Clinical application effect of vascular imaging technology in repairing limb wounds with free transplantation of superficial circumflex iliac artery perforator flaps

Zhang Lu; Li Dong; Fan Anwei

doi:10.3760/cma.j.cn501225-20250228-00100

Volume 41 Issue 9

Sep. 2025

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(9): 877-886

Zhang L,Li D,Fan AW.Clinical application effect of vascular imaging technology in repairing limb wounds with free transplantation of superficial circumflex iliac artery perforator flaps[J].Chin J Burns Wounds,2025,41(9):877-886.DOI: 10.3760/cma.j.cn501225-20250228-00100.

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Clinical application effect of vascular imaging technology in repairing limb wounds with free transplantation of superficial circumflex iliac artery perforator flaps

doi: 10.3760/cma.j.cn501225-20250228-00100

Department of Orthopedics Ⅲ, Xingtai General Hospital of North China Medical Health Group, Xingtai 054000, China

Funds:

Xingtai Science and Technology Plan Project 2021ZC073

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Corresponding author: Zhang Lu, Email: 30149696@qq.com
Received Date: 2025-02-28

Abstract

Abstract

Objective To investigate the clinical application effect of vascular imaging technology in repairing limb wounds with free transplantation of superficial circumflex iliac artery (SCIA) perforator flaps. Methods This study was a retrospective cohort study. Forty patients (26 males and 14 females, aged 19-60 years) with skin and soft tissue defects of the limbs who met the inclusion criteria were admitted to Xingtai General Hospital of North China Medical Health Group from March 2019 to August 2023. According to the exploration method for blood vessels in the flap area to be cut, the patients were divided into color Doppler flow imaging (CDFI) group with CDFI exploration and three-dimensional computed tomography angiography (3D-CTA) group with 3D-CTA exploration, with 20 cases in each group. Preoperatively, based on the CDFI results, the vessel diameter at the origin and the length of SCIA and superficial circumflex iliac vein (SCIV) were measured in CDFI group of patients, and the resulting values were recorded as the estimated values. Preoperatively, the vessel diameter at the origin and the length of SCIA and SCIV were measured in 3D-CTA group of patients based on the 3D-CTA results, and the resulting values were recorded as the estimated values; the anatomic relationship between the SCIA and the deep circumflex iliac artery as well as the superficial inferior epigastric artery in the inguinal region was identified, and the SCIA perforators were classified into 5 types (type 1, 2, 3, 4, and 5) based on this. The wound area of the limbs ranged from 3.0 cm×3.0 cm to 16.0 cm×8.0 cm after debridement. SCIA perforator flaps were designed and harvested to repair the wounds. During surgery, the preoperatively located perforator vessels (detected by 3D-CTA or CDFI) were identified, the anatomic relationship between the SCIA and the deep circumflex iliac artery as well as the superficial inferior epigastric artery was observed, the actual vessel diameter at the origin and the length of the SCIA and SCIV were measured, and the resulting values were recorded as the actual measured values. The area of the harvested flaps ranged from 4.0 cm×4.0 cm to 17.0 cm×9.0 cm. The wounds at donor sites were closed directly. In 3D-CTA group, the SCIA perforators classification of patients identified by preoperative 3D-CTA technology was statistically analyzed and compared with the intraoperative findings. The estimated values of vessel diameter at the origin and the length of SCIA and SCIV detected by either CDFI or 3D-CTA in the two groups of patients were recorded and compared with the actual values measured intraoperatively. Postoperatively, the flap survival was observed in the two groups of patients. During follow-up, flap appearance and sensory recovery were evaluated in the two groups of patients, and the wounds healing at donor site was observed. Results Preoperative 3D-CTA exploration in the 3D-CTA group of patients showed the SCIA perforators were type 1 in 6 cases, type 2 in 5 cases, type 3 in 4 cases, type 4 in 3 cases, and type 5 in 2 cases, which was consistent with the results in intraoperative observation. Compared with those in CDFI group, the estimated values of vessel diameter at the origin of SCIA and SCIV in 3D-CTA group of patients were significantly smaller (with t values of 2.83 and 2.23, respectively, P<0.05). Compared with the estimated values, the actual measured values of vessel diameter at the origin of SCIA and SCIV in CDFI group of patients were significantly smaller (with t values of 3.12 and 2.16, respectively, P<0.05), and the mean differences between the groups (95% confidence intervals) were 0.25 (0.12-0.38) and 0.26 (0.14-0.38) mm, respectively. Compared with those in CDFI group, the estimated values of vessel length of SCIA and SCIV in 3D-CTA group of patients were significantly shorter (with t values of 2.43 and 2.18, respectively, P<0.05). Compared with the estimated values, the actual measured values of vessel length of SCIA and SCIV in CDFI group of patients were significantly shorter (with t values of 2.06 and 2.10, respectively, P<0.05), and the mean differences within groups (95% confidence intervals) were 1.5 (1.0-2.0) and 1.5 (1.0-2.0) cm, respectively. In CDFI group, 2 patients developed partial flap necrosis postoperatively, which healed well after dressing change, and the remaining patients exhibited satisfactory flap survival. All flaps in 3D-CTA group of patients survived completely. During postoperative follow-up of 12 to 18 months, both groups of patients showed favorable flap appearance and sensory functional recovery. The wounds in donor sites healed well, with only linear scars remaining. Conclusions Preoperative application of 3D-CTA technology for vascular exploration can clarify the type of SCIA perforators and the vessel diameter at the origin and the length of SCIA, thereby guiding the design of the SCIA perforator flap and enabling its precise harvest.
- Ultrasonography, Doppler, color,
- Perforator flap,
- Microsurgery,
- Extremities,
- Three-dimensional computed tomography angiography,
- Wound repair

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References(39)

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