[Application effects of enhanced computed tomography and three-dimensional reconstruction technology in reconstruction of pediatric post-burn scars with expanded flaps].

• L Liu
• Y N Wang
• J Yu
• H Y Qi

抄録

To explore the application effects of enhanced computed tomography (CT) and three-dimensional reconstruction technology in the reconstruction of pediatric post-burn scars with expanded flaps. From May 2016 to March 2019, 19 children with hypertrophic scars after thermal injuries were admitted to our unit, including 10 boys and 9 girls, aged from 4 years and 5 months to 15 years and 11 months. The area of scars ranged from 5 cm×4 cm to 23 cm×9 cm. One or more skin and soft tissue expanders with suitable volume and shape were implanted into the normal skin area around scar of children. Three to six months later, enhanced CT and three-dimensional reconstruction were performed before the second stage operation to obtain three-dimensional images of the vascular branches in the donor site for expanded flaps to be cut, so as to determine the course and distribution of the vascular branches and guide the design of expanded flaps. According to the design scheme, the resection of scar, removal of expanders, and excision and transfer of flaps were performed to repair the wounds after scar resection. The area of flaps ranged from 6 cm×4 cm to 25 cm×10 cm. The donor site was closed directly. The number of flaps was counted. The anatomical structure, vascular distribution, and adverse reactions during enhanced CT and three-dimensional reconstruction of site for expanded flaps to be cut, the survival of expanded flaps and the follow-up after the second-stage operation were observed. A total of 48 expanded flaps were designed and excised in 19 children. The anatomical structure of the site for expanded flaps to be cut and the adjacent spatial position relationship were visually observed through the three-dimensional reconstruction after enhanced CT, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 29 sites for expanded flaps to be cut. All the expanded flaps survived well without blood supply disorder after the second stage operation. The children were followed up for 6 months to 1 year and 6 months after the second stage operation. The appearance of the flaps was natural, and the color and thickness of the flaps were similar to those of the surrounding normal skin, except for one child with obvious linear scar. Enhanced CT and three-dimensional reconstruction can assist the vascular assessment of the expended flaps, which is helpful for rational design of the flap excision and transfer protocol to improve the survival rate of flaps. Thus, it has certain clinical application value in the reconstruction of post-burn scar in children with expanded flaps.

探讨增强CT及三维重建技术在扩张皮瓣整复小儿烧伤后瘢痕中的应用效果。 2016年5月—2019年3月，笔者单位收治热力损伤后瘢痕增生患儿19例，其中男10例、女9例，年龄4岁5个月～15岁11个月，瘢痕面积为5 cm×4 cm～23 cm×9 cm。于患儿瘢痕周围正常皮肤区域置入1个或多个合适容量和形状的皮肤软组织扩张器，3～6个月后在Ⅱ期手术前行增强CT及三维重建，获得供区拟切取扩张皮瓣区域血管分支的三维图像，明确血管分支走行和分布，指导扩张皮瓣设计。依据设计方案，进行瘢痕切除、扩张器取出、扩张皮瓣切取转移修复瘢痕切除后创面，皮瓣面积6 cm×4 cm～25 cm×10 cm。供区拉拢缝合。统计皮瓣个数；观察拟切取扩张皮瓣区域增强CT及三维重建中解剖结构、血管分布及不良反应情况，Ⅱ期术后扩张皮瓣成活情况及随访情况。 本组19例患儿共设计切取48个扩张皮瓣，增强CT后三维重建中均能直观观察到拟切取扩张皮瓣区域解剖结构和毗邻空间位置关系，均未见不良反应，其中29个拟切取扩张皮瓣区域可见动脉分支供血或静脉回流。Ⅱ期术后所有扩张皮瓣存活良好，无血运障碍。Ⅱ期术后随访6个月～1年6个月，除1例患儿遗留明显线性瘢痕外，其余皮瓣外观自然，颜色、厚度与周围正常皮肤相近。 增强CT及三维重建技术可对扩张皮瓣进行血管评估，有助于合理设计皮瓣切取转移方案，提高皮瓣成活率，在扩张皮瓣整复小儿烧伤后瘢痕治疗中具有一定的应用价值。.