ABSTRACT
Objective To localise and evaluate the precise position of the shank perforators preoperatively with the CTA and hand-held color Doppler (HHD),then evaluate the clinical efficacy of the method.Methods From April,2013 to June,2017,designed 36 propeller perforator flaps in 36 patients by following methods.Firstly,the CTA test was performed to calculate the parameters of perforator vessel positioning.Secondly,a HHD was typically used to verify the location of perforators found on preoperative CTA.At last,according to the "like with like" principle,the propeller perforator flaps were accurately designed.The regular followed-up was performed.Results All patients were followed-up for 3-24 months after operation.Thirty-six propeller perforator flaps survived,and 3 cases among them showed partial epidermal necrosis and healed after skin grafting.Donor sites were closed primarily in 24 cases,and skin grafting were performed in 12 cases.The skin graft sites survived without necrosis,and the average time of cutting flaps was 45 min.Conclusion By the methods of mapping the perforator propeller flaps with CTA and HHD,the perforator vessel can be positioned more accurately and quickly.The operation time was shortened,and the clinical efficiency can be achieved with the good clinical application values.
ABSTRACT
Objective To investigate the design of the postoperatively marker system based on the perforator flap and its clinical application.Methods According to the basic anatomy and blood supply characteristics of perforator flap,the observation points were marked on the flap surface and recipient area postoperatively,and judge flap blood flow changes with hand-held Doppler(HHD) and clock-face measurement based on perforators.From November,2015 to November,2017,prospectively conducted a control study evaluating the incidence of vascular crisis,accuracy rate,reoperation rate and survival rate of flaps between simple traditional flap monitoring group (n=100) and traditional flap monitoring combine with postoperatively marker system monitoring group (n=100).Results Vascular crisis was mostly concentrated with in 48 h postoperative in traditional flap monitoring group and combined group.There was no significant difference in the incidence,positive rate and negative rate of vascular crisis in the two groups (P＞0.05).The reoperation rate in the traditional flap monitoring group (87.5％) was higher than the combined group (27.8％)(P＜0.01).The survival rate of flap of combined group (99％) was higher than the traditional falp monitoring group (90％) (P＜0.05).Conclusion The postoperatively marker system of perforator flap can effectively guide the medical staff to observe the blood supply of the flap,detect and judge the vascular crisis in time,and It is simple and easy to do without increasing the patient's trauma and medical expenses as well as no additional equipments.