ObjectiveTo study the effectiveness of digital technique in repairing of heel wound with peroneal artery perforator propeller flap.MethodsBetween March 2016 and March 2019, the heel wounds of 31 patients were repaired with the peroneal artery perforator propeller flaps. There were 21 males and 10 females, with an average age of 36 years (range, 12-53 years). Seventeen patients were admitted to hospital in emergency after trauma, the time from injury to admission was 6.0-12.5 hours, with an average of 8.5 hours; 14 patients were chronic infectious wounds and ulcer. The wound area ranged from 5 cm×4 cm to 12 cm×8 cm. Before flap repair, CT angiography (CTA) data of lower extremity was imported into Mimics19.0 software and three-dimensional reconstruction of peroneal artery perforator and skin model, accurate location of perforator, accurate design of perforator flap, and simulated operation according to the defect range and location were obtained.ResultsThe origin and course of peroneal artery perforator, the position of perforator, the diameter of perforator, and the maximum length of the naked perforator were determined based on the three-dimensional model. There was no significant difference in locating point of perforator, diameter of perforator, maximum length of naked perforator between the pre- and intra-operative measurements (P>0.05). The position of the lower perforator of the peroneal artery were on the posterolateral lateral ankle tip (5-10 cm) in 31 cases. The total incidence of perforating branches within 10 cm on the tip of lateral malleolus was 96.9%, and the length of vascular pedicle was (3.44±0.65) cm. The flap removal and transposition in 31 patients were successfully completed. The average operation time was 45 minutes (range, 30-65 minutes). After operation, vein crisis and partial necrosis occurred in 4 cases and 3 cases, respectively, which were survived after symptomatic treatment. All the grafts survived and the incisions healed by first intention. All the patients were followed up 3-18 months, with an average of 12 months. At last follow-up, according to the American Orthopaedic Foot and Ankle Society (AOFAS) score, 17 cases were excellent, 11 cases were good, and 3 cases were fair, and the excellent and good rate was 87.5%.ConclusionThe digital technique can improve the accuracy of perforator localization and the design of peroneal artery perforator propeller flap, and reduce the difficulty of operation, and the risk caused by the variation of vascular anatomy.
Objective To investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap. Methods Between August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case. Results Superficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM). Conclusion The preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.
ObjectiveTo provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck’s disease) by studying its morphology and blood supply pattern based on digital technique.MethodsTwelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. ResultsThere were significant differences in the longitudinal and transverse diameters between pisiform and lunate (t=6.653, P=0.000; t=6.265, P=0.000), but there was no significant difference in thickness (t= 1.269, P=0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side (P<0.05), but there was no significant difference in the diameter of nutrient foramina between different sides (P>0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch (P<0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch (P>0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch (P>0.05). But the differences between the other vascular pedicles were significant (P<0.05). ConclusionThere are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck’s disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.