Clinical Application Of Mimics Software Combined With Imaging To Assist The Preoperative Design Of Gracilis Muscle Flap

Objective:Mimics software combined with CTA,MRA and other imaging data were used to identify and reconstruct the perforator vessels of gracilis muscle based on three-dimensional reconstruction technology,to clarify the anatomical relationship between the course of the perforator vessels and the surrounding tissues,to simulate the design of the skin flap,and to guide the operation of cadaver specimens and intraoperative verification.To explore the related influencing factors of Mimics software combined with imaging to assist the design of gracilis musculocutaneous flap and the clinical effect of flap transplantation,optimize the preoperative design of gracilis musculocutaneous flap,and evaluate the prospect and significance of clinical application.Methods:First,the gracilis muscle was dissected from 3 lower extremity cadavers after vascular perfusion.The morphological characteristics of gracilis muscle were observed.The source,outer diameter,length of the internal artery of gracilis muscle,and the adjacent relationship between muscle,blood vessel and bone were recorded respectively.At the same time,3 male and 3 female patients with lower extremity skin and soft tissue defect who were treated in our department from January 2019 to December 2020 and planned to be treated with skin flap transplantation were selected as the research subjects.CTA or MRA imaging examinations were performed with gracilis muscle donor region as the target vector,and CT examination was performed in the recipient region.Mimics software was used to construct three-dimensional images of gracilis muscle donor region and its perforator vessels,and the specific travel types were judged,and the data of the images were measured and collected.Referring to the 3D reconstruction images obtained before the operation,the corresponding perforator position was marked in it,and the skin flap shape was drawn to simulate the preoperative skin flap design.The anatomy of the perforating artery can be clearly shown on the 3D image without any obvious contraindications,so that the scope of the flap can be accurately evaluated.During the operation,one group of physicians cut the skin flap and sutured the donor area;the other group of physicians prepared the foundation,anastomosed the blood vessels and fixed the skin flap.The follow-up was conducted 1-3 months after the operation to evaluate the postoperative effect and calculate the results.Results:Anatomical experiment results confirmed that the vascular branches of gracilis muscle followed the same course as muscle fibers,which mainly originated from the profunda artery and the medial circumflex femoral artery,and presented a chain distribution.After the anatomy of the first specimen,it was found that there were 2 perforator branches on the left,all from the profunda artery,and 3 perforator branches on the right,2 from the profunda artery,and 1 from the medial circumflex femoral artery.After the second specimen was dissected,it was found that there were 3 branches on the left side,2 from the profunda artery,1 from the profunda artery,and 4 branches on the right side,2 from the profunda artery,1 from the medial circumflex femoral artery,and 1 from the popliteal artery.After dissection of the third specimen,it was found that there were 4 branches on the left side,3 from the profunda artery,1 from the obturator artery,and 2 branches on the right side,all of which were from the profunda artery.According to the three-dimensional image model built for the perforator vessels and muscles at the donor site,the observation found that the distribution of the perforator vessels could be clearly presented.A total of 9 perforating vessels were found in 6 patients by 3D reconstruction images,of which 6(66.7%)were from the profunda artery and 3(33.3%)were from the medial circumflex femoral artery.Surgeon A identified,10 perforating branches were found before operation,and 9 branches were shown by 3D reconstruction.Surgeon B identified,10 were found before operation,and 8 were shown.Consistency analysis showed a Kappa value of 0.7(>0.6),indicating a fairly reliable consistency.Use of preoperative 3 d image reconstruction,patients were successfully simulated the donor flap,clearly show that the morphology of the gracilis muscle,direction and its wear vascular anatomical relationship with the surrounding tissue structure,guiding intraoperative flap cut,postoperative patients followed up for 1 to 3 months,by the donor skin flap survival,local swelling,no burst organization function and the tension is good,no contracture deformity.Conclusion:Joint imaging Mimics software to build the gracilis muscle three-dimensional images,can clear display perforators of the blood vessels and reduce the risk of damaged blood vessels has paved the way for the separation of clinical blood vessels at the same time,design personalized operation scheme for different patients,shorten the operation time,also reduce the operation risk,which can realize defect accurate restoration and the three-dimensional visualization of the wound repair.The scar at the incision site of the donor site was concealed after surgery,which had almost no effect on the function and appearance of the thigh.The flap survived well,and there were no local complications such as rupture and purulent,which achieved a good therapeutic effect and was more reliable.