Establishment and clinical application effects of a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography

Yin Qixiang; Mi Jingyi; Cai Huazhong; Zhou Feng; Yao Qun; Hua Yong

doi:10.3760/cma.j.cn501225-20240407-00123

Volume 41 Issue 2

Feb. 2025

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(2): 171-179

Yin QX,Mi JY,Cai HZ,et al.Establishment and clinical application effects of a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography[J].Chin J Burns Wounds,2025,41(2):171-179.DOI: 10.3760/cma.j.cn501225-20240407-00123.

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Establishment and clinical application effects of a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography

doi: 10.3760/cma.j.cn501225-20240407-00123

1.
Department of Emergency, Affiliated Hospital of Jiangsu University, Zhenjiang 212001, China
2.
Department of Sports Medicine, Wuxi No. 9 People's Hospital, Wuxi 214062, China

Funds:

Shanghai Key Laboratory of Peripheral Nerve and Microsurgery/Key Laboratory of Hand Reconstruction of National Health Commission 20DZ2270200

Zhenjiang Science and Technology Innovation Fund SH2021051, SH2023033

Major Scientific Research Project of Wuxi Municipal Health Commission Z202108

Promotion and Application Project of Wuxi Municipal Health Commission T202346

Wuxi Science and Technology Development Fund Project Y20232020

Zhenjiang Science and Technology Plan SH2024043

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Corresponding author: Mi Jingyi, Email: mijingyi@suda.edu.cn
Received Date: 2024-04-07

Abstract

Abstract

Objective To establish a three-dimensional navigation process for design and resection of perforator flaps based on multi-detector computed tomography angiography (MDCTA) and to explore its clinical application effects. Methods This study was a retrospective observational study. From January 2021 to October 2023, 7 patients and 6 patients with post-traumatic skin and soft tissue defects in extremity and conformed to the inclusion criteria were admitted to the Affiliated Hospital of Jiangsu University and Wuxi No. 9 People's Hospital, respectively. There were 8 males and 5 females, aged 21 to 68 years. Nine patients had wounds on the hand and 4 patients had wounds on the foot. The wound area after debridement ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm. Through the three-dimensional navigation process based on MDCTA, 14 perforator flaps were designed and resected, including 11 free anterolateral thigh perforator flaps and 3 pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain, with flap size ranging from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm. Six wounds in the flap donor sites were directly sutured, and eight wounds in the flap donor sites were transplanted with skin grafts. The consistency of the location, type, and source of the perforators was compared between the preoperative navigation display and actual intraoperative detection. Immediately after surgery, the coverage of wound by the flap was evaluated according to the self-made criteria. The postoperative flap survival was observed. The occurrence of complications was observed during follow-up. At the last follow-up, the appearance of the flaps was observed, the blood supply of the flaps and the hand function of the 9 patients with hand trauma were evaluated according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and the foot function of the 4 patients with foot trauma was assessed using the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scoring System. Results The location, type, and source of the perforators displayed in preoperative navigation were consistent with the actual intraoperative detection. Immediately after surgery, the coverage of the wounds by 11 flaps was rated as excellent, and that of 3 flaps was rated as moderate. Postoperatively, 13 flaps survived completely, and 1 flap had partial necrosis, which healed after a full-thickness skin grafting from the thigh. Patients were followed up for 4 to 24 months postoperatively, one patient developed a hematoma under the flap, and one patient had local infection. At the last follow-up, the flaps of all patients were good in color and texture, and 5 patients with bloated flaps post operation had good appearance after thinning surgery; the blood supply was excellent in 12 flaps and was good in 2 flaps; among patients with hand trauma, the hand function was rated as excellent in 2 cases, good in 4 cases, and poor in 3 cases; among patients with foot trauma, the foot function was rated as excellent in 3 cases and good in 1 case. Conclusions The three-dimensional navigation process for design and resection of perforator flaps based on MDCTA realizes precise evaluation of perforator vessels in flap donor sites and skin and soft tissue defects in the recipient sites. Guided by the three-dimensional navigation process, the application of free anterolateral thigh perforator flaps and pedicled peroneal artery perforator flaps with sural nerve nutritional vessel chain in repairing skin and soft tissue defects in extremity realizes precise surgery, reducing flap donor site injury and achieving excellent clinical outcomes.
- Perforator flap,
- Angiography,
- Imaging, three-dimensional,
- Preoperative navigation process,
- Wound repair

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References

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