THREE-DIMENSIONAL VISUALIZATION RECONSTRUCTION OF MEDIAL SURAL ARTERY PERFORATOR FLAP based on Digital technology_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QINGLiming , HUYihe ,  TANGJuyu , WUPanfeng , YUFang , LIANGJieyu

Department of Orthopedics, Xiangya Hospital of Central South University, Changsha Hunan, 410008, P. R. China;

Corresponding?author：

TANGJuyu, Email: juyutang163@163.com

Keywords：

Medial sural artery perforator flap; Digital technology; Three-dimensional visualization reconstruction; CT angiography

DOI：

10.7507/1002-1892.20140154

Video：

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Objective To explore the feasibility of three-dimensional (3-D) visualization reconstruction of the medial sural artery perforator flap based on digital technology. Methods A series of Dicom images were obtained from three healthy adult volunteers by dual source CT angiography. Then the Mimics software was used to construct the medial sural artery model and measure the indexes, including the starting position of medial sural artery, external diameters of vascular pedicle, the number of perforators, location perforated deep fascia, and the maximum pedicle length of perforators based on medial sural artery perforator flap. Results The 3-D visualization reconstruction models were successfully finished with Mimics software, which can clearly display the distribution, travel, and perforating point. Thirteen perforators were found in 6 legs, which started at the popliteal artery with a mean external diameter of 2.3 mm (range, 1.9-2.7 mm). Each specimen had 1-3 perforators, which located at the site of 6.2-15.0 cm distal to popliteal crease and 2.5-4.2 cm from posterior midline. The maximum pedicle length of medial sural artery perforator flap was 10.2-13.8 cm (mean, 11.8 cm). Conclusion The 3-D visualization reconstruction models based on digital technology can provide dynamic visualization of the anatomy of the medial sural artery for individualized design of the medial sural artery perforator flap.

Citation： QINGLiming, HUYihe, TANGJuyu, WUPanfeng, YUFang, LIANGJieyu. THREE-DIMENSIONAL VISUALIZATION RECONSTRUCTION OF MEDIAL SURAL ARTERY PERFORATOR FLAP based on Digital technology. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(6): 697-700. doi: 10.7507/1002-1892.20140154 Copy

1.	Cavadas PC, Sanz-Giménez-Rico J, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
2.	Hallock GG. Evidence-based medicine:lower extremity acute trauma. Plast Reconstr Surg, 2013, 132(6):1733-1741.
3.	Hallock GG. Anatomic basis of the gastrocnemius perforator based flap. Ann Plast Surg, 2001, 47(5):517-522.
4.	Thione A, Valdatta L, Buoro M, et al. The medial sural artery perforator anatomic basis for a surgical plan. Ann Plast Surg, 2004, 53(3):250-255.
5.	Kao HK, Chang KP, Chen YA, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2010, 125(4):1135-1145.
6.	唐茂林, 徐象黨, 戴開宇, 等. 小腿后部穿支的3D可視化研究與皮瓣設計. 解剖與臨床, 2009, 14(1):7-11.
7.	張元智, 陸聲, 溫樹正, 等. 數字化技術在隱動脈皮瓣血供的可視化及其臨床初步應用. 中華創傷骨科雜志, 2013, 15(1):32-35.
8.	唐舉玉. 特殊形式穿支皮瓣的臨床應用教程. 中華顯微外科雜志, 2013, 36(2):202-206.
9.	徐達傳, 張世民, 唐茂林, 等. 穿支皮瓣的發展與現狀. 中國修復重建外科雜志, 2011, 25(9):1025-1029.
10.	Zeltzer AA, Van Landuyt K. Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap. J Plast Reconstr Aesthet Surg, 2012, 65(2):e42-45.
11.	Tang J, Fang T, Song D, et al. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery, 2013.[Epub ahead of print].
12.	Shafighi M, Constantinescu MA, Huemer GM, et al. The extended diep flap:Extending the possibilities for breast reconstruction with tissue from the lower abdomen. Microsurgery, 2013, 33(1):24-31.
13.	Kim CK, Kim YH. Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps. Plast Reconstr Surg, 2012, 130(1):135-144.
14.	Winterton RI, Pinder RM, Morritt AN, et al. Long term study into surgical re-exploration of the ‘free flap in difficulty’. J Plast Reconstr Aesthet Surg, 2010, 63(7):1080-1086.
15.	Higueras Su?é MC, López Ojeda A, Narváez Garía JA, et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities. J Plast Reconstr Aesthet Surg, 2011, 64(9):1207-1213.
16.	Masia J, Larra?aga J, Clavero JA, et al. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap:our experience in 162 cases. Ann Plast Surg, 2008, 60(1):29-36.
17.	何永靜, 王繼華, 楊云, 等. CT血管造影在背闊肌皮瓣游離移植修復頭皮撕脫傷創面中的應用. 中國修復重建外科雜志, 2013, 27(3):299-303.
18.	陳世新, 吳東方, 丁茂超, 等. 穿支體區血管及其相互間吻合的3D可視化研究. 中國臨床解剖學雜志, 2011, 29(3):237-242.
19.	Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory:vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5):1529-1544.
20.	Tayor GI, Chubb DP, Ashton MW. True and "choke" anastomoes between perforator angiosomes:Part I. anatomical location. Plast Reconstr Surg, 2013, 132(5):1447-1456.
21.	Chubb DP, Tayor GI, Ashton MW. True and "choke" anastomoes between perforator angiosomes:Part Ⅱ. dynamic thermographic identification. Plast Reconstr Surg, 2013, 132(6):1457-1464.
22.	Scott JR, Liu D, Said H, et al. Computed tomographic angiography in planning abdomen-based microsurgical breast reconstruction:a comparison with color duplex ultrasound. Plast Reconstr Surg, 2010, 125(2):446-453.
23.	黎健偉, 任義軍, 任高宏, 等. 三維重建技術在腓腸肌皮瓣臨床手術中的應用. 南方醫科大學學報, 2009, 29(4):747-750.
24.	任義軍, 任高宏, 金丹, 等. 數字化股前外側皮瓣的可視技術在臨床中的初步應用. 中華創傷骨科雜志, 2008, 10(5):432-435.
25.	Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3):125-129.

1. Cavadas PC, Sanz-Giménez-Rico J, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
2. Hallock GG. Evidence-based medicine:lower extremity acute trauma. Plast Reconstr Surg, 2013, 132(6):1733-1741.
3. Hallock GG. Anatomic basis of the gastrocnemius perforator based flap. Ann Plast Surg, 2001, 47(5):517-522.
4. Thione A, Valdatta L, Buoro M, et al. The medial sural artery perforator anatomic basis for a surgical plan. Ann Plast Surg, 2004, 53(3):250-255.
5. Kao HK, Chang KP, Chen YA, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction. Plast Reconstr Surg, 2010, 125(4):1135-1145.
6. 唐茂林, 徐象黨, 戴開宇, 等. 小腿后部穿支的3D可視化研究與皮瓣設計. 解剖與臨床, 2009, 14(1):7-11.
7. 張元智, 陸聲, 溫樹正, 等. 數字化技術在隱動脈皮瓣血供的可視化及其臨床初步應用. 中華創傷骨科雜志, 2013, 15(1):32-35.
8. 唐舉玉. 特殊形式穿支皮瓣的臨床應用教程. 中華顯微外科雜志, 2013, 36(2):202-206.
9. 徐達傳, 張世民, 唐茂林, 等. 穿支皮瓣的發展與現狀. 中國修復重建外科雜志, 2011, 25(9):1025-1029.
10. Zeltzer AA, Van Landuyt K. Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap. J Plast Reconstr Aesthet Surg, 2012, 65(2):e42-45.
11. Tang J, Fang T, Song D, et al. Free deep inferior epigastric artery perforator flap for reconstruction of soft-tissue defects in extremities of children. Microsurgery, 2013.[Epub ahead of print].
12. Shafighi M, Constantinescu MA, Huemer GM, et al. The extended diep flap:Extending the possibilities for breast reconstruction with tissue from the lower abdomen. Microsurgery, 2013, 33(1):24-31.
13. Kim CK, Kim YH. Supermicrosurgical reconstruction of large defects on ischemic extremities using supercharging techniques on latissimus dorsi perforator flaps. Plast Reconstr Surg, 2012, 130(1):135-144.
14. Winterton RI, Pinder RM, Morritt AN, et al. Long term study into surgical re-exploration of the ‘free flap in difficulty’. J Plast Reconstr Aesthet Surg, 2010, 63(7):1080-1086.
15. Higueras Su?é MC, López Ojeda A, Narváez Garía JA, et al. Use of angioscanning in the surgical planning of perforator flaps in the lower extremities. J Plast Reconstr Aesthet Surg, 2011, 64(9):1207-1213.
16. Masia J, Larra?aga J, Clavero JA, et al. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap:our experience in 162 cases. Ann Plast Surg, 2008, 60(1):29-36.
17. 何永靜, 王繼華, 楊云, 等. CT血管造影在背闊肌皮瓣游離移植修復頭皮撕脫傷創面中的應用. 中國修復重建外科雜志, 2013, 27(3):299-303.
18. 陳世新, 吳東方, 丁茂超, 等. 穿支體區血管及其相互間吻合的3D可視化研究. 中國臨床解剖學雜志, 2011, 29(3):237-242.
19. Saint-Cyr M, Wong C, Schaverien M, et al. The perforasome theory:vascular anatomy and clinical implications. Plast Reconstr Surg, 2009, 124(5):1529-1544.
20. Tayor GI, Chubb DP, Ashton MW. True and "choke" anastomoes between perforator angiosomes:Part I. anatomical location. Plast Reconstr Surg, 2013, 132(5):1447-1456.
21. Chubb DP, Tayor GI, Ashton MW. True and "choke" anastomoes between perforator angiosomes:Part Ⅱ. dynamic thermographic identification. Plast Reconstr Surg, 2013, 132(6):1457-1464.
22. Scott JR, Liu D, Said H, et al. Computed tomographic angiography in planning abdomen-based microsurgical breast reconstruction:a comparison with color duplex ultrasound. Plast Reconstr Surg, 2010, 125(2):446-453.
23. 黎健偉, 任義軍, 任高宏, 等. 三維重建技術在腓腸肌皮瓣臨床手術中的應用. 南方醫科大學學報, 2009, 29(4):747-750.
24. 任義軍, 任高宏, 金丹, 等. 數字化股前外側皮瓣的可視技術在臨床中的初步應用. 中華創傷骨科雜志, 2008, 10(5):432-435.
25. Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3):125-129.

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THREE-DIMENSIONAL VISUALIZATION RECONSTRUCTION OF MEDIAL SURAL ARTERY PERFORATOR FLAP based on Digital technology

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