Application of three-dimensional reconstruction technology in preoperative planning of anterolateral thigh flap transplantation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Zhipeng , DING Jian , CHEN Xinglong , CHEN Mingming , HONG Zipu ,  YAN Hede

Department of Hand Surgery, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou Zhejiang, 325000, P. R. China;

Corresponding?author：

YAN Hede, Email: yanhede@hotmail.com

Keywords：

Three-dimensional reconstruction; anterolateral thigh flap; soft tissue defect; repair

DOI：

10.7507/1002-1892.202504035

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the application of three-dimensional (3D) reconstruction technology in preoperative planning for anterolateral thigh flap transplantation. Methods A retrospective analysis was performed on the clinical data of 11 patients with skin and soft tissue defects treated with free anterolateral thigh flap transplantation between January 2022 and January 2024, who met the selection criteria. There were 8 males and 3 females, aged 34-70 years (mean, 50.8 years). Causes of injury included traffic accidents (4 cases), machine trauma (3 cases), heavy object crush injury (3 cases), and tumor (1 case). The time from injury to flap repair ranged from 7 to 35 days (mean, 23 days). Preoperatively, the patients’ CT angiography images were imported into Mimics21.0 software. Through the software’s segmentation, editing, and reconstruction functions, 3D visualization and measurement of the vascular pedicle, perforators, wound size, and morphology were performed to plan the flap harvest area, contour, vascular pedicle length, and anastomosis site, guiding the implementation of flap transplantation. Results The length of the vascular pedicle needed by the recipient site was (9.1±0.9) cm, and the maximum length of vascular pedicle in the donor area was (10.6±0.6) cm, with a significant difference (t=4.230, P<0.001). The operation time ranged from 220 to 600 minutes (mean, 361.9 minutes). One patient had poor wound healing at the recipient site, which healed after dressing changes. All 11 flaps survived well without necrosis. All patients were followed up 6-19 months (mean, 11 months). Four flaps showed bulkiness and underwent secondary debulking; the remaining flaps had good contour and soft texture. The donor sites healed well, with no sensory disturbance around the incision or complications such as walking impairment.Conclusion Preoperative planning using CT angiography data and 3D reconstruction software can effectively determine the flap area, contour, required vascular pedicle length, anastomosis site, and whether vascular grafting is needed, thereby guiding the successful execution of anterolateral thigh flap transplantation.

Citation： WU Zhipeng, DING Jian, CHEN Xinglong, CHEN Mingming, HONG Zipu, YAN Hede. Application of three-dimensional reconstruction technology in preoperative planning of anterolateral thigh flap transplantation. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 748-753. doi: 10.7507/1002-1892.202504035 Copy

1.	左良, 喻建軍, 周曉, 等. 游離股前外側Kiss皮瓣修復巨大頭皮惡性腫瘤術后缺損. 中國修復重建外科雜志, 2018, 32(3): 346-349.
2.	張興, 吳攀峰, 李誠, 等. 旋股外側動脈及其分支類型的數字解剖學研究. 中國臨床解剖學雜志, 2024, 42(5): 535-542.
3.	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.
4.	陸浩, 薛明宇, 王進, 等. 數字化與3D打印技術輔助設計逆轉旋髂淺動脈皮瓣接力修復股前外側皮瓣供區8例. 中華顯微外科雜志, 2023, 46(2): 168-173.
5.	陳芝武, 林光豪, 於恩興, 等. 定位膜聯合CTA輔助設計股前外側穿支皮瓣修復足和踝關節周圍軟組織缺損的臨床應用. 中華顯微外科雜志, 2023, 46(6): 625-630.
6.	Gazyakan E, Xiong L, Sun J, et al. Vein grafting in microsurgical lower extremity reconstruction: Outcome analysis of primary versus secondary salvage procedures. J Reconstr Microsurg, 2021, 37(7): 608-616.
7.	徐永清, 唐舉玉, 劉元波, 等. 股前外側皮瓣穿支解剖學特征與定位方法的專家共識(2024版). 中國臨床解剖學雜志, 2024, 42(5): 489-499.
8.	唐舉玉, 孫念哲, 吳攀峰, 等. 股前外側穿支皮瓣的個性化精準設計: 十年1079例臨床療效分析. 中國臨床解剖學雜志, 2024, 42(5): 510-516.
9.	金文虎, 張子陽, 吳祥奎, 等. 旋股外側動脈嵌合皮瓣在足踝部復雜創面中的應用. 中國修復重建外科雜志, 2021, 35(7): 891-895.
10.	戰杰, 孫鵬, 吳錦生, 等. 分葉股前外側穿支皮瓣在四肢軟組織缺損修復中的應用. 中國臨床解剖學雜志, 2024, 42(5): 564-569.
11.	Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
12.	徐慶, 吳雙江, 吳劍, 等. 聚醚醚酮定位標志物聯合混合現實技術在股前外側穿支皮瓣血管定位中的應用研究. 中國修復重建外科雜志, 2024, 38(12): 1499-1504.
13.	Shen Y, Huang J, Dong MJ, et al. Application of computed tomography angiography mapping and located template for accurate location of perforator in head and neck reconstruction with anterolateral thigh perforator flap. Plast Reconstr Surg, 2016, 137(6): 1875-1885.
14.	周飛亞, 張弦, 蔡樂益, 等. 精準定位的微型股前外側穿支皮瓣修復手指中等面積皮膚軟組織缺損的效果. 中華燒傷與創面修復雜志, 2024, 40(2): 165-171.
15.	張月恒, 崔文舉, 宋坤修, 等. 改良CT血管造影術輔助基于淺筋膜穿支的股前外側皮瓣穿支評估與偏心設計的前瞻性研究. 中華燒傷與創面修復雜志, 2023, 39(2): 141-149.
16.	卿黎明, 賀繼強, 唐舉玉, 等. 基于活體造影數據的股深動脈穿動脈穿支血管的數字解剖學研究. 中國臨床解剖學雜志, 2016, 34(1): 12-15.
17.	Godina M, Arnez ZM, Lister GD. Preferential use of the posterior approach to blood vessels of the lower leg in microvascular surgery. Plast Reconstr Surg, 1991, 88(2): 287-291.
18.	王丹瑩, 劉元波, 陳威威, 等. CT血管造影預估近端蒂股前外側皮瓣血管蒂長度的臨床應用研究. 中國修復重建外科雜志, 2022, 36(3): 322-328.
19.	王石, 董帥, 曹陽, 等. 高選擇性動脈吲哚菁綠造影在游離股前外側皮瓣設計中的應用. 中華燒傷與創面修復雜志, 2024, 40(10): 948-954.
20.	趙海福, 方柏榮. choke血管血流動力學及血管重構的研究進展. 中華整形外科雜志, 2022, 38(1): 109-114.

1. 左良, 喻建軍, 周曉, 等. 游離股前外側Kiss皮瓣修復巨大頭皮惡性腫瘤術后缺損. 中國修復重建外科雜志, 2018, 32(3): 346-349.
2. 張興, 吳攀峰, 李誠, 等. 旋股外側動脈及其分支類型的數字解剖學研究. 中國臨床解剖學雜志, 2024, 42(5): 535-542.
3. 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.
4. 陸浩, 薛明宇, 王進, 等. 數字化與3D打印技術輔助設計逆轉旋髂淺動脈皮瓣接力修復股前外側皮瓣供區8例. 中華顯微外科雜志, 2023, 46(2): 168-173.
5. 陳芝武, 林光豪, 於恩興, 等. 定位膜聯合CTA輔助設計股前外側穿支皮瓣修復足和踝關節周圍軟組織缺損的臨床應用. 中華顯微外科雜志, 2023, 46(6): 625-630.
6. Gazyakan E, Xiong L, Sun J, et al. Vein grafting in microsurgical lower extremity reconstruction: Outcome analysis of primary versus secondary salvage procedures. J Reconstr Microsurg, 2021, 37(7): 608-616.
7. 徐永清, 唐舉玉, 劉元波, 等. 股前外側皮瓣穿支解剖學特征與定位方法的專家共識(2024版). 中國臨床解剖學雜志, 2024, 42(5): 489-499.
8. 唐舉玉, 孫念哲, 吳攀峰, 等. 股前外側穿支皮瓣的個性化精準設計: 十年1079例臨床療效分析. 中國臨床解剖學雜志, 2024, 42(5): 510-516.
9. 金文虎, 張子陽, 吳祥奎, 等. 旋股外側動脈嵌合皮瓣在足踝部復雜創面中的應用. 中國修復重建外科雜志, 2021, 35(7): 891-895.
10. 戰杰, 孫鵬, 吳錦生, 等. 分葉股前外側穿支皮瓣在四肢軟組織缺損修復中的應用. 中國臨床解剖學雜志, 2024, 42(5): 564-569.
11. Zhang YX, Hayakawa TJ, Levin LS, et al. The economy in autologous tissue transfer: Part 1. The kiss flap technique. Plast Reconstr Surg, 2016, 137(3): 1018-1030.
12. 徐慶, 吳雙江, 吳劍, 等. 聚醚醚酮定位標志物聯合混合現實技術在股前外側穿支皮瓣血管定位中的應用研究. 中國修復重建外科雜志, 2024, 38(12): 1499-1504.
13. Shen Y, Huang J, Dong MJ, et al. Application of computed tomography angiography mapping and located template for accurate location of perforator in head and neck reconstruction with anterolateral thigh perforator flap. Plast Reconstr Surg, 2016, 137(6): 1875-1885.
14. 周飛亞, 張弦, 蔡樂益, 等. 精準定位的微型股前外側穿支皮瓣修復手指中等面積皮膚軟組織缺損的效果. 中華燒傷與創面修復雜志, 2024, 40(2): 165-171.
15. 張月恒, 崔文舉, 宋坤修, 等. 改良CT血管造影術輔助基于淺筋膜穿支的股前外側皮瓣穿支評估與偏心設計的前瞻性研究. 中華燒傷與創面修復雜志, 2023, 39(2): 141-149.
16. 卿黎明, 賀繼強, 唐舉玉, 等. 基于活體造影數據的股深動脈穿動脈穿支血管的數字解剖學研究. 中國臨床解剖學雜志, 2016, 34(1): 12-15.
17. Godina M, Arnez ZM, Lister GD. Preferential use of the posterior approach to blood vessels of the lower leg in microvascular surgery. Plast Reconstr Surg, 1991, 88(2): 287-291.
18. 王丹瑩, 劉元波, 陳威威, 等. CT血管造影預估近端蒂股前外側皮瓣血管蒂長度的臨床應用研究. 中國修復重建外科雜志, 2022, 36(3): 322-328.
19. 王石, 董帥, 曹陽, 等. 高選擇性動脈吲哚菁綠造影在游離股前外側皮瓣設計中的應用. 中華燒傷與創面修復雜志, 2024, 40(10): 948-954.
20. 趙海福, 方柏榮. choke血管血流動力學及血管重構的研究進展. 中華整形外科雜志, 2022, 38(1): 109-114.

Chinese Journal of Reparative and Reconstructive Surgery

Application of three-dimensional reconstruction technology in preoperative planning of anterolateral thigh flap transplantation

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content