ABSTRACT
Objective:To investigate the clinical value of the free fibula flap transplantation in repair of the defect of tibia and soft tissue with the help of augmented reality (AR) technology.Methods:From May, 2017 to May, 2019, 9 patients with tibial and soft tissue defects were treated. Before operation, CTA scan was performed on both shanks to obtain DICOM data of tibial bone defect. Images of the designed fibular flap and its blood supply model were imported into Sina software through computer virtual surgery assistant technology. With the AR technology, information of virtual fibula flap were projected onto the body surface at the donor site, and the operation was carried out under the precise positioning. In this group, the free fibular flap was harvested with an area of 6.0 cm×4.0 cm-12.0 cm×6.0 cm and the length of fibula was 6.0-13.5 cm. The free fibula flap were used to repair the tibial defect with 5.0-12.0 cm in length and soft tissue defect area at 5.0 cm×3.0 cm-10.0 cm×4.5 cm. Patients were followed-up to observe the survival of fibular flap and the functional recovery of the repaired lower limb, and evaluate the clinical effect.Results:All the fibular flaps survived without vascular crisis and without serious complications occurred at both of donor and recipient sites. After 8-12 months of follow-up, the flap was soft in texture and good in blood supply. The appearance of the repair site was not bloated. Callus began to form at the junction of fibula and tibia at 3-5 months and healed well in 8-12 months. No bone resorption, nonunion, loosening or falling off of screws were found. There was no pain in the shank of the recipient area. Patients could stand and walk freely, and the weight-bearing function was close to normal. According to Enneking system, the average score was 27 points; 7 cases were excellent and 2 cases were good.Conclusion:Application of AR technology in the repair of tibial bone defect with fibular flap transplantation has good clinical effect and has certain practical value.
ABSTRACT
Objective:To investigate the clinical value of augmented reality (AR) technology combined with Doppler ultrasound in repairing soft tissue defects around ankle with posterior tibial artery perforator flap.Methods:From June, 2017 to June, 2020, 13 patients with soft tissue defects around ankle were repaired with the posterior tibial artery perforator flap sized 3.0 cm×7.0 cm-5.0 cm×10.0 cm. Preoperative CTA scan was performed to obtain the 3-dimensional image of the blood supply of the donor site. The origin and direction of blood supply, length of pedicle, diameter and the location of perforator were determined. An image fusion software based on Android mobile phone was used from the body surface to realize the navigation by AR, and to mark the locations of the points where blood vessels ran and passed by. At the same time, Doppler ultrasound was employed to confirm the navigation. The optimal puncture fulcrum was used as the flap rotation point in design of the flap. After the flap had been designed, the flap was harvested and the defect was repaired. Outpatient clinic follow-up was performed to evaluate the survival of flap and the function of ankle.Results:All 13 flaps survied without vascular issues. After 6-16 (average 10) months follow-up, all flaps survived. The flaps appeared soft with good blood supply. The colour of the repaired sites were basically the same as normal skin. According to American Orthopedic Foot and Ankle Society (AOFAS) , the ankle function was excellent in 9 patients and good in 4 patients. There was no obvious scar formation on the donor sites.Conclusion:The application of AR technology combined with Doppler ultrasound in the surgical planning of posterior tibial artery perforator flap has advantages in easy to operate in clinical practice. It can reduce the risk of surgery, and has significance in clinical practice.