Preoperative 3D visualization of peroneal artery perforator flap / 中华显微外科杂志

ABSTRACT

Objective:To study the preoperative CTA and 3D medical reconstruction software, aiming to provide an imaging basis for the preoperative design of peroneal artery perforator flap.Methods:From January 2016 to January 2018, 13 patients with soft tissue defect on foot were studied. Of the patients, 7 injuries were caused by traffic accident, 2 by machine crush and 4 by heavy object crush. The size of defect ranged from 5.0 cm×3.0 cm to 17.0 cm×10.0 cm. CTA technology was used to obtain the images of the affected lower limb, and the 3D visual reconstruction of peroneal artery perforators was generated by using Mimics software. The distribution of peroneal artery perforator was observed. The preoperative design of the flap was completed with the tools come with the software package. The peroneal artery perforator flap was harvested according to the design by computer simulation. Data taken before the surgery were compared with the data taken in the operation. Then the flap was rotated 180° to repair the defect. Regular follow-ups were made in outpatient clinic or via internet after operation. The appearance, texture, colour and blood supply of the flap were observed. The function of foot and ankle was scored according to the American Orthopaedic Foot Ankle Association(AOFAS). Results:A visible 3D flap model of the peroneal artery perforator flap was successfully reconstructed by Mimics software. The anatomical characteristics and region of blood supply of the 13 cases were basically comparable to what were found in the operation. The size of the flap was 6.0 cm×4.0 cm-18.0 cm×11.0 cm. All the flaps survived completely. All the patients completed 6-17(mean, 8.1) months follow-up. The colour and texture of the flaps were good. At the last follow-up, according to the AOFAS score, 7 cases were in excellent, 4 in good and 2 in fair, with an excellent and good rate at 84.61%.Conclusion:Aided by digital technology, it provides a visual 3D morphological support for the design of peroneal artery perforator flap and overcomes the blind spot in the preoperative design, hence it leads to an accurate harvest of the flap in operation.