Application of digital technology in superficial lateral sural artery perforator flap for tiny hand wounds reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Guodong ,  XU Yongqing , HE Xiaoqing , LUO Haotian , DONG Kaixuan , WANG Teng

Department of Orthopedics, Kunming General Hospital of Chengdu Military Region, Kunming Yunnan, 650032, P.R.China;

Corresponding?author：

XU Yongqing, Email: xuyongqingkm@163.net

Keywords：

Superficial lateral sural artery perforator flap; digital technology; CT angiography; hand wound

DOI：

10.7507/1002-1892.201612088

Video：

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Objective To investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap. Methods Between August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case. Results Superficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM). Conclusion The preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.

Citation： LI Guodong, XU Yongqing, HE Xiaoqing, LUO Haotian, DONG Kaixuan, WANG Teng. Application of digital technology in superficial lateral sural artery perforator flap for tiny hand wounds reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(5): 564-569. doi: 10.7507/1002-1892.201612088 Copy

1.	?徐永清, 何曉清, 段家章, 等. 腓腸外側淺動脈穿支皮瓣在手部創面修復中的臨床應用. 中華顯微外科雜志, 2016, 39(3): 213-216.
2.	孫廣峰, 聶開瑜, 祁建平, 等. 腓腸內側動脈穿支皮瓣游離移植修復前足背側創面的研究. 中國修復重建外科雜志, 2016, 30(3): 378-381.
3.	Pan HT, Zheng QX, Yang SH, et al. Versatility of reverse sural fasciocutaneous flap for reconstruction of distal lower limb soft tissue defects. J Huazhong Univ Sci Technolog (Med Sci), 2014, 34(3): 382-386.
4.	Wolff KD, Bauer F, Kunz S, et al. Superficial lateral sural artery free flap for intraoral reconstruction: anatomic study and clinical implications. J Head Neck, 2012, 34(9): 1218-1224.
5.	朱洪章, 楊有優, 朱慶棠, 等. 穿支皮瓣術前血管評估的研究進展. 中華顯微外科雜志, 2016, 39(4): 415-416.
6.	朱洪章, 楊有優, 朱慶棠, 等. CT 血管造影與手持式多普勒在股前外側皮瓣術前穿支體表定位的比較. 中華顯微外科雜志, 2016, 39(5): 432-436.
7.	段家章, 何曉清, 徐永清, 等. 數字化技術在股前外側皮瓣修復手足創面中的應用. 中國修復重建外科雜志, 2015, 29(7): 807-811.
8.	張元智, 陸聲, 溫樹正, 等. 數字化技術在隱動脈皮瓣血供的可視化及其臨床初步應用. 中華創傷骨科雜志, 2013, 15(1): 32-35.
9.	Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. J Plast Reconstr Surg, 2008, 122(2): 429-437.
10.	卿黎明, 胡懿郃, 唐舉玉, 等. 基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究. 中國修復重建外科雜志, 2014, 28(6): 697-700.
11.	Laungani AT, Van Alphen N, Christner JA, et al. Three-dimensional CT angiography assessment of the impact of the dermis and the subdermal plexus in DIEP flap perfusion. J Plast Reconstr Aesthet Surg, 2015, 68(4): 525-530.
12.	郭金寶. 萬古霉素硫酸鈣或萬古霉素骨水泥局部應用治療脛骨開放性骨折術后并發骨髓炎的療效分析. 世界最新醫學信息文摘(電子版), 2015, 15(69): 225, 230.
13.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
14.	Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg, 2014, 30(7): 463-468.
15.	Zhang YZ, Wen SZ, Zhang HQ, et al. Three-dimensional digitalized virtual planning for saphenous artery flap: a pilot study. J Comput Assist Surg (Abingdon), 2016, 21(1): 102-106.
16.	Hayashida K, Saijo H, Fujioka M. Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report. J Microsurgery, 2016. [Epud ahead of print].
17.	Leclére F M, Eggli S, Mathys L, et al. Anatomic study of the superficial sural artery and its implication in the neurocutaneous vascularized sural nerve free flap. J Clin Anat, 2013, 26(7): 903-910.
18.	Pease NL, Davies A, Townley WA. Free sural artery perforator flap: An occasional gift in oral cavity reconstruction. J Head Neck, 2016, 38(7): E2454-E2456.

1. ?徐永清, 何曉清, 段家章, 等. 腓腸外側淺動脈穿支皮瓣在手部創面修復中的臨床應用. 中華顯微外科雜志, 2016, 39(3): 213-216.
2. 孫廣峰, 聶開瑜, 祁建平, 等. 腓腸內側動脈穿支皮瓣游離移植修復前足背側創面的研究. 中國修復重建外科雜志, 2016, 30(3): 378-381.
3. Pan HT, Zheng QX, Yang SH, et al. Versatility of reverse sural fasciocutaneous flap for reconstruction of distal lower limb soft tissue defects. J Huazhong Univ Sci Technolog (Med Sci), 2014, 34(3): 382-386.
4. Wolff KD, Bauer F, Kunz S, et al. Superficial lateral sural artery free flap for intraoral reconstruction: anatomic study and clinical implications. J Head Neck, 2012, 34(9): 1218-1224.
5. 朱洪章, 楊有優, 朱慶棠, 等. 穿支皮瓣術前血管評估的研究進展. 中華顯微外科雜志, 2016, 39(4): 415-416.
6. 朱洪章, 楊有優, 朱慶棠, 等. CT 血管造影與手持式多普勒在股前外側皮瓣術前穿支體表定位的比較. 中華顯微外科雜志, 2016, 39(5): 432-436.
7. 段家章, 何曉清, 徐永清, 等. 數字化技術在股前外側皮瓣修復手足創面中的應用. 中國修復重建外科雜志, 2015, 29(7): 807-811.
8. 張元智, 陸聲, 溫樹正, 等. 數字化技術在隱動脈皮瓣血供的可視化及其臨床初步應用. 中華創傷骨科雜志, 2013, 15(1): 32-35.
9. Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers. J Plast Reconstr Surg, 2008, 122(2): 429-437.
10. 卿黎明, 胡懿郃, 唐舉玉, 等. 基于數字化技術的腓腸內側動脈穿支皮瓣血供的三維可視化重建研究. 中國修復重建外科雜志, 2014, 28(6): 697-700.
11. Laungani AT, Van Alphen N, Christner JA, et al. Three-dimensional CT angiography assessment of the impact of the dermis and the subdermal plexus in DIEP flap perfusion. J Plast Reconstr Aesthet Surg, 2015, 68(4): 525-530.
12. 郭金寶. 萬古霉素硫酸鈣或萬古霉素骨水泥局部應用治療脛骨開放性骨折術后并發骨髓炎的療效分析. 世界最新醫學信息文摘(電子版), 2015, 15(69): 225, 230.
13. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3): 130-135.
14. Yu P. Inverse relationship of the anterolateral and anteromedial thigh flap perforator anatomy. J Reconstr Microsurg, 2014, 30(7): 463-468.
15. Zhang YZ, Wen SZ, Zhang HQ, et al. Three-dimensional digitalized virtual planning for saphenous artery flap: a pilot study. J Comput Assist Surg (Abingdon), 2016, 21(1): 102-106.
16. Hayashida K, Saijo H, Fujioka M. Peroneal perforator-based peroneus longus tendon and sural neurofasciocutaneous composite flap transfer for a large soft-tissue defect of the forearm: A case report. J Microsurgery, 2016. [Epud ahead of print].
17. Leclére F M, Eggli S, Mathys L, et al. Anatomic study of the superficial sural artery and its implication in the neurocutaneous vascularized sural nerve free flap. J Clin Anat, 2013, 26(7): 903-910.
18. Pease NL, Davies A, Townley WA. Free sural artery perforator flap: An occasional gift in oral cavity reconstruction. J Head Neck, 2016, 38(7): E2454-E2456.

Chinese Journal of Reparative and Reconstructive Surgery

Application of digital technology in superficial lateral sural artery perforator flap for tiny hand wounds reconstruction

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