UNASSIGNED: To explore the feasibility and effectiveness of mixed reality technology for localizing perforator vessels in the repair of mandibular defects using free fibular flap.
UNASSIGNED: Between June 2020 and June 2023, 12 patients with mandibular defects were repaired with free fibular flap. There were 8 males and 4 females, with an average age of 61 years (range, 35-78 years). There were 9 cases of ameloblastomas and 3 cases of squamous cell carcinomas involving the mandible. The disease duration ranged from 15 days to 2 years (median, 14.2 months). The length of mandibular defects ranged from 5 to 14 cm (mean, 8.5 cm). The area of soft tissue defects ranged from 5 cm×4 cm to 8 cm×6 cm. Preoperative enhanced CT scans of the maxillofacial region and CT angiography of the lower limbs were performed, and the data was used to create three-dimensional models of the mandible and lower limb perforator vessels. During operation, the mixed reality technology was used to overlay the three-dimensional model of perforator vessels onto the body surface for harvesting the free fibular flap. The length of the fibula harvested ranged from 6 to 15 cm, with a mean of 9.5 cm; the size of the flap ranged from 6 cm×5 cm to 10 cm×8 cm. The donor sites were sutured directly in 7 cases and repaired with free skin grafting in 5 cases.
UNASSIGNED: Thirty perforator vessels were located by mixed reality technology before operation, with an average of 2.5 vessels per case; the distance between the exit point of the perforator vessels located before operation and the actual exit point ranged from 1 to 4 mm, with a mean of 2.8 mm. All fibular flaps survived; 1 case had necrosis at the distal end of flap, which healed after dressing changes. One donor site had infection, which healed after anti-inflammatory dressing changes; the remaining incisions healed by first intention, and the grafts survived smoothly. All patients were followed up 8-36 months (median, 21 months). The repaired facial appearance was satisfactory, with no flap swelling. Among the patients underwent postoperative radiotherapy, 2 patients had normal bone healing and 1 had delayed healing at 6 months.
UNASSIGNED: In free fibular flap reconstruction of mandibular defects, the use of mixed reality technology for perforator vessel localization can achieve three-dimensional visualization, simplify surgical procedures, and reduce errors.
UNASSIGNED: 探讨在游离腓骨皮瓣修复下颌骨缺损中，使用混合现实技术定位穿支血管的可行性和效果。.
UNASSIGNED: 2020年6月—2023年6月，采用游离腓骨皮瓣修复12例下颌骨缺损患者。男8例，女4例；年龄35～78岁，平均61岁。下颌骨成釉细胞瘤9例，侵犯下颌骨口腔鳞癌3例。病程15 d～2年，中位病程14.2个月。下颌骨缺损长度5～14 cm，平均8.5 cm；软组织缺损范围为5 cm×4 cm～8 cm×6 cm。术前均行颌面部增强CT和下肢CT血管造影检查，将所得数据制成下颌骨、下肢穿支血管三维模型。术中使用混合现实技术将穿支血管三维模型重叠于患者体表，制取游离腓骨皮瓣修复缺损。腓骨切取长度为6～15 cm，平均9.5 cm；皮瓣切取范围6 cm×5 cm～10 cm×8 cm，供区拉拢缝合（7例）或游离植皮修复（5例）。.
UNASSIGNED: 12例患者术前使用混合现实技术定位穿支血管30支，每例平均2.5支；术中测量术前定位穿支血管穿出点与实际穿出点距离为1～4 mm，平均2.8 mm。术后12例腓骨瓣顺利成活；1例皮瓣远端边缘坏死，换药后延期愈合。供区发生感染1例，经抗炎换药治疗后愈合；其余患者切口Ⅰ期愈合，植皮顺利成活。患者均获随访，随访时间8～36个月，中位时间21个月。修复面部外形好，皮瓣无臃肿。3例术后接受放化疗患者中，随访6个月时2例正常骨愈合、1例延迟愈合。.
UNASSIGNED: 在游离腓骨皮瓣修复下颌骨缺损手术中使用混合现实技术，可以实现穿支血管三维可视化，手术操作简便，误差较小。.

The fibular myocutaneous flap is a classic flap used to reconstruct oral and maxillofacial defects. This study aimed to evaluate the effectiveness of high-frequency color Doppler ultrasound in detecting the blood vessels in the fibular myocutaneous flap, analyze the influence of variations in the peroneal vessels and perforating peroneal arteries on the surgical design, and explore the value of this technology in preoperatively assessing the blood vessels of the fibular myocutaneous flap.
Twenty-five patients with mandibular disease or defect underwent preoperative evaluation of the blood vessels of the calf by high-frequency color Doppler ultrasound. The inner diameter and peak systolic velocity (PSV) of the peroneal arteries and veins and the perforating peroneal arteries were compared between different groups. The consistency between the perforating peroneal arteries marked by ultrasonography and the intraoperative findings was analyzed.
The initial segment of the peroneal artery had a larger inner diameter (p<0.001) and lower PSV (p<0.05) than the middle segment. The perforating peroneal arteries were mainly distributed in the middle of the fibula. The inner diameter of the perforating peroneal artery was larger in men than in women (p<0.05). In comparison with surgical exploration as the gold standard, high-frequency color Doppler ultrasound results showed good consistency (Kappa=0.684, 95% CI: 0.512-0.856, p<0.001), with a sensitivity of 89.36%, specificity of 78.57%, and accuracy of 85.33%.
High-frequency color Doppler ultrasound can detect, quantitatively evaluate, and accurately mark the peroneal artery and vein and perforating peroneal artery before fibular myocutaneous flap transplantation.

UNASSIGNED: To explore the application value of infrared thermography (IRT) technique assisted peroneal artery perforator flap in repairing oral and maxillofacial defects.
UNASSIGNED: The clinical data of 20 patients with oral and maxillofacial malignant tumors treated with peroneal artery perforator flap between October 2020 and December 2021 were retrospectively analysed. There were 13 males and 7 females, with an average age of 56.5 years (range, 32-76 years). There were 8 cases of tongue cancer, 5 cases of parotid gland cancer, 4 cases of buccal cancer, and 3 cases of mandibular gingival cancer; and 12 cases of squamous cell carcinoma, 3 cases of adenoid cystic carcinoma, and 5 cases of mucoepidermoid carcinoma. Color Doppler ultrasound (CDU) and IRT technique were performed before operation to locate the peroneal artery perforator and assist in the design of the flap. The sensitivity, specificity, positive predictive value, and negative predictive value of CDU and IRT technique were compared with the actual exploration during operation. The accuracy of CDU and IRT technique in detecting the number of peroneal artery perforator and the most viable perforating points was compared. The patients were followed up regularly to observe the recovery of donor and recipient sites, the occurrence of complications, and the recurrence and metastasis of tumors.
UNASSIGNED: The sensitivity, specificity, positive predictive value, and negative predictive value of peroneal artery perforators detected by IRT technique before operation were 72.22%, 50.00%, 92.86%, and 16.67% respectively, which were higher than those by CDU (64.17%, 33.33%, 84.62%, and 14.29% respectively). Forty-five peroneal artery perforators were found by CDU before operation, and 35 were confirmed during operation, with an accuracy rate of 77.8%; 43 \"hot spots\" were found by IRT technique, and 32 peroneal artery perforators were confirmed within the \"hot spots\" range during operation, with an accuracy rate of 74.4%; there was no significant difference between the two methods ( χ²=0.096, P=0.757). The accuracy rates of the most viable perforating points found by CDU and IRT technique were 80.95% (17/21) and 94.74% (18/19), respectively, and there was no significant difference between them ( χ²=0.115, P=0.734). The localization errors of CDU and IRT technique were (5.12±2.10) and (4.23±1.87) mm, respectively, and there was no significant difference between them ( t=1.416, P=0.165). All the perforator flaps survived, and the incisions of donor and recipient sites healed by first intention. All patients were followed up 5-18 months, with an average of 11 months. The skin flap was soft and had good blood supply, and the lower limb scar was concealed and the lower limb had good function. No lower limb swelling, pain, numbness, ankle instability, or other complications occurred, and no tumor recurrence and metastasis were found during the follow-up.
UNASSIGNED: Compared with the CDU, using the IRT technique to assist the preoperative peroneal artery perforator flap design to repair the oral and maxillofacial defects has a high clinical application value.
UNASSIGNED: 探讨红外热成像（infrared thermography，IRT）技术辅助腓动脉穿支皮瓣在修复口腔颌面部缺损中的应用价值。.
UNASSIGNED: 回顾分析2020年10月—2021年12月行腓动脉穿支皮瓣修复的20例口腔颌面部恶性肿瘤患者临床资料。男13例，女7例；年龄32～76岁，平均56.5岁。舌癌8例、腮腺癌5例、颊癌4例、下颌牙龈癌3例；鳞状细胞癌12例，腺样囊性癌3例，黏液表皮样癌5例。术前常规行彩色多普勒超声（color Doppler ultrasound，CDU）和IRT技术对腓动脉穿支进行定位并辅助设计皮瓣，与术中实际探查情况比较，分析CDU、IRT技术检查的灵敏度、特异度、阳性预测值和阴性预测值；比较CDU和IRT技术检测穿支数目及最具活力穿支点的准确性。术后定期随访，观察患者供受区恢复情况、并发症发生及肿瘤复发转移情况等。.
UNASSIGNED: 与术中探查结果比较显示，术前IRT技术检查腓动脉穿支的灵敏度、特异度、阳性预测值和阴性预测值分别为72.22%、50.00%、92.86%、16.67%，均高于CDU检查结果（分别为64.17%、33.33%、84.62%、14.29%）。术前CDU检查共发现腓动脉穿支45支，术中探查证实35支，准确率77.8%；IRT技术检查共发现43个“热点”，术中证实“热点”范围内腓动脉穿支32支，准确率74.4%；两者比较差异无统计学意义（ χ²=0.096， P=0.757）。CDU和IRT技术检查发现的最具活力穿支点的准确率分别为80.95%（17/21）和94.74%（18/19），两者比较差异无统计学意义（ χ²=0.115， P=0.734）。CDU与IRT技术的穿支定位误差分别为（5.12±2.10）、（4.23±1.87）mm，两者比较差异无统计学意义（ t=1.416， P=0.165）。20例穿支皮瓣均成活，供、受区切口均Ⅰ期愈合。所有患者均获随访，随访时间5～18个月，平均11个月。皮瓣质地柔软、血运良好；下肢瘢痕隐蔽，功能良好。无下肢肿胀、疼痛、麻木、踝关节不稳定等并发症发生，随访过程中未见肿瘤复发和转移。.
UNASSIGNED: 与CDU比较，采用IRT技术辅助腓动脉穿支皮瓣术前设计修复口腔颌面部缺损具有较高的临床应用价值。.

OBJECTIVE: This prospective study was performed to investigate the distribution of proximal ulnar artery perforating vessels through three-dimensional blood vessel reconstruction and examine the presence and consistency of the perforating vessels intraoperatively.
METHODS: For anatomical guidance, three-dimensional blood vessel reconstruction was performed to determine the consistent presence of perforating vessels in the proximal ulnar artery. A free proximal ulnar artery perforator flap was then transferred in 17 patients to resurface skin defects on the hands. Color Doppler ultrasound was used to identify and mark the perforating vessels. Intraoperative evaluation was conducted to check for anastomosis of the perforating vessels at the marked sites and assess the vessel anastomosis conditions.
RESULTS: No vascular crisis, flap necrosis, or wound infection occurred after surgery in 15 patients. Postoperative follow-up was conducted for 6 to 36 months. The appearance of the flap was satisfactory, the texture of the flap was soft, sensation was well restored, and hand function was not limited. The mean two-point discrimination of the flap was 7.6 ± 2.2 mm.
CONCLUSIONS: Free sensory proximal ulnar artery perforator flap transfer is a safe and reliable surgical technique with respect to restoration of both the appearance and sensory function of the hand.

Meridian point and angiosome are the concepts in two different medical systems with a thousand year in between. In comparison between the angiosome concept and the meridian point structure characteristics in Huangdi Neijing (Yellow Emperor\'s Internal Classic), it is found that angiosome and meridian point are distri-buted in the head, face, trunk and four limbs. Both of them are the complex tissues of stereostructure. The essential structure of them is the vessel for blood circulation and the relevant vascular grades are of equity relationship. Both meridian point and angiosome are distributed segmentally and the number of perforator vessels is very near to that of meridian points. It is indicated on the basis of analysis that both of them are of high similarity in terms of human body structure and it is further discovered that the study achievement on angiosome not only benefits the understanding of traditional literature of meridian point, but also contributes to the deep research on the structural morphology of meridian point in terms of modern science and technology.

OBJECTIVE: Perforator flaps increasingly find acceptance and use in hand reconstructive surgery. A propeller flap is an island flap that moves from one orientation to another by rotating around its vascular pedicle. It is now possible to design propeller flaps based on a single perforator, so-called \"perforator-based propeller flaps,\" but they are more prone to vascular impairment when twisted more than 90°.
METHODS: We present a prospective study conducted in the Plastic and Reconstructive Surgery Department of the Rehabilitation Hospital over 17 months. All perforator-based propeller flaps that were used for hand reconstruction were analyzed. The parameters studied included the size and location of the defect, the size and shape of the flap, the perforator (length and location) that was used, the degree of twisting of the perforator, the degree of perforator dissection, the management of the donor site, and flap survival area.
RESULTS: In this study we investigated the circulatory impairment induced by twisting of the pedicle on a true perforator flap. All flaps survived completely with the exception of partial skin necrosis in few cases. Some of these cases required debridement and skin grafting.
CONCLUSIONS: Perforator-based propeller flaps provide a reliable option for covering small- to medium-size hand complex tissue defects. They have the advantages of using similar tissues in reconstruction, not damaging another area, they do not require main vessels sacrifice, and the donor site can be generally directly closed.