本文選題：外側(cè)腓腸淺動脈穿支皮瓣　切入點(diǎn)：數(shù)字化技術(shù)　出處：《中國修復(fù)重建外科雜志》2017年05期 　論文類型：期刊論文

【摘要】：目的探討數(shù)字化技術(shù)在外側(cè)腓腸淺動脈穿支皮瓣修復(fù)手部中小創(chuàng)面中的應(yīng)用價值。方法 2013年8月—2016年10月,應(yīng)用外側(cè)腓腸淺動脈穿支皮瓣修復(fù)手部中小創(chuàng)面10例。男6例,女4例;年齡19~47歲,平均31.2歲。致傷原因:機(jī)器絞傷6例,交通事故傷3例,電燒傷1例。傷后至入院時間4 h~10 d,平均3.5 d。創(chuàng)面部位:虎口2例,拇指指腹3例,示指指腹1例,掌背3例,指背1例。創(chuàng)面范圍4 cm×3 cm~8 cm×7 cm,均伴骨骼或肌腱外露。術(shù)前首先常規(guī)行腹主動脈至雙側(cè)脛前、后動脈CT血管造影(CT angiography,CTA),初步觀察雙側(cè)肢體膝關(guān)節(jié)周圍外側(cè)腓腸淺動脈穿支血管情況,并挑選合適一側(cè)肢體作為供區(qū);然后,將CTA數(shù)據(jù)導(dǎo)入Mimics15.0軟件三維重建穿支血管、骨骼、皮膚,并根據(jù)創(chuàng)面大小動態(tài)模擬皮瓣設(shè)計(jì)、切取過程。術(shù)中根據(jù)術(shù)前設(shè)計(jì)切取皮瓣,皮瓣切取范圍5 cm×4 cm~10 cm×8 cm。9例供區(qū)直接縫合,1例供區(qū)游離植皮修復(fù)。結(jié)果除3例患者外側(cè)腓腸淺動脈較細(xì),術(shù)中改為內(nèi)側(cè)腓腸淺動脈穿支皮瓣修復(fù)外,其余患者均順利切取皮瓣修復(fù)創(chuàng)面。術(shù)后24 h 1例皮瓣發(fā)生靜脈危象,經(jīng)對癥處理后成活;其余皮瓣均順利成活,創(chuàng)面及供區(qū)均Ⅰ期愈合�；颊呔@隨訪,隨訪時間3~18個月,平均10個月。皮瓣外形良好,末次隨訪時按關(guān)節(jié)總活動度(TAM)評價標(biāo)準(zhǔn)評定手部功能,優(yōu)6例,良3例,可1例。結(jié)論 CTA結(jié)合Mimics15.0軟件能實(shí)現(xiàn)術(shù)前外側(cè)腓腸淺動脈穿支皮瓣的個體化、精確化設(shè)計(jì),降低了手術(shù)風(fēng)險。
[Abstract]:Objective to evaluate the application of digital technique in the repair of small and middle wounds of the hand with the perforating branch flap of the lateral superficial sural artery. Methods from August 2013 to October 2016, 10 patients (6 males) were treated with the perforating branch flap of the lateral superficial sural artery. Four cases were female, the age was 1947 years old (mean 31.2 years). The causes of injury were: mechanical wound in 6 cases, traffic accident in 3 cases, electric burn in 1 case. The time from injury to admission was 4 hours and 10 days, with an average of 3.5 days. Wound site: Tiger mouth in 2 cases, thumb finger in 3 cases. There were 1 case of finger abdomen, 3 cases of dorsal metacarpal and 1 case of dorsal finger. The wound area was 4 cm 脳 3 cm~8 cm 脳 7 cm, with bone or tendon exposure. Before operation, abdominal aorta was performed to bilateral tibia. Ct angiography of the posterior artery was performed to observe the perforating branch of lateral superficial sural artery around the knee joint of bilateral limbs, and to select a suitable limb as donor area. Then, the CTA data were imported into Mimics15.0 software to reconstruct perforating vessels and bones. The skin was designed according to the size of the wound, and the skin flap was designed according to the size of the wound. The range of flap was 5 cm 脳 4 cm~10 cm 脳 8 cm.9. One case was repaired by direct suture of donor area with free skin graft. Results except for 3 cases, the lateral superficial sural artery was thin and the flap was replaced by medial superficial sural artery perforating branch flap during the operation. After 24 hours of operation, venous crisis occurred in 1 case of the flap and survived after symptomatic treatment. All the other flaps survived successfully and the wounds and donor areas were healed in the first stage. All the patients were followed up for 3 ~ 18 months. The average was 10 months. The skin flap had a good shape. At the last follow-up, the hand function was evaluated according to the assessment criteria of total motion of joint (TAM), excellent in 6 cases, good in 3 cases, excellent in 6 cases and good in 3 cases. Conclusion CTA combined with Mimics15.0 software can individualize the perforating branch flap of lateral superficial sural artery and reduce the risk of operation.
【作者單位】： 成都軍區(qū)昆明總醫(yī)院骨科;
【基金】：全軍后勤科研計(jì)劃面上項(xiàng)目(CCD14J003)~~
【分類號】：R658.2

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