CTA联合CDFI在股前外穿支皮瓣修复软组织损伤中的应用

doi:10.7517/issn.1674-0475.210830

摘要/Abstract

摘要： 探讨CT血管成像(CTA)联合彩色多普勒血流成像(CDFI)在股前外穿支皮瓣修复上下肢软组织损伤中的应用。选取拟进行股前外穿支皮瓣(ALTPF)移植的患者58例,将其分为CTA组和CDFI组,每组各29例。术前,分别应用CTA、CDFI进行皮瓣设计和骨前外穿支定位,观察受试者修复情况。结果发现,CTA组和CDFI组皮瓣皮温均有1例较高,其他温度均处于正常范围,无血管危险出现,全部存活;CTA组与CDFI组旋股外侧动脉降支的平均流速和最大流速均无显著差异(P>0.05)。CDFI与CTA均可应用于股前外穿支皮瓣,满足受损上下肢软组织重建手术。

关键词: CT血管成像, 彩色多普勒血流成像, 股前外穿支皮瓣, 软组织修复, 术前定位

Abstract: This article explored the application of CT angiography(CTA) imaging combined with color Doppler flow imaging (CDFI) in the repair of soft tissue injuries of the upper and lower extremities with external perforator flaps. Fifty-eight patients planned to undergo anterolateral thigh perforator flap (ALTPF) transplantation were selected in this hospital and divided into CTA group and CDFI group, each with 29 cases. CTA and CDFI were used for skin grafting before surgery. The flap design and the positioning of the anterior and outer perforating branches of the bone, observe the repair of the subjects. The results showed that the skin temperature of the flaps in the CTA group and the CDFI group was higher in 1 case, and the other temperatures were in the normal range. There was no risk of blood vessels and all survived; the average flow velocity and the maximum value of the descending branch of the lateral femoral circumflex artery in the CTA group and the CDFI group. There was no significant difference in flow rate (P>0.05). Both CDFI and CTA can be applied to the anterior thigh and outer perforator flap to meet the needs of reconstructing soft tissues in the upper and lower limbs.

Key words: CT angiography, color Doppler flow imaging, anterior thigh perforator flap, soft tissue repair, preoperative positioning

张炜, 刘倩芸, 张洋. CTA联合CDFI在股前外穿支皮瓣修复软组织损伤中的应用[J]. 影像科学与光化学, 2022, 40(2): 353-356.

ZHANG Wei, LIU Qianyun, ZHANG Yang. Application of CTA Combined with CDFI in the Repair of Soft Tissue Injury with Anterior Thigh Perforator Flap[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(2): 353-356.

参考文献

[1] Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. British Journal of Plastic Surgery, 1989, 42(6):645-648.
[2] Abdelfattah U, Power H A, Song S, et al. Algorithm for free perforator flap selection in lower extremity reconstruction based on 563 cases[J]. Plastic and Reconstructive Surgery, 2019, 144(5):1202-1213.
[3] Wong S, Goggin J D, Webster N D, et al. Pre-expanded internal mammary artery perforator flap[J]. Clinics In Plastic Surgery, 2017, 44(1):65-72.
[4] Lellouch A G, Ng Z Y, Pozzo V, et al. Reconstruction of post-burn anterior neck contractures using a butterfly design free anterolateral thigh perforator flap[J]. Archives of Plastic Surgery, 2020, 47(2):194-197.
[5] Jaiswal D, Ghalme A, Yadav P, et al. Free anteromedial thigh perforator flap:Complementing and completing the anterolateral thigh flap[J]. Indian Journal of Plastic Surgery:Official Publication of the Association of Plastic Surgeons of India, 2017, 50(1):16-20.
[6] Haribhakti V V, Thorat T S, Powle V R, et al. Prospective study to analyse the efficiency of acoustic Doppler v/s colour duplex ultrasound in locating perforators for antero-lateral thigh flap in reconstructive head and neck surgery[J]. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2021, 74(9):2026-2033.
[7] Thomas W W, Calcagno H E, Azzi J, et al. Incidence of inadequate perforators and salvage options for the anterior lateral thigh free flap[J]. The Laryngoscope, 2020, 130(2):343-346.
[8] Cohen O D, Abdou S A, Nolan I T, et al. Perforator variability of the anterolateral thigh flap identified on computed tomographic angiography:Anatomic and clinical implications[J]. Journal of Reconstructive Microsurgery , 2020, 36(8):616-624.
[9] 申林, 战杰, 马俊伟, 等. 游离股前外穿支皮瓣治疗胫前及足踝部大面积皮肤软组织缺损的临床观察[J]. 航空航天医学杂志, 2020, 31(4):413-414.
[10] Smith R K, Wykes J, Martin D T, et al. Perforator variability in the anterolateral thigh free flap:A systematic review[J]. Surgical and Radiologic Anatomy, 2017, 39(7):779-789.
[11] Ratanshi I, McInnes C W, Islur A. The proximal superficial femoral artery perforator flap:Anatomic study and clinical cases[J]. Microsurgery, 2017, 37(6):581-588.
[12] Karakawa R, Yoshimatsu H, Tanakura K, et al. An anatomical study of the lymph-collecting vessels of the medial thigh and clinical applications of lymphatic vessels preserving profunda femoris artery perforator (LpPAP) flap using pre- and intraoperative indocyanine green (ICG) lymphography[J]. Journal of Plastic, Reconstructive & Aesthetic Surgery, 2020, 73(9):1768-1774.
[13] Sheng J F, Li C, Tang P, et al. Comparison of the efficacy of the anterolateral thigh flap for perforator localization in the repair of head and neck soft tissue defects patients:A protocol study for a randomized controlled trial[J]. Medicine (Baltimore), 2020, 99(50):e23080.
[14] Thomas B, Warszawski J, Falkner F, et al. A comparative study of preoperative color-coded Duplex ultrasonography versus handheld audible Dopplers in ALT flap planning[J]. Microsurgery, 2020, 40(5):561-567.
[15] Bastos P, Fry A, Cascarini L, et al. Real-time optical vascular imaging:A method to assess the microvascular circulation of myofascial free flaps used in the head and neck region[J]. International Journal of Oral and Maxillofacial Surgery, 2020, 49(5):582-586.
[16] Ramalli A, Rodriguez-Molares A, Avdal J, et al. High-frame-rate color Doppler echocardiography:A quantitative comparison of different approaches[J]. IEEE Transactions on Ultrasonics, Ferroelectrics, and Frequency Control, 2020, 67(5):923-933.
[17] Mehregan F, Tournoux F, Muth S, et al. Doppler vortography:A color Doppler approach to quantification of intraventricular blood flow vortices[J]. Ultrasound In Medicine & Biology, 2014, 40(1):210-221.
[18] Mathew R C, Gottbrecht M, Salerno M. Computed tomography fractional flow reserve to guide coronary angiography and intervention[J]. Interventional Cardiology Clinics, 2018, 7(3):345-354.
[19] 莫勇军, 杨克勤, 谭海涛, 等. CTA联合彩色多普勒超声检测在股前外侧穿支皮瓣中的应用[J]. 中华显微外科杂志, 2018, 41(1):68-72.