Background: Reconstruction with the use of perforator flaps makes it possible to make the skin surface resistant to the influence of mechanical factors and as similar to the lost skin cover as possible. However, while planning any flap, along with the design of the required shape and size, its blood supply should be taken into account to ensure optimal viability. Therefore, the task to precisely determine the topographic-anatomical relationships suitable for the formation of a pedicle of perforators is still relevant. The aim of this study was to increase the efficiency of surgical reconstruction of wound defects by transposition of locoregional perforator flaps. Methods: The authors conducted a retrospective analysis of 72 cases of reconstruction by means of locoregional perforator flaps with vascular pedicle detachment to determine the efficiency of preoperative diagnostic preparation with the help of multidetector-row computed tomographic angiography (MDCT) in the process of reconstruction. Thirty-seven individual cases of surgical interventions were chosen using a case-controlled study from the study group when MDCT with angiography was used for preoperative planning of perforator flaps, as well as 35 control cases similar in terms of important predictive peculiarities with the reconstruction at the same level of difficulty. The patient groups were precisely matched by gender (P = .950), age (P = .804), flap area (P = .192), and type of reconstruction that was performed. Results: In all cases, the location of the perforator with a diameter greater than 1.0 mm was marked. All perforators determined during MDCT scanning were faultlessly localized intraoperatively. The distance between the intraoperative position of the perforator and the position obtained in the result of the examination did not exceed 1 cm. There was no need to change the planned design of the flap intraoperatively. In all cases where MDCT was performed, the duration of the surgical procedure varied from 60 to 150 minutes (average: 120.77 [18.90] minutes) and was reduced by 49.40 minutes (95% CI: 39.17-59.63) compared with the patients who did not undergo preoperative visualization of perforators where the average duration of the operation was 170.17 (19.19) minutes (from 140 to 220 minutes). Among the patients examined by MDCT, surgical complications were noted in 5 cases (13.51%) compared to 14 cases (40.00%) in the control group. Conclusions: The preoperative MDCT for the locoregional perforator flap reconstruction makes it possible to increase the efficiency of patient treatment given the reduction in surgery duration by 49.40 minutes (95% CI: 39.17-59.63) on average and the reduction in the level of postsurgery complications from 40% to 13.5% compared with the group of patients in whom presurgical visualization was not performed (P = .031).
Contexte : La reconstruction faisant appel à des lambeaux perforants permet de rendre la surface de la peau résistante à l’influence de facteurs mécaniques et de la rendre aussi semblable que possible à la couverture cutanée perdue. Cependant, tout en planifiant un lambeau, son approvisionnement en sang doit être pris en compte au même titre que sa forme et sa taille pour assurer une viabilité optimale. Par conséquent, la tâche visant à déterminer avec précision les rapports topographiques-anatomiques convenables pour la formation d’un pédicule perforateur reste pertinente. L’objectif de cette étude était d’augmenter l’efficacité de la reconstruction chirurgicale des lacunes post-blessures par transposition de volets perforateurs locorégionaux. Méthodes : Les auteurs ont réalisé une analyse rétrospective de 72 cas de reconstruction utilisant le détachement d’un pédicule vasculaire de volets perforateurs locorégionaux pour déterminer l’efficacité de la préparation diagnostique préopératoire aidée par la tomoangiographie numérisée à multidétecteurs (MDCT) dans le processus de reconstruction. 37 cas individuels d’interventions chirurgicales ont été choisis dans une étude cas-contrôles à partir du groupe d’étude quand la tomoangiographie numérisée à multidétecteurs a été utilisée pour la planification préopératoire des lambeaux perforants. 35 cas-contrôles similaires en termes de particularismes prédictifs importants pour la reconstruction avec le même niveau de difficulté. Les groupes de patients ont été appariés avec précision pour le genre (P = 0,950), l’âge (P = 0,804), la surface du lambeau (P = 0,192) et le type de reconstruction qui était exécuté. Résultats : Dans tous les cas, l’emplacement du perforateur avec un diamètre supérieur à 1 mm a été marqué. Tous les perforateurs déterminés au cours de la MDCT ont été localisés sans erreur en peropératoire. La distance entre la position peropératoire du perforateur et la position obtenue dans le résultat de l’examen n’a pas dépassé 1 cm. Il n’a pas été nécessaire de modifier le plan prévu du lambeau en peropératoire. Dans tous les cas où la MDCT a été réalisée, la durée de la procédure chirurgicale a été de 60 à 150 minutes (moyenne, 120,77 [18,90] minutes) et a été réduite de 49,40 minutes (IC à 95%: 39,17 à 59,63) comparativement aux patients qui n’ont pas eu de visualisation préopératoire des perforateurs; pour ces derniers, la durée de l’intervention a été de 170,17 (19,19) minutes (de 140 à 220 minutes). Parmi les patients examinés par MDCT, des complications chirurgicales ont été observées dans 5 cas (13,51%) comparativement à 14 cas (40,00%) dans le groupe témoin. Conclusions : La MDCT préopératoire pour la reconstruction avec lambeau perforateur locorégional permet d’améliorer l’efficacité du traitement des patients compte tenu de la réduction des temps opératoires de 49,40 minutes (IC à 95%, 39,17 à 59,63) en moyenne et de la réduction de 40% à 13,5% des complications postopératoires comparativement au groupe de patients n’ayant pas bénéficié de visualisation avant l’intervention (P = 0,031).

Introduction: Caesarean section (CS) is the most prevalent surgical procedure in women. The incidence of surgical site infection (SSI) after CS remains high but recent observations of CS wounds using infrared thermography has shown promise for the technique in SSI prognosis. Although thermography is recognised as a \'surrogate\' of skin perfusion, little is known of the relationship between skin temperature and skin perfusion in the context of wound healing. Aim: To assess the extent of literature regarding the application of infrared thermography and mapping of abdominal cutaneous perfusion after CS. Methods: Wide eligibility criteria were used to capture all relevant studies of any design, published in English, and addressing thermal imaging or skin perfusion mapping of the abdominal wall. The CINAHL and MEDLINE databases were searched, with two independent reviewers screening the title and abstracts of all identified citations, followed by full-text screening of relevant studies. Data extraction from included studies was undertaken using a pre-specified data extraction chart. Data were tabulated and synthesised in narrative format. Results: From 83 citations identified, 18 studies were considered relevant. With three additional studies identified from the reference lists, 21 studies were screened via full text. None of the studies reported thermal imaging and cutaneous perfusion patterns of the anterior abdominal wall. However, two observational studies partially met the inclusion criteria. The first explored analysis methodologies to \'interrogate\' the abdominal thermal map. A specific thermal signature (\'cold spots\') was identified as an early \'flag\' for SSI risk. A second study, by the same authors, focusing on obesity (a known risk factor for SSI after CS) showed that a 1 °C lower abdominal skin temperature led to a 3-fold odds of SSI. Conclusion: There is a significant gap in knowledge on how to forewarn of wound complications after CS. By utilising the known association between skin temperature and blood flow, thermographic assessment of the wound and adjacent thermal territories has potential as a non-invasive, independent, imaging option with which to identify tissue \'at risk\'. By identifying skin \'hot\' or \'cold\' spots, commensurate with high or low blood flow regions, there is potential to shed light on the underlying mechanisms leading to infective and non-infective wound complications.

Objective:To investigate the application of free fibular flap based on digital technology in mandibular defects. Method:Eight cases of mandibular defects underwent virtual surgery and guide plate design before operation. The mandibular osteotomy guide plate, fibula plastic guide plate and mandibular reconstruction model were prepared by rapid prototyping technology. The individualized reconstruction titanium plates were prefabricated on the mandibular reconstruction model. Based on the guide plates and the individualized reconstruction titanium plates, the mandibular defects were repaired accurately. At the same time, CT angiography was used to observe the variation of peroneal artery. For patients with soft tissue defects, the superficial position of the point going out muscle of perforator vessels was located, and the skin flaps were designed to repair the soft tissue defect. Result:The free fibular flaps survived in all patients. The guide plates were successfully implanted, the position of the individualized reconstruction titanium plates were accurate, and the occlussions were well recovered. Preoperative CT angiography was carried out without complication in all patients, the desired anatomy was adequately demonstrated in all patients. The superficial position of the point going out muscle of perforator vessels during operation were basically in accordance with those detected by CT angiography. Conclusion:The free fibular flaps based on digital technology can successfully repair mandibular defects with good aesthetic and functional results.
目的：探讨基于数字化技术的游离腓骨肌皮瓣在下颌骨缺损中的应用价值。 方法：8例拟行游离腓骨肌皮瓣修复手术的患者，术前行虚拟手术及导板设计，利用快速成型技术制备下颌骨截骨导板、腓骨塑形导板以及下颌骨修复后模型，在下颌骨修复后模型上预制个体化重建钛板，术中根据导板和个体化重建钛板，完成对下颌骨缺损的精确修复。同时通过术前下肢CT血管造影观察腓动脉有无变异，对合并软组织缺损的患者，定位穿支血管出肌点的体表位置，以其为中心设计皮瓣，完成软组织缺损的修复。 结果：8例患者术后移植游离腓骨肌皮瓣均成活，导板术中就位顺利，个体化重建钛板位置准确，患者咬合关系恢复良好。术前CT血管造影检查顺利，CT血管造影可以准确显示腓动脉的解剖位置，定位穿支血管出肌点的体表位置与术中所见完全吻合。 结论：基于数字化技术的游离腓骨肌皮瓣能够成功修复下颌骨缺损，获得良好的美观和功能效果。.

Objective:To explore the application value of anteromedial thigh flap（AMT） as alternative flap in repairing maxillofacial soft tissue defects. Method:Sixty patients were scheduled to underwent anterolateral thigh flap（ALT） reconstruction. Preoperative CT angiography were conducted. Imaging workstations were used to locate perforator vessels in the anterolateral and anteromedial areas respectively. Four patients had no suitable perforator during the preparation of AMT flaps. In the same operation area, ALT flaps were prepared to reconstruct the defect according to the location of the perforator vessels in the anteromedial areas. Result:All four AMT flaps survived uneventfully. Flap sizes ranged from 9 cm×6 cm to 7 cm×4 cm. The follow-up period ranged from 6 to 12 months, the functions of recipient and donor sites recovered well. Conclusion:Preoperative CT angiography can improve the accuracy of the preparation of skin flap effectively. When no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap.
目的：探讨股前内侧皮瓣作为替代皮瓣在颌面部软组织缺损修复中的应用价值。 方法：60例拟行股前外侧皮瓣修复手术的患者，术前常规行CT血管造影，利用影像工作站，分别于股前内侧、外侧区定位穿支血管的体表位置。其中有4例在股前外侧皮瓣制备过程中无合适穿支，在同一术区依据股前内侧区定位的穿支血管的体表位置，再次制备股前内侧皮瓣修复缺损。 结果：4例股前内侧皮瓣均完全成活，切取皮瓣面积最大9 cm×6 cm，最小7 cm×4 cm，随访6～12个月，受区及供区功能恢复满意。 结论：术前应用CT血管造影能够有效地提高皮瓣制备的准确性，制备股前外侧皮瓣无合适穿支血管时，使用同侧股前内侧皮瓣是一种有效的替代方案。.

Objective:To investigate the effectiveness of CT angiography for detecting perforator vessels in the anterolateral thigh flap surgery.Method:Eight patients with oral and maxillofacial soft tissue defects were repaired with the anterolateral thigh flap. Preoperative CT angiography was conducted to detect perforator vessels. The perforator vessel with large diameter, abundant blood flow, and long pedicle was selected to design the flap.Result:The position of perforator vessels during operation were completely consistent with those detected by CT angiography. The anterolateral thigh flap for 8 cases tally survived.One case had the vascular crisis，which was survived after surgical exploration. The flap ranged from 10 cm×5 cm to 6 cm×4 cm in size. Donor recipient site was not severe complications.Conclusion: CT angiography can be used to locate the perforator vessels preoperatively and accurately，which is beneficial for surgeons to design the flap and reduce surgical complications. The anterolateral thigh flap is an effective method of repairing oral and maxillofacial soft tissue defects.

BACKGROUND: Mandibular reconstruction performed after virtual planning has become more common during recent years. The gold standard for extensive mandibular reconstruction is of course a fibular free flap. In designing an osteomyocutaneous fibula flap, poor planning, aberrant anatomy and/or inadequate perforator vessels are the most frequent causes of complications and may force the surgeon to modify the flap design, explore the contralateral leg or harvest an additional microvascular flap. The goal of our study was to pre-operatively evaluate the vascular anatomy of the fibula and localize the cutaneous perforator vessels, so to create the fibular cutting guide based on the position of the cutaneous perforator and safely harvest the reconstructive flap.
METHODS: Twenty consecutive patients who were candidates for mandibular reconstruction using a fibular microvascular free flap were enrolled in this study between January 2016 and August 2016. The patients were preoperatively assessed with a Computed Tomographic scan of head and neck and with a Computed Tomographic Angiography (CTA) scan of the lower limbs to evaluate the vascular anatomy of the fibula. Virtual planning was carried out for all patients. The fibular cutting guide was based on the position of the perforator cutaneous vessels, which were used to harvest the cutaneous part of the flap. Preoperative CT measurements were performed in order to identify the cutaneous perforators on the patients\' skin. Intraoperative checking was performed to evaluate the accuracy of the perforators\' position and the reproducibility of the virtual planning.
RESULTS: In 5 patients out of 20 (25%), anatomical anomalies were discovered, without clinical evidence. The perforator vessels were localized in all patients. The average difference between the CTA and the intraoperative perforator localization was 1 mm (range 0-2 mm). Fibular cutting guide was positioned and fitted the anatomy of the patients in all treated patients. This allowed us to perform the planned segmentation of the fibula, obtaining the correct number of segments. In all cases, flap insetting was carried out and skin paddle was positioned as preoperatively planned. Neither donor site complications nor flap complications occurred.
CONCLUSIONS: Preoperative evaluation of the legs using CTA, in patients who undergo an osteomyocutaneous fibular free flap for mandibular reconstruction, is a valuable approach to reduce altered-anatomy related complications and to improve the accuracy and outcomes of the reconstruction, especially in reconstructions of complex defects. In these cases, a soft tissue-based cutting guide can be planned based on the perforator vessels of the skin paddle, minimizing the harvesting risks of vascular lesions. Further studies and longer follow-ups are needed to evaluate the long-term outcomes and advantages of this procedure.

Thermal representations on the surface of a human forearm of underlying perforator vessels have previously been mapped via recovery-enhanced infrared imaging, which is performed as skin blood flow recovers to baseline levels following cooling of the forearm. We noted that the same vessels could also be observed during reactive hyperaemia tests after complete 5-min occlusion of the forearm by an inflatable cuff. However, not all subjects showed vessels with acceptable contrast. Therefore, we applied a thermographic signal reconstruction algorithm to reactive hyperaemia testing, which substantially enhanced signal-to-noise ratios between perforator vessels and their surroundings, thereby enabling their mapping with higher accuracy and a shorter occlusion period.