骨膜分支和隔皮穿支对游离腓骨皮瓣结果的影响

使用游离腓骨皮瓣 (FFF) 进行颌骨重建的虚拟手术计划 (VSP) 已成为常规程序，需要计算机断层扫描血管造影 (CTA) 对下肢血管系统和骨骼进行术前评估。 该研究的目的是评估腓骨动脉的骨膜分支 (PB) 和皮肤隔穿支 (SCP) 的分布和密度是否对皮瓣成功有影响。

这项回顾性临床研究评估了 72 名接受 FFF 手术的患者的膝下血管系统和小血管系统的术前 CTA。 皮瓣转移的手术结果包括伤口愈合、小计和总皮瓣丢失与节段性血管供应相匹配。

共有 72 名患者（28 名女性，38.9%；44 名男性，61.1%）符合研究纳入标准。 平均年龄为 58.5 岁（± 15.3 岁）。 下肢血管狭窄 (n = 14) 主要在腓动脉 (n = 11) 中检测到。 皮瓣成功记录在 n = 59 (82.0%) 中，皮瓣部分失败在 n = 4 (5.5%) 中，皮瓣完全丢失在 n = 9 (12.5%) 中。 该研究发现供体现场 FA 的平均数 (± SD) 为 2.53 ± 1.60 PB 和 1.39 ± 1.03 SCP。 多节段颌骨重建的近端 FFF 段显示每个皮瓣段的 PB 率高于远端段。 基于准备节段的总数 (n = 121)、46.7% (n = 7) 的单段、40.4% (n = 21) 的双段和 31.5% (n = 17) 的三段腓骨皮瓣 至少由成功组中的一个 PB 提供。 总体而言，这相当于所有成功的 FFF 的 37.2%（121 个中的 45 个）。 对于总皮瓣损失 (n = 14)，记录了不同供应段的相对数量 42.9% (n = 6)。 供体部位的伤口愈合障碍在统计学上不受 SCP 检出率的显著影响。

一般来说，较高的 PB 和 SCP 发生率与皮瓣成功率之间的相关性无法通过研究样本进行统计证明。 得出结论，基于常规 CTA 成像的术前 PB 和 SCP 映射不适合预测皮瓣结果。

骨膜分支和隔皮穿支对游离腓骨皮瓣结果的影响

本研究的工作流程。 总共 n = 72 计算机断层扫描血管造影 (CTA) DICOM 数据集的虚拟计划下颌重建与游离腓骨皮瓣被纳入调查。 腘动脉下血管分支模式、狭窄、骨膜分支和腓动脉隔皮穿支的分布和密度的发现与皮瓣手术结果相匹配。

骨膜分支和隔皮穿支对游离腓骨皮瓣结果的影响

56 岁男性，口腔鳞状细胞癌 (T4) 在 38 区浸润性生长（图 5 中的 ID 18）。 (A) OPT 中骨质破坏的扩展和 (B) 电影体积渲染 CT 重建。

骨膜分支和隔皮穿支对游离腓骨皮瓣结果的影响

(A) 最终成型的双节段复合腓骨瓣和 (B) 新下颌骨。 追加三角游离植骨，平滑新下颌骨轮廓。 最后，在这种情况下发生了完全的皮瓣丢失。 手术修复显示合并有动脉和静脉血栓形成。

骨膜分支和隔皮穿支对游离腓骨皮瓣结果的影响

(A) 供体部位的 CTA 扫描（轴向平面）。 黄线将发现的 PB 和 SCP 与虚拟手术计划联系起来。 (B) 游离腓骨瓣双节段下颌骨重建的最终虚拟手术计划。 (C) 黄线将相应的容器与操作区域连接起来。 (D) 应用切割指南，进行截骨术，并塑造新髁。 案例是图 5 中的 ID 18。在 CTA 评估中，记录了 5 PB 和一个 FA 在捐助地点的 SCP。 每个腓骨皮瓣段由一个 PB 提供，而三个位于设计皮瓣的近端。 基于 CTA 的 SCP 位置位于近端腓骨皮瓣段皮肤桨叶的中间。 FA 的放射学检查没有病理学发现（I-B 型：膝下分支模式，这意味着 ATA、PTA 和 FA 中的腘动脉三分叉）。 总体而言，对手术没有放射学保留或限制。 图 3A、C 显示放射学和手术结果之间存在差异。 SCP 的数量至少为 4（绿色箭头）。

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