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Objective@#To explore the clinical application value of mixed reality technology in locating perforator vessels and assisting perforator vessel dissection to harvest anterolateral thigh flaps.@*Methods@#Six patients who needed anterolateral thigh flap repair after resection of oral and maxillofacial tumors were recruited from the Department of Oral and Maxillofacial Surgery of Nanchong Central Hospital from January 2020 to January 2021. Before surgery, the CT angiography data of the lower limbs of the patients carrying the calibration points were imported into the data workstation to perform 3D reconstruction of the perforator vessels and surrounding tissues of the thigh, and the reconstruction results were imported into Microsoft HoloLens 2 glasses. During the operation, calibration was performed at the calibration point of the operative area so that the preoperative reconstruction results were superimposed on the operative area through Microsoft HoloLens 2 glasses. The clinical application value of mixed reality technology assisted perforator vessel location and anatomy of anterolateral femoral perforator flap was discussed from six aspects: whether the perforator vessel was reconstructed preoperatively, intraoperative calibration time, whether the actual position of the perforating vessels passing through the fascia lata fulcrum deviated from the preoperative reconstruction result within 1 cm, time required to harvest the flap, and whether the actual route of the perforator vessel was consistent with the reconstruction result, and whether the postoperative flap survived.@*Results @# The position and course of perforating vessels were successfully reconstructed in 6 cases before the operation. The actual course of perforating vessels during the operation was consistent with the reconstruction results. The deviation between the actual position of the perforating points and the preoperative reconstruction results was within 1 cm, which met the requirements of the actual asisting of the anterolateral thigh flap. The average time of flap harvest was (70.50 ± 7.20) min. The average calibration time was (13.33 ± 5.50) min. All flaps survived.@* Conclusions @# Mixed reality technology projects the reconstruction results of anterolateral femoral perforator vessels directly into the operative area, which provides a new method for asisting localization and anatomy of anterolateral femoral flap perforator vessels and reduces the possibility of injury to perforator vessels.
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Objective@#To investigate the design of free perforator flap, and the efficacy of utilizing perforator flaps for Ⅳ degree Ischia-sacral ulcer treatment.@*Methods@#From January 2010 to October 2016, 18 patients with Ⅳ degree ischia-sacral ulcer were treated. The surface area of the sacral tail ranged from 4 cm×5 cm to 8 cm ×12 cm.Doppler sonography was used to detect potential perforator.All defects were repaired with free perforator flaps, designed based on the size and shape of the wound. The flap size ranged from 6 cm×11 cm to 9 cm×15 cm.@*Results@#One perforator flap went dehiscence after surgery, repaired by V-Y flap. All the rest of perforator flaps survived well, after 3-24 months follow-up. Flap texture and appearance was good, no ulcer reoccurred.@*Conclusions@#The free perforator flap is a simple technique.It does not need to tracethe trunk of vessels, and it does not cause major morbidities to the buttocks. Therefore, it is one of the ideal ways to repair Ⅳ degree Ischia-sacral ulcer.
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Objective To evaluate the effects of nasolabial flap with facial artery and its branches perforator for reconstruction of nasal defect.Methods Between March 2013 and April 2017,21 patients underwent operations for the reconstruction of nasal defect,caused by trauma,surface tumors,moles and infection.The size of the defect was 1.5 cm × 2.0 cm to 3.0 cm × 3.0 cm.Designed various nasolabial perforator flap was pedicled with the facial artery.The pulsed blood flow detector determined the location of the facial artery and its perforation position,which was the rotation point,and the rotation of the nasolabial fold flap covered the nasal defect area to repair.Results 21 flaps survived.Surface artery perforation nasolabial fold flap was good blood supply,of which 1 case of flap was congested and recovered after treatment.After 1 month to 3 years follow-up on 21 cases,20 cases showed good results and 1 case had generally accepted.The color,shape and function of the flap were significant,similar to the normal skin.Conclusions A small area defect in the nose is preferred by using facial arterial perforation nasolabial fold flap repair,which does not need secondary repair,and is worthy of clinical application.
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Objective: To evaluate the surgical technique and the effectiveness of the free superficial palmar branch of the radial artery flap to repair soft tissue defect of fingers. Methods: Between June 2014 and June 2017, 10 cases (10 fingers) of soft tissue defects of fingers were repaired with the free superficial palmar branch of the radial artery flaps. There were 8 males and 2 females with an average age of 29.8 years (range, 23-42 years). The causes of injury included the chainsaw cutting injury in 6 cases, the machine crush injury in 2 cases, and the glass scratching in 2 cases. The time from injury to admission was 1-8 hours with an average of 3 hours. The locations were the volar of the middle of index finger in 3 cases, the volar of the distal of index finger in 1 case, the volar of the distal of middle finger in 3 cases, the ulnar side of distal interphalangeal joint of ring finger in 1 case, and the volar of the distal of the little finger in 2 cases. The area of soft tissue defect ranged from 1.8 cm×0.9 cm to 2.8 cm×2.1 cm, and the area of flap ranged from 2.0 cm×1.0 cm to 3.0 cm×2.3 cm. The donor sites were sutured directly. Results: All flaps survived after operation, and the wounds healed by first intention. The incisions of donor site also healed by first intention with a linear scar. All cases were followed up 6-12 months (mean, 9 months). The appearance and texture of the flaps were satisfactory. The pain sensation, warm sensation, and touch sensation of the flap recovered. At last follow-up, the two-point discrimination of the flap was 6-13 mm (mean, 7.5 mm). According to the assessment of the upper limb function issued by tha Hand Surgery Society of Chinese Medical Association, the results were graded as excellent in 8 cases and good in 2 cases. Conclusion: The free superficial palmar branch of the radial artery flap is easy to harvest and anastomose and has small injury. It is an ideal method in repairing of soft tissue defects of fingers.
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Objective To observe the curative effect of repairing the distal foot skin and soft tissue defect by using flap.Methods We used nutrient artery flap and low external ankle to repair the foot distal skin soft tissue defect in 16 cases.Results The flap survived,necrosis happened in small skin edge part and distal skin flap of sural nerve nutrient artery flap in two cases,and the skin graft healing with dots after removed the necrotic tissue and changed dressing.16 cases were followed up for 3-16 months,2 cases of flap slightly bloated,1 case back to the hospital got thin skin flap repairing technique;14 cases of walking were as usual,2 lame cases,related to some tissue defect in patients with forefoot injury.The use of flap to repair the foot injury,could maximially recover the limb function,reduce the rate of the sick.Conclusion Skin flap is a kind of operation which is simple,with smaller cost for skin area,beautiful and effective to repair skin and soft tissue defect of foot.
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Objective To introduce a method of using perforators flap adjacent to the defect to repair small sized skin defect.Methods From October 2009 to December 2013,a total of 23 cases of skin lesions were treated with perforators flap adjacent to the defect.The perforator artery was preoperatively detected with Portable Doppler in the region of relative slack skin.Skin defects with the area changed from 1.5 cm × 2.0 cm to 5.0 cm × 4.0 cm.Results All the flap survived smoothly,with pleased appearance and primary healing.Postoperative follow-up of 3 to 6 month showed no recurrence in tumor patients during the follow-up period.Conclusions Application of perforators flap adjacent to defect to repair small sized skin defect has the advantages of flexibility,reliable blood supply,which obtains good result.
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Objective To investigate a new method of improving design of the skin flap pedicled with descending hranch of lateral femoral circumflex artery,in order to increase the accuracy of preoperative Doppler location.Methods Six fresh cadavers underwent a whole body,intra-arterial injection of a lead ox- ide and gelatine preparation.Observe the perforators of anterolateral thigh by dissection,measured their diam- eter;course,branches and location for there were showed up by angiography and photography.A specific pro- gram,3D-doctor,was used for the detection of the regions of interest in angisome and its 3D-reconstructive.In addition to the average area supplied by a single perforator within that territory was calculated from digital an- giograms using Scion Image.Results There were 16 perforators that the diameter≥0.5 ram,20%were septocutaneous,80%were musculocutaneous.Their average external diameter was 0.8 ram.The average ped- icle length from the deep fascia was(3.15?1.43)ram;the perforators from descending branch of lateral cir- cumflex femoral artery walk length average about 2.63 cm in superficial fascia.The area of each perforator supplied blood was average 45.61 cm~2.Conclusion Modified lead oxid-gelatine technique provides high quality angiograms for the study of cutaneous artery and perforator falp.Based on our data,the maximum di- mension of the anterolateral thigh perforator flap can be 30 cm?20 cm in with only a single dominant perfora- tor.The perforator flaps deviced by perforators from the anterolateral thigh are transplanted to the lower limbs and the other part of the body.