Application Of CTA In Three-dimensional Reconstruction Of Peroneal Perforator Vessels

Part I: Imaging study of peroneal perforator vesselsObjective Peroneal artery perforator flap is widely used in clinical practice,especially in maxillofacial defect repair.To be familiar with its anatomical characteristics is helpful for the preparation and removal of flap.Therefore,this study focused on the distribution,number,diameter and pedicle length of peroneal perforator branches.To support a new method for the clinical application of the flap.Methods The data of 20 patients who underwent CTA examination in the lower leg in the First Affiliated Hospital of Bengbu Medical College were retrospectively analyzed.Two methods were used for analysis:(1)We can divide fibula into four sections from high to low,and the number,distribution,diameter and pedicle length of perforating arteries in each section were counted.(2)According to the occurrence rule of the wear branch,the wear branch is numbered as: 1,2,3...,n-2,n-1,N,each perforator branch’s diameter,vessel pedicle’s length,perforator branch’s position,etc.,were recorded,and the results were statistically analyzed.Results1.There were 3 perforators on 5 sides,4 perforators on 22 sides,5 perforators on 12 sides,and 6 perforators on 1 side in 40 legs,a total of 169 perforators,with an average of 4.23±0.70 branches on each leg.2.From top to bottom,the proportion of the fourth leg segment is 23%,37%,33%,7%;There are more perforating branches in the middle section than on the two sides.3.The occurrence probability of the 3rd,4th and 5th perforator branches of the peroneal artery is frequent,with more larger diameter and longer vessel pedicle.conclusion1.The peroneal artery has 3 to 6 perforators.2.Peroneal artery perforator branch has a high probability of appearing in the middle region of the leg and the perforator branch condition is good.3.The external diameters of the 3rd,4th and 5th perforators of the peroneal artery were larger and the vascular pedicle was longer,which met the transplantation standards of microsurgery.Part II: Clinical application of peroneal perforator flap assisted by 3D-CTAObjective Development of imaging technology provides a condition for visual perforating flap.Through the analysis of the application effect of 3 D-CTA in peroneal artery perforator flap after abdominal oral cancer,a new method for clinical application of the flap is provided..Methods Select 14 cases of oral cancer patients admitted to the Department of Stomatology of the first affiliated Hospital of Bengbu Medical College,select the time from December 2018 to February 2021.According to the results of three-dimensional CTA examination,the peroneal artery perforating branch was measured and the qualified perforating vessels were selected.According to the preoperative data,the peroneal artery perforating flap was used to repair the defect area after operation.Postoperative reexamination was performed on time to observe the recovery of oral skin flap and the functions of speech and mastication,so as to evaluate the application effect of peroneal perforator skin flap.Results1.14 patients underwent perforator branch localization successfully and the operation was successfully completed.13 patients survived the flap and 1 patient was necrotic and exfoliated.2.The range of skin flaps was 3.5cm × 3.0cm ~ 5.5cm × 6.0cm,the average preparation time is 49 min,and the average length of vessel pedicle is 6.9cm.3.Three months after surgery,the patient’s mouth opening,chewing,speech and other functions are poor;From 6 to 12 months after operation,mouth opening,speech and mastication were improved to some extent.1 year postoperatively,all patients with open mouth achieves Ⅱ degrees and above,moderate and severe mouth constrained problem,13 patients speech,chew close to normal,1 case of skin flap,chewing the words is still poor,bad basic normal lower limb,all patients can walk independently.Conclusion1.3D-CTA can accurately provide the anatomical characteristics of the peroneal artery perforator,and provide good imaging support for the preparation of the peroneal artery perforator flap.2.The peroneal artery perforator flap can be used to repair the tissue defect after oral cancer operation.