术前虚拟设计在股前外侧皮瓣修复口腔颌面部缺损中的应用

目的:探讨术前数字化技术虚拟设计股前外侧皮瓣应用于口腔颌面部缺损修复重建中的可行性及精确性。方法:选择2019年6月至10月就诊于北京大学口腔医院口腔颌面外科的10例采用股前外侧皮瓣修复口腔颌面部缺损的患者。术前应用高频彩色多普勒超声对患者股前外侧皮瓣穿支进行定位,明确穿支位置;利用螺旋CT对患者下肢进行扫描,获取DICOM格式的CT数据,将之导入Proplan CMF 3.0软件,进行股前外侧皮瓣虚拟设计,并计算皮瓣体积;术中按照术前设计进行股前外侧皮瓣制备,并利用排水法对皮瓣实际体积进行测量,计算术前高频彩色多普勒超声定位的股前外侧皮瓣穿支位置与术中穿支实际穿出位置的符合率。应用配对样本t检验统计分析术前虚拟设计的股前外侧皮瓣体积与术中排水法所测得的皮瓣实际体积之间的差异。结果:术前利用彩色多普勒超声共发现皮瓣内穿支15支,术中实际发现穿支16支,总体符合率为87.5%。术前虚拟设计的股前外侧皮瓣体积与术中排水法所测得的皮瓣实际体积之间的差异无统计学意义(t=0.318,P=0.758)。结论:采用数字化技术对股前外侧皮瓣进行术前虚拟设计的方法具有良好的可行性和精确性,可用于指导术中制备股前外侧皮瓣。

Application of computer-assisted design for anterolateral thigh flap in oral and maxillofacial reconstruction

Objective: To investigate the feasibility and accuracy of using digital technology to design anterolateral thigh flap (ALTF) in oral and maxillofacial defect reconstruction. Methods: Ten cases underwent oral and maxillofacial defects reconstruction with ALTFs in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2019 to Oct. 2019 were enrolled. There were 7 males and 3 females with the mean age of 47.1 years. Preoperative high frequency color Doppler ultrasound examination was performed to detect the perforators of ALTF. CT data of the thigh was imported in DICOM (digital imaging and communications in medicine) format to the Proplan CMF 3.0 software (Materalise, Belgium), then virtual harvest of ALTF was performed according to the points of perforators detected by high frequency color Doppler ultrasound and the virtual flap volume was calculated by Proplan CMF 3.0 software. ALTF was harvested followed by preoperative virtual design, and the actual flap volume of ALTF was measured by the draining method during the surgery. Finally, the accuracy rate of using high frequency color Doppler ultrasound to detect perforators of ALTFs was calculated, and the differences between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume of ALTF by the draining method were compared using paired samples T test. Results: Fifteen perforators in the flaps area of 10 patients who underwent oral and maxillofacial defects reconstruction with ALTFs were detected by high frequency color Doppler ultrasound, and 16 perforators were identified during the surgery, with the accuracy rate of 87.5%. The flaps size ranged from 5 cm×7 cm to 8 cm×15 cm, all the 10 flaps survived. The donor sites were primarily closed without skin graft, and no surgery complication was found on the donor site. The mean flap volume measured by Propaln CMF 3.0 software was 71.4 cm ³ (range: 36.1-188.4 cm ³), and the mean volume measured by the draining method was 70.7 cm ³ (range: 38.3-172.5 cm ³). There was no significant difference between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume measured by draining method (t=0.318; P=0.758). Conclusion: Preoperative virtual design of ALTF has good feasibility and accuracy and can be used to guide the harvest of ALTF during operation.