the pre-selected perforator side were analyzed further, and the body surface projection position of the perforating point of the medial sural artery in the calf region was marked. Based on the above examination, the flap was designed and cut according to the shape and area of the patient's foot tissue defect, and the area of flaps ranged from 5.0 cm×4.0 cm to 10.0 cm×9.0 cm. The donor sites were sutured directly or covered by skin grafting. The type of perforator, the diameters of perforator at the beginning and outlet point, and the location of the outlet point of perforator of the medial sural artery were observed under 3D-CTA examination before operation and compared to see if they were consistent with the observation under intraoperative condition. The survival of the flaps after operation was recorded. During follow-up, the satisfaction of patients with the wound repair effects, the sensory recovery of the recipient flaps, the healing of the donor wound, and whether there were complications affecting limb functions were recorded. Data were statistically analyzed with Kappa consistency test and equivalence test, and the 95% confidence intervals of measurement difference of perforator diameter and outlet point position of perforator were -0.50-0.50 mm and -2.0-2.0 cm, respectively.   Results   The types of medial sural artery perforators observed during operation were type Ⅰ in 3 cases, type ⅡA in 6 cases, type ⅡB in 8 cases, and type Ⅲ in 1 case, which was consistent with the results of 3D-CTA before operation (Kappa=1.00, P<0.05). The blood vessel diameter detected by 3D-CTA before operation at the beginning of perforator of medial sural artery was (1.81±0.39) mm, and the blood vessel diameter at the outlet point of the perforator was (0.83±0.21) mm, which were close to the actual intraoperative measurement of (1.83±0.43) and (0.86±0.22) mm, respectively; equivalence test showed that the 95% confidence intervals of the measurement differences of diameter of medial sural artery perforator at beginning and outlet point were -0.18-0.22 and -0.08-0.14 mm, respectively, with both P values <0.05. The preoperative 3D-CTA detected that the perforating position at the deep fascia of the perforator of the medial sural artery, namely the vertical distance with the popliteal fold was (12.2±1.4) cm, and the horizontal distance with the posterior midline was (2.6±0.7) cm, which were respectively close to the actual intraoperative measurement of (12.4±1.4) and (2.6±0.7) cm; equivalence test showed that the 95% confidence intervals of the measurement differences in the vertical distance with the popliteal fold and the horizontal distance with the posterior midline of the outlet point of medial sural artery perforator were -1.06-1.26 and -0.46-0.66 cm, respectively, with both Pvalues <0.05. After surgery, all flaps of 18 patients survived without vascular crisis. After 1 year of follow-up, the satisfaction degree of 16 patients was excellent and 2 patients was good with the wound repair effects, with a satisfaction ratio of 16/18; the sensory recovery of flap was evaluated as S 3 in 11 cases and S 2 in 7 cases; the donor wounds healed well without obvious scar or contracture, with no effect on limb joint functions.   Conclusions   The medial sural artery perforator flap achieved good results in repairing foot wound with high degree of patient satisfaction. Preoperative application of 3D-CTA can realize the standardization, systematization, and visualization of artery perforator flap.

     

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  • [1]
    潘冬经,姚志伟,姜魏,等.腓肠内侧穿支皮瓣修复四肢及面部皮肤软组织缺损六例[J].中华烧伤杂志,2017,33(12):772-775. DOI: 10.3760/cma.j.issn.1009-2587.2017.12.010.
    [2]
    郭佳, 刘勇, 韩宁. 腓肠内侧动脉和胫后动脉穿支螺旋桨皮瓣接力修复足踝部皮肤软组织缺损[J]. 中华整形外科杂志, 2021, 37(10):1158-1162. DOI: 10.3760/cma.j.cn114453-20201111-00567.
    [3]
    方杰,肖军杰,张威,等. 两组不同源血管穿支供养的腓肠内侧动脉穿支体区皮瓣修复手挤压伤创面一例[J]. 中华显微外科杂志,2022,45(2):218-220. DOI: 10.3760/cma.j.cn441206-20211228-00306.
    [4]
    杨涛,赵磊,宋科,等. 游离腓肠内侧穿支皮瓣对足趾皮肤缺损的美学修复[J]. 中华整形外科杂志,2022,38(2):176-179. DOI: 10.3760/cma.j.cn114453-20200507-00271.
    [5]
    徐宝成,蒙显晨,汪金根,等. 游离腓肠内侧穿支皮瓣修复四肢软组织缺损[J]. 中华手外科杂志,2022,38(3):233-235. DOI: 10.3760/cma.j.cn311653-20210607-00188.
    [6]
    唐茂林,刘元波.穿支皮瓣的解剖学研究进展[J].中华整形外科杂志,2018,34(9):785-790. DOI: 10.3760/cma.j.issn.1009-4598.2018.09.022.
    [7]
    杨智斌,牛建栋,马勇,等.CT血管造影及三维重建在组织瓣修复颈肩、腋窝及上臂高压电烧伤创面中的临床应用[J].中华烧伤杂志,2018,34(12):874-880. DOI: 10.3760/cma.j.issn.1009-2587.2018.12.011.
    [8]
    孙国文,杨旭东,文建民,等.数字化外科技术辅助腓骨肌皮瓣修复上颌骨前部缺损[J].中华整形外科杂志,2021,37(10):1122-1128. DOI: 10.3760/cma.j.cn114453-20200707-00409.
    [9]
    夏成德,薛继东,狄海萍,等.CT血管造影及三维重建在额部轴型扩张皮瓣修复口周及颏部瘢痕中的应用效果[J].中华烧伤杂志,2018,34(10):677-682. DOI: 10.3760/cma.j.issn.1009-2587.2018.10.006.
    [10]
    杨丽,方柏荣,贺吉庸,等.基于CT血管造影的腹壁下动脉穿支皮瓣三维模型的构建及应用[J].中华烧伤杂志,2018,34(5):297-302. DOI: 10.3760/cma.j.issn.1009-2587.2018.05.010.
    [11]
    李孝亮,廖圣恺,陈永锋,等.三维CT血管造影在旋髂深动脉组织瓣修复下颌骨缺损中的临床应用[J].中华整形外科杂志,2021,37(5):495-500. DOI: 10.3760/cma.j.cn114453-20200419-00231.
    [12]
    徐永清,何晓清,陈雪松,等.手和足部创面修复时四种吻合血管的皮神经营养血管穿支皮瓣的选择[J].中华显微外科杂志,2020,43(4):331-337. DOI: 10.3760/cma.j.cn441206-20200218-00068.
    [13]
    张浩,张晓东,庾东春,等.应用带蒂皮瓣修复皮肤软组织缺损[J].中华骨科杂志,2012,32(3):260-264. DOI: 10.3760/cma.j.issn.0253-2352.2012.03.013.
    [14]
    GutkowskaO, MartynkiewiczJ, MiziaS, et al. Results of operative treatment of brachial plexus injury resulting from shoulder dislocation: a study with a long-term follow-up[J]. World Neurosurg,2017, 105:623-631. DOI: 10.1016/j.wneu.2017.06.059.
    [15]
    杨力,蔡斌,薛君荣,等.个体化股前外侧皮瓣游离移植修复复杂难愈性创面的临床效果[J].中华烧伤杂志,2020,36(8):730-734. DOI: 10.3760/cma.j.cn501120-20190621-00281.
    [16]
    林传甫,林文君,吕建敏. 端侧吻合动脉行游离腓肠内侧穿支皮瓣移植修复四肢皮肤软组织缺损[J]. 临床骨科杂志,2021,24(1):61-63. DOI: 10.3969/j.issn.1008-0287.2021.01.023.
    [17]
    刘元波,朱珊,臧梦青,等.穿支皮瓣研究领域的新技术、新方法[J].中华整形外科杂志,2019,35(9):835-846. DOI: 10.3760/cma.j.issn.1009-4598.2019.09.001.
    [18]
    汪翔,温贤金,古欣庆,等. 游离腓肠内侧穿支皮瓣修复手足软组织缺损[J]. 实用手外科杂志,2021,35(2):214-216. DOI: 10.3969/j.issn.1671-2722.2021.02.024.
    [19]
    金文虎,张子阳,吴祥奎,等. 游离腓肠内侧穿支皮瓣修复手背软组织缺损[J]. 中华创伤杂志,2020,36(12):1090-1095. DOI: 10.3760/cma.j.cn501098-20200821-00558.
    [20]
    裴广楠,滕道练,李甲,等. 游离腓肠内侧穿支皮瓣移植修复拇指再造供区[J]. 临床骨科杂志,2020,23(3):364-366. DOI: 10.3969/j.issn.1008-0287.2020.03.021.
    [21]
    张月恒, 崔文举, 宋坤修, 等. 改良CT血管造影术辅助基于浅筋膜穿支的股前外侧皮 瓣穿支评估与偏心设计的前瞻性研究[J].中华烧伤与创面修复杂志,2023,39(2):141-149. DOI: 10.3760/cma.j.cn501225-20220902-00376.
    [22]
    刘磊,王燕妮,于静,等.增强CT及三维重建技术在扩张皮瓣整复小儿烧伤后瘢痕中的应用效果[J].中华烧伤杂志,2019,35(10):715-719. DOI: 10.3760/cma.j.issn.1009-2587.2019.10.003.
    [23]
    李晓庆,王欣,韩亚龙,等.CT血管造影联合股前外侧穿支皮瓣加阔筋膜移植修复伴颅骨坏死外露头部电烧伤创面的效果[J].中华烧伤杂志,2018,34(5):283-287. DOI: 10.3760/cma.j.issn.1009-2587.2018.05.006.
    [24]
    梁伟强,石芬,张剑,等.应用组织瓣修复小腿及足踝部瘢痕癌的适应证及组织瓣选择与修复效果[J].中华烧伤杂志,2021,37(4):363-368.DOI: 10.3760/cma.j.cn501120-20200227-00099.
    [25]
    刘晶毅,冯秉华. 腓肠内侧穿支皮瓣转移术的手术配合[J]. 实用手外科杂志,2019,33(3):350-352. DOI: 10.3969/j.issn.1671-2722.2019.03.032.
    [26]
    刘军,吴永伟,王建兵,等.四种膝周非主干血管作为游离组织瓣受区血管的选择探讨[J].中华整形外科杂志,2021,37(6):659-665.DOI: 10.3760/cma.j.cn114453-20200313-00140.
    [27]
    徐永清.小腿穿支皮瓣在中国的临床应用及进展[J].中华显微外科杂志,2020,43(6):521-534.DOI: 10.3760/cma.j.cn441206-20200527-00243.
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