Abstract：
The aim of this study was to introduce and report on a 3D-printed perforator navigator and its clinical application. Integrated imaging and 3D printing techniques were employed for the design and manufacture of a perforator navigator. Key techniques included establishing a digital image coordinate system, localizing perforator fascia piercing points, creating a reference plane for the perforator course, and projecting the perforator course onto the body surface. All cases of maxillofacial defect repaired with free fibular myocutaneous flaps, from January 2019 to January 2022, were reinvestigated. Patients treated using traditional perforator localization methods were assigned into group Ⅰ, while those who had a navigator used during treatment were allocated to group Ⅱ. Outcome measurements included perforator positioning accuracy, perforator preparation time (PT), and flap growth score. Capillary refilling time and degree of flap swelling were recorded on the 1st, 3rd, and 7th days after surgery. On the 10th day after surgery, the flap survival situation was graded. In total, 25 patients were included in the study. Perforator preparation time for group Ⅱ was significantly less (p ＝ 0.04) than for group Ⅰ (1038.6 ± 195.4 s versus 1271.4 ± 295.1 s. In group Ⅱ, the mean positioning deviation for the perforator navigator was 2.12 cm less than that for the high-frequency color Doppler (p ＝ 0.001). Group Ⅱ also had a higher score than group Ⅰ for overall flap growth evaluation (nonparametric rank sum test, p ＝ 0.04). Within the scale of the study, it seems that perforator localization and navigation using a 3D-printed navigator is technically feasible, and helps to improve the clinical outcome of free fibular flaps. The perforator navigator will play a useful role in displaying the perforator course, improving the accuracy of perforator localization, reducing surgical injury, and ultimately enhancing flap success rate.
摘要：
这项研究的目的是介绍和报告3D打印穿孔器及其临床应用。集成成像和3D打印技术用于穿孔器导航仪的设计和制造。关键技术包括建立数字图像坐标系,定位穿支筋膜穿刺点,为射孔道创建参考平面，并将穿孔器路线投影到身体表面。所有病例均采用游离腓骨肌皮瓣修复颌面部缺损,从2019年1月到2022年1月，进行了重新调查。采用传统穿孔器定位方法治疗的患者分为Ⅰ组,而在治疗期间使用导航仪的患者被分配到Ⅱ组。结果测量包括射孔器定位精度，射孔器准备时间(PT),和皮瓣生长得分。1日记录毛细血管再充盈时间和皮瓣肿胀程度，3rd,手术后第7天.手术后的第10天,皮瓣存活情况分级。总的来说,25名患者被纳入研究。Ⅱ组穿孔器准备时间(p＝0.04)明显少于Ⅰ组(1038.6±195.4svs.1271.4±295.1s)。射孔器的平均定位偏差比高频彩色多普勒小2.12cm(p＝0.001)。Ⅱ组的皮瓣总体生长评估得分也高于Ⅰ组（非参数秩和检验，p＝0.04)。在研究范围内,似乎使用3D打印的导航仪进行穿孔器定位和导航在技术上是可行的，并有助于改善腓骨游离皮瓣的临床效果。穿孔器导航仪将在显示穿孔器路线方面发挥有益作用，提高射孔器定位的准确性，减少手术损伤，最终提高皮瓣成功率。
