| Objective:This paper aims to explore the accurate positioning of the descending branch of the lateral femoral circumflex artery by using three-dimensional(3D)printing three-dimensional guide plate before operation,assist in the clinical application of free flap to repair soft tissue defects of limbs,and compare the number and position of the preoperative positioning perforator vessels with the actual situation during operation,so as to improve the accuracy of preoperative positioning,improve the operation efficiency,and provide some reference for the operation scheme.Methods:A total of 15 patients with skin and soft tissue defects of limbs repaired by free anterolateral femoral perforator flap in the hand microsurgery of the Fourth People’s Hospital Affiliated to Jishou University from July 2019 to December 2021 were collected,including 13 males and 2 females,aged 39-70 years,with an average of(57.33±9.22)years,including 3 cases of heavy object injury,5 cases of traffic accident injury,4 cases of mechanical strangulation(including agricultural machinery),1 case of falling injury Bone exposure in 1 case after mass resection and skin necrosis after snake bite in 1 case;Including 3 cases of left upper limb,3 cases of right upper limb,4 cases of left lower limb and 5 cases of right lower limb.Before operation,all trauma patients were treated with debridement+negative pressure closed drainage system(VSD)to cover the wound.After the trauma patients were excluded from infection and the tumor patients were excluded from malignant tumors,the secondary flap transplantation was performed.Before operation,all patients were routinely applied with color Doppler ultrasound,computed tomography angiography(CTA)and corresponding three-dimensional printing guide plate,according to the color Doppler ultrasound and guide plate,the position of perforator artery passing through fascia late was located and marked,and the number of perforators located by color Doppler ultrasound and guide plate were recorded respectively before operation.During operation,the perforator vessels of flap were carefully separated according to the actual situation;Secondly,the actual number of perforating branches during the operation was recorded,and the distance between the perforating branches penetrating the fascia late and the preoperative positioning point was measured and compared.The donor area of the flap should be closed in one stage as far as possible;Finally,the time of flap cutting and the blood supply of the flap after vascular anastomosis were recorded in 15 patients.The survival of the flap,infection,arteriovenous crisis,and other complications were closely observed after operation.The appearance and functional recovery of the recipient and donor area of the flap were observed 6 months after discharge.Results:All 15 flaps survived successfully.Among them,the average number of perforating vessels predicted by color Doppler ultrasound before operation was(2.67 ±0.7).A total of 27 perforating vessels were visually seen by 3D printing three-dimensional guide plate before operation,with an average of(1.8 ± 0.4)per patient.33 perforating vessels were seen under direct vision during operation,with an average of(2.2 ± 0.4).Among them,the 27 perforating vessels located by the guide plate were accurately verified during operation,and only single perforating vessels were seen on the guide plate in 3 patients,However,2-3 perforating vessels could be seen under the actual direct vision during the operation.The positioning accuracy of the number of perforating vessels assisted by color Doppler ultrasound and guide plate and the actual number of perforating vessels during the operation were 40%and 60%respectively.The false negative of guide plate was 6 cases(40%),the false positive of color Doppler ultrasound was 8 cases(53.3%),and the false negative of color Doppler ultrasound was 1 case(6.7%).The intraoperative perforator position was consistent with the preoperative positioning of the guide plate(d≤5mm)in 17(63%),more consistent(5<d≤10mm)in 9(33%),and less consistent(d>10mm)in 1(4%).The difference between intraoperative perforator position and preoperative color Doppler ultrasound positioning was consistent(f ≤ 5mm)19,Abstract Ⅱ(58%),more consistent(5<f≤ 10mm)in 8(30%),less consistent(f>10mm)4(12%).The flap cutting time during the operation was 100～183 min,with an average of(139.67 ± 25.84)min.the actual course of perforating vessels was basically consistent with the preoperative 3D printing guide plate model.The transplantation was carried out according to the preoperative planning.All the 15 patients healed well within 14～28 days after operation.After 6 months of discharge,the blood supply of the flap was good,the texture was soft,and the elasticity was good.There were no obvious complications such as pigmentation,rupture,and infection.The sense of protection was restored,and some superficial skin sensation was restored;Among the 15 patients,3 cases had scar after skin grafting,the rest were linear scar,no scar contracture was found,and there was no hypersensitivity and dullness around the scar.Conclusion:Using the three-dimensional(3D)printing technology,the three-dimensional positioning guide plate of the lateral femoral circumflex artery perforator flap can assist in repairing the skin and soft tissue defects of the limbs.It can accurately locate the perforator of the descending branch of the lateral femoral circumflex artery.On the one hand,it can more intuitively design the operation scheme,improve the operation efficiency,increase the operation accuracy,reduce the blindness of the operation,repair accurately,and obtain better shape and function;On the other hand,the guide plate can be used repeatedly to facilitate preoperative interpretation and communication with family members. |
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