Background It is challenging to repair wide or irregular defects with traditional skin flaps, and anterolateral thigh (ALT) lobulated perforator flaps are an ideal choice for such defects. However, there are many variations in perforators, so good preoperative planning is very important. This study attempted to explore the feasibility and clinical effect of digital technology in the use of ALT lobulated perforator flaps for repairing complex soft tissue defects in limbs. Methods Computed tomography angiography (CTA) was performed on 28 patients with complex soft tissue defects of the limbs, and the CTA data were imported into Mimics 20.0 software in DICOM format. According to the perforation condition of the lateral circumflex femoral artery and the size of the limb defect, one thigh that had two or more perforators from the same source vessel was selected for 3D reconstruction of the ALT lobulated perforator flap model. Mimics 20.0 software was used to visualize the vascular anatomy, virtual design and harvest of the flap before surgery. The intraoperative design and excision of the ALT lobulated perforator flap were guided by the preoperative digital design, and the actual anatomical observations and measurements were recorded. Results Digital reconstruction was successfully performed in all patients before surgery; this reconstruction dynamically displayed the anatomical structure of the flap vasculature and accurately guided the design and harvest of the flap during surgery. The parameters of the harvested flaps were consistent with the preoperative parameters. Postoperative complications occurred in 7 patients, but all flaps survived uneventfully. All of the donor sites were closed directly. All patients were followed up for 13–27 months (mean, 19.75 months). The color and texture of each flap were satisfactory and each donor site exhibited a linear scar. Conclusions Digital technology can effectively and precisely assist in the design and harvest of ALT lobulated perforator flaps, provide an effective approach for individualized evaluation and flap design and reduce the risk and difficulty of surgery.

中文翻译：

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数字化技术在股前外侧分叶穿支皮瓣修复四肢复杂软组织缺损中的临床应用

背景 使用传统皮瓣修复宽大或不规则的缺损具有挑战性，而大腿前外侧（ALT）分叶穿支皮瓣是此类缺损的理想选择。然而，穿支有很多变化，因此良好的术前计划非常重要。本研究试图探讨数字技术应用ALT分叶穿支皮瓣修复四肢复杂软组织缺损的可行性和临床效果。方法对28例四肢复杂软组织缺损患者进行计算机断层扫描血管造影（CTA），并将CTA数据以DICOM格式导入Mimics 20.0软件中。根据旋股外侧动脉穿孔情况及肢体缺损大小，选择1条具有2个及以上同源血管穿支的大腿进行ALT分叶穿支皮瓣模型3D重建。 Mimics 20.0软件用于术前可视化血管解剖、虚拟设计和皮瓣采集。 ALT分叶穿支皮瓣的术中设计和切除以术前数字设计为指导，并记录实际的解剖观察和测量。结果所有患者术前数字重建均成功；这种重建动态地显示了皮瓣脉管系统的解剖结构，并在手术过程中准确指导皮瓣的设计和收获。收获的皮瓣参数与术前参数一致。 7例患者出现术后并发症，但全部皮瓣均顺利成活。所有的捐献点都直接关闭了。所有患者均获得随访，随访时间13～27个月，平均19.75个月。每个皮瓣的颜色和质地都令人满意，并且每个供体部位都显示出线性疤痕。结论数字化技术可以有效、精准地辅助ALT分叶穿支皮瓣的设计和获取，为个体化评估和皮瓣设计提供有效途径，降低手术风险和难度。