Objective To evaluate the feasibil ity and cl inical significance of the computed tomography angiography (CTA) for the latissimus dorsi muscle (LDM) flap transplantation. Methods From September 2007 to August 2008, 3 cases of soft tissue defects in l imbs were treated with LDM flap transplantation. Three patients included 2 males and 1 female whowere 23 to 42 years old. All of soft tissue defects were caused by trauma. The locations were the forearm in 2 cases and the leg in 1 case. The area of defect was 17 cm × 8 cm-20 cm × 10 cm. All cases received CTA to observe the distribution and anastomosis of thoracodorsal artery. Subsequently, three-dimensional computer reconstruction were carried out to display the stereoscopic structure of the LDM flap and to design the LDM flap before operation. Results The anatomy characteristic of LDM flap can be displayed accurately by the three-dimensional reconstruction model. The distribution of thoracodorsal artery in 3 cases of flaps was in concordance with preoperative design completely. All the flaps were excised successfully, the area of the flap was 19 cm × 10 cm-22 cm × 12 cm. All the transferred flaps survived completely. All cases were followed up from 4 months to 12 months. The color and texture of the flaps were good. Conclusion The three-dimensional reconstructive images can provide visible, stereoscopic and dynamic anatomy for cl inical appl ication of LDM flap. The digitized three-dimensional reconstructive models of LDM flap structures can be appl ied in cl inical training and pre-operative design.
ObjectiveTo investigate the efficacy of anterolateral thigh (myocutaneous) flap designed with computed tomography angiography (CTA) to reconstruct oral and maxillofacial soft tissue defects.MethodsBetween January 2011 and December 2015, 23 cases of oral and maxillofacial tumors were treated. There were 14 males and 9 females with the age range from 45 to 72 years (mean, 56.8 years). There were 12 cases of tongue carcinoma, 5 cases of buccal mucosa carcinoma, 4 cases of mouth floor carcinoma, and 2 cases of oropharynx carcinoma; all were squamous cell carcinoma. According to standard TNM staging of the Union for International Cancer Control (UICC), 8 cases were rated as T2N0M0, 3 cases as T2N1M0, 1 case as T2N2M0, 4 cases as T3N0M0, 2 cases as T3N1M0, 2 cases as T3N2M0, 2 cases as T4N1M0, and 1 case as T4N2M0. The course of disease was 1-6 months (mean, 2.4 months). CTA was performed before operation to locate the perforator vessel and its surface projection of emerging point and to design anterolateral thigh (myocutaneous) flap by computer. The defects of soft tissue ranged from 6 cm×4 cm to 11 cm×7 cm after resection of tumor. The flap was used to repair defects, including 14 thinned anterolateral thigh flaps, 7 anterolateral thigh myocutaneous flaps, and 2 anterolateral bilobed flaps; and the flap area ranged from 7 cm× 5 cm to 12 cm×8 cm. The donor sites were sutured directly.ResultsCTA showed that myocutaneous perforators penetrated at the fascias of the vastus lateralis muscles in 22 cases with a location rate of 95.7% (22/23). Submandibular fistula occurred in 1 case at 5 days after operation and fistula healed after changed dressings. Other wounds at recipient site and donor site healed at primary stage. Anastomose with 2 vein was performed because of poor venous return in 1 case, and the flap survived. The other flaps survived well. All the patients were followed up 6-36 months (mean, 16.4 months). At 3 months after operation, the simplified recovery standard of speech function and swallow function was established according to the University of Washington Quality of Life Scale (UW-QOL). The speech and swallow function recovered satisfactorily in 22 cases, and not very satisfactorily in 1 case of well differentiated squamous cell carcinoma of the right mouth floor (T 4N1M0). No obvious tissue atrophy was observed in 23 cases. No dysfunction was found at the donor site. There was no tumor recurrence in 21 patients; 1 patient accepted the second operation due to lymphonodi metastasis of contralateral neck at 6 months after first operation, who died after 23 months; 1 patient died of distant metastasis at 10 months after first operation.ConclusionThe anterolateral thigh (myocutaneous) flap designed with CTA could well recover the morphology and function of the recipient site.
ObjectiveTo explore the application value of thin CT angiography (CTA) of pedicle sagittal plane of axis for preoperative evaluation planning pedicle screw placement.MethodsBetween February 2016 and August 2017, 34 patients (68 pedicles) who underwent thin CTA scan before posterior axial surgery were retrospectively analyzed. The vertebral artery development was statistically analyzed. The continuous layers of transverse process hole pedicle height more than or equal to 4 mm (f) were measured and read. The axial fixation methods, clinical manifestations of vertebral artery and spinal cord injury and the bone union of fractures or implants were recorded. Postoperative results of pedicle screws were evaluated by CT scan.ResultsThe right sides of 8 cases and the left sides of 18 cases were dominant vertebral arteries, and equilibrium was reached in 8 cases; f>9 layers were found in 16 pedicles,f=9 layers in 27 pedicles, f=8 layers in 17 pedicles, and f<8 layers in 8 pedicles. The 43 pedicles off≥9 layers used pedicle screw fixation; in the 17 pedicles of f=8 layers, 16 used pedicle screw fixation, and the other one used laminar screw fixation; in the 8 pedicles of f<8 layers, 4 used pedicle screw fixation, and the other 4 used laminar screw fixation. A self-defined pedicle screw grading system was used to evaluate the excellence, and the result showed that,f>9 layers: 14 pedicles were class A, 2 were class B, none was class C;f=9 layers: 16 pedicles were class A, 7 were class B, 4 were class C; f=8 layers: 3 pedicles were class A, 5 were class B, 8 were class C; f<8 layers: none was pedicles class A or class B, 4 were class C. The other 4 lamina screws fixation didn’'t invade the spinal canal. One case of pedicle class C showed clinical manifestations of mild dizziness and drowsiness. The patients were followed up for 6-11 months with an average of (8±3) months, and the fracture or bone graft fusion were observed after 6 months of following-up.ConclusionBased on preoperative CTA thin layer scanning, through measuring and reading continuous layers of transverse process hole pedicle height more than or equal to 4 mm, can effectively judge the security of axial pedicle screws in order to subsequently choose the reasonable operation methods so as to improve success rate and decrease surgical risk.