3D visualisation technology combined with perforator flap transfer in reconstruction of soft tissue defects in traumatic hand and foot injury
10.3760/cma.j.cn441206-20231222-00111
- VernacularTitle:三维可视化技术结合穿支皮瓣修复手和足创伤后软组织缺损
- Author:
Qixiang YIN
1
;
Jingyi MI
;
Huazhong CAI
;
Feng ZHOU
;
Qun YAO
;
Yong HUA
Author Information
1. 江苏大学附属医院急诊科,江苏 镇江 212001
- Keywords:
Perforator flap;
3D visualisation technology;
Hand;
Foot;
Soft tissue defect;
Reconstruction
- From:
Chinese Journal of Microsurgery
2024;47(4):393-399
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the application of 3D visualisation technology combined with perforator flap transfer in reconstruction of soft tissue defects in traumatic hand and foot injury and explore the clinical outcomes.Methods:Between January 2021 and February 2023, a retrospective analysis was conducted in the Department of Emergency of the Affiliated Hospital of Jiangsu University and the Department of Sports Medical of Wuxi No. 9 People's Hospital, on the data of 12 patients (13 flaps) who received surgery of 3D visualisation technology combined with perforator flap transfer for soft tissue defects left by traumatic hand and foot injuries. The patients were 7 males and 5 females aged 45 [36.5, 55.8] years old. Nine patients had the defects in hand and 3 in foot, with 3 in the left and 9 in the right. The sizes of defects ranged from 8.0 cm×6.0 cm to 18.0 cm×17.0 cm. The time from injury to surgery was 13.5 [8.3, 20.8] days. Preoperative CTA scans of donor and recipient sites were performed, and the imaging data were processed for 3D image reconstruction and visualisation. A total of 13 flaps were designed and harvested, including 10 free anterolateral thigh perforator flaps (ALTPFs) and 3 pedicled perforator flaps of fibular artery containing fibular nerve nutrient vessel chains. The flap sizes ranged from 9.0 cm×6.0 cm to 20.0 cm×15.0 cm. Five of the donor sites were directly closed by suture and 8 by skin grafting. Monthly outpatient follow-ups were conducted for the first 3 months after surgery, and then the follow-up reviews were conducted through visits of outpatient clinic or reviewed via WeChat interviews. Information about the outcomes of the transferred flaps, complications and function recovery were recorded on all patients.Results:All 13 flaps were successfully harvested and transferred with the assistance of 3D visualisation technology. Preoperative location of perforator vessels was accurate and flap design was reasonable. The 3D visualisation provided an effective guidance for surgical manipulation. Twelve flaps survived completely after surgery. One flap that had partial necrosis healed after skin grafting. All patients were included in more than 6 months of postoperative follow-up, with a mean follow-up duration of 8.1 months±1.7 months. All flaps had good colour and texture. Four flaps that had swollen appearance received secondary thinning surgery with satisfactory outcomes. The recovery of 9 patients with hand injury was evaluated according to the Blood Circulation Elauation of Severed Finger Replantation Evaluation Standard of Upper Limb Functional of Hand Surgery of Chinese Medical Association. At the final follow-up, the blood supply of flaps was excellent in 11 flaps and good in 2 flaps. Hand function was excellent in 2 hands, good in 4 hands and poor in 3 hands. Scores of American Orthopedic Foot and Ankle Societ(AOFAS) ankle-hindfoot was used for foot function evaluation and all 3 patients were in excellent. Of the postoperative complications, due to a haematoma beneath the flap, a local infection and a delayed fracture healing were occurred in 3 patients separately.Conclusion:The 3D visualisation technology assisted perforator flap transfer can achieve high-quality reconstruction of defects in hand and foot through precise preoperative flap design and simulated surgical incision, therefore it provides a better treatment outcomes for patients.
