The Clinical Application Of 3D-CTA In The Repair Of Mandibular Defects With Deep Circumflex Iliac Arterial Tissue Flap

Objective To study the clinical effect of three-dimensional CT angiography in the Deep circumflex iliac artery(DCIA)tissue flap for repairing mandibular defects.Method 5 patients who needed bone graft repair after mandibular surgery were selected,from January 2019 to January 2020.Three-dimensional CT angiography of jaw and both lower extremities were performed preoperatively,Mimics19.0 system software was used for data processing.According to the size and shape of the defect in the operative area,a three-dimensional model of DCIA tissue flap was constructed.The shape of DCIA,the diameter of the starting point,the Angle between the line from the starting point to the anterior superior iliac spine(ASIS)and the line from the bilateral ASIS,and the distance from the starting point to ASIS were observed and measured.According to the three-dimensional model of DCIA tissue flap,the composite tissue flap pedicled with DCIA was designed and prepared,and the mandibular defect was repaired.At the same time,the actual situation during the operation was compared with the three-dimensional model of DCIA tissue flap before operation.After 3,6,12 months of follow-up,the graft was observed to see if the graft was successful,1/3 of the patients’ subfacial appearance,occlusal function,mandibular alveolar ridge height,width recovery and donor area numbness,whether affect the shape,weight-bearing and other complications.Result The average diameter of the starting point of DCIA in 5 cases was(2.3 ±0.24)mm.The angle between the starting point of the DCIA and the bilateral ASIS connection is 39.3.The distance from the starting point to ASIS was(5.83 ±0.24)cm.During the operation,the shape and position of DCIA were basically consistent with the three-dimensional model.During the follow-up of 3,6,12 months,all the flaps were successfully transplanted,and the bilateral maxillofacial regions of the patients were basically symmetrical.Follow-up examination showed that the transplanted iliac bone flap healed well,the mandibular dental ridge height,the width is satisfactory,and there were no complications such as numbness,abdominal hernia and abnormal gait in iliac and abdominal region.Conclusion The three-dimensional model of DCIA tissue flap made by three-dimensional CT angiography can accurately locate the position and shape of DCIA,and can clearly display the three-dimensional spatial structure among skin,muscle and bone around DCIA;Intraoperative application can obviously shorten the ischemia time of skin flap,improve the accuracy,shorten the preparation process of skin flap to the utmost extent and achieve the best reconstruction effect;It is also time-consuming and laborious to reconstruct DCIA tissue flap based on mimics software.