ObjectiveTo investigate the effectiveness of digital technology in repairing wounds of the hand and foot with anterolateral thigh flap. MethodsBetween September 2013 and September 2014, 16 cases of wounds of the hand and foot were treated with the anterolateral thigh flap. There were 10 males and 6 females, with an average age of 31 years (range, 20-52 years). The causes included traffic accident injury in 8 cases, crushing injury by machine in 6 cases, burning injury in 1 case, and animal biting injury in 1 case. The locations of soft tissue defect were the dorsum of the foot in 5 cases, the ankle in 4 cases, the planta pedis in 1 case, and the hand and forearm in 6 cases. The time was 2 hours to 45 days from injury to hospitalization (mean, 14.3 days). All defects were associated with exposure of bone and tendon. The size of wound was from 9.0 cm×4.0 cm to 29.0 cm×8.5 cm. CT angiography (CTA) was performed before operation, and the appropriate perforator as well as the donor site was selected. Then the Mimics15.0 software was used to reconstruct the data of CTA so as to locate the main perforators, design the three-dimensional models of the anterolateral thigh flap, and simulate operation. The flap was obtained according to preoperative plan during operation. The size of flaps varied from 11 cm×5 cm to 31 cm×10 cm. The donor sites were sutured directly in 14 cases and were repaired by free skin graft in 2 cases. ResultsThe lateral femoral circumflex artery identified by Mimics15.0 software before operation, as well as the starting position of its descending branch, the blood vessel diameter at start site, vascular distribution, the maximum cutting length of the vascular pedicle were consistent with the actual observation during operation. All flaps were harvested and were used to repair defect smoothly. Vascular crisis occurred in 1 flap after operation, and the other flaps survived successfully. The wounds and the incisions obtained healing by first intention, and grafted skin survived completely. All cases were followed up 6-17 months (mean, 9 months). Fifteen flaps had good shape;but a second-stage operation was performed to make the flap thinner in 1 case. At last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case according to total active motion (TAM) in 6 cases of hand and forearm injury;the results were excellent in 5 cases, good in 3 cases, and fair in 2 cases according to American Orthopaedic Foot and Ankle Society (AOFAS) in 10 cases of foot injury. The total excellent and good rate was 81.25%. ConclusionThe preoperative individualization design of the flap can be realized through CTA digital technology and Mimics15.0 software;it can reduce the operation risk.
Good collateral circulation can effectively improve the prognosis of patients with severe stenosis or occlusion of cerebral blood supply artery. Studies have shown that CT angiography (CTA) can non-invasively and intuitively evaluate the degree of stenosis and collateral blood flow in diseased vessels. Rapid and accurate CTA collateral circulation score is of great significance for clinical decision-making and judging the prognosis of ischemic stroke. At present, there are many scoring scales based on CTA collateral circulation. This article will review the existing 7 CTA collateral circulation scoring scales, the advantages and disadvantages of clinical application and related research progress in predicting prognosis, aiming to provide a reference for clinicians to choose the collateral circulation score scale and the best treatment plan according to different situations.
ObjectiveTo study the digital anatomy and application value of the thoracic dorsal artery based on CT angiography (CTA). MethodsBetween September 2012 and June 2014, aorta CTA images were chosen from 10 cases (20 sides) undergoing aorta CTA. By using Mimics 17.0 software for three dimensional (3D) reconstruction of image post-processing, the digital vascular anatomical information were obtained after observing and measuring the origin of the thoracic dorsal artery, the number of perforators, type, inner diameter, and pedicle length; and the body surface location of perforator vessel was determined, and then the thoracic dorsal artery perforators tissue flap harvesting was simulated. Results3D reconstruction images showed that the thoracic dorsal artery originated from subscapular artery, 76 perforator vessels were found, including 32 perforators (42.1%) from the medial branch of the thoracic dorsal artery and 44 perforators (57.9%) from the lateral branch of the thoracic dorsal artery, of which 69 were intramuscular perforators (90.8%) and 7 were direct skin artery (9.2%). The inner diameter of the thoracic dorsal artery was (1.69±0.23) mm, and its pedicle length was (2.12±0.64) cm. The first lateral perforator of the thoracic dorsal artery located at (1.65±0.42) cm above the horizontal line of the inferior angle of scapula and at (1.68±0.31) cm lateral to vertical line of the inferior angle of scapula. The first medial perforator located at (1.43 ±0.28) cm above the horizontal line of the inferior angle of scapula and at (1.41±0.28) cm lateral to vertical line of the inferior angle of scapula. The thoracic dorsal artery perforators flap harvesting was successfully simulated. ConclusionCTA is a more intuitive method to study the thoracic dorsal artery in vivo, it can clearly display 3D information of the main blood supply artery course and distribution after flap reconstruction, so it can effectively and accurately guide the design of the flap.
Objective To investigate the influence of axis pedicle and intra-axial vertebral artery (IAVA) alignment on C2 pedicle screw placement by measuring the data of head and neck CT angiography. MethodsThe axis pedicle diameter (D), isthmus height (H), isthmus thickness (T), and IAVA alignment types were measured in 116 patients (232 sides) who underwent head and neck CT angiography examinations between January 2020 and June 2020. Defined the IAVA offset direction by referencing the vertical line through the center of C3 transverse foramen on the coronal scan, it was divided into lateral (L), neutral (N), and medial (M). Defined the IAVA high-riding degree by referencing the horizontal line through the outlet of the C2 transverse foramen, it was divided into below (B), within (W), and above (A). The rate of pedicle stenosis, high-riding vertebral artery, and different IAVA types were calculated, and their relationships were analysed. Simulative C2 pedicle screws were implanted by Mimics 19.0 software, and the interrelation among the rates of pedicle stenosis, high-riding vertebral artery, IAVA types, and vertebral artery injury were analyzed. ResultsThe rate of C2 pedicle stenosis was 33.6% (78/232), and the rate of high-riding vertebral artery was 35.3% (82/232). According to the offset direction and the degree of riding, IAVA was divided into 9 types, among which the N-W type (29.3%) was the most, followed by the L-W type (19.0%) and the L-B type (12.9%), accounting for 60.9%. The vertebral artery injury rate of simulative implanted C2 pedicle screws was 35.3% (82/232). The vertebral artery injury rate in patients with pedicle stenosis and high-riding vertebral artery was significantly higher than that who were not (P<0.001). The rate of pedicle stenosis, high-riding vertebral artery, and vertebral artery injury were significantly different among IAVA types (P<0.001), and M-A type was the most common. ConclusionVertebral artery injury is more common in pedicle stenosis and/or high-riding vertebral artery and/or IAVA M-A type. Preoperative head and neck CT angiography examination has clinical guiding significance.
Objective To explore the application value of artificial intelligence (AI) pulmonary artery assisted diagnosis software for suspected pulmonary embolism patients. Methods The data of 199 patients who were clinically suspected of pulmonary embolism and underwent pulmonary artery CT angiography (CTA) from June 2016 to December 2021 were retrospectively analyzed. Images of pulmonary artery CTA diagnosed by radiologists with different experiences and judged by senior radiologists were compared with the analysis results of AI assisted diagnostic software for pulmonary artery CTA, to evaluate the diagnostic efficacy of this software and low, medium, and senior radiologists for pulmonary embolism. The agreement of pulmonary embolism based on pulmonary artery CTA between the AI software and radiologists with different experiences was evaluated using Kappa test. Results The agreement of the AI software and the evaluation of pulmonary embolism lesions by senior radiologists based on pulmonary artery CTA was high (Kappa=0.913, P<0.001), while the diagnostic results of pulmonary artery CTA AI software was good after judged by senior radiologists based on pulmonary artery CTA (Kappa=0.755, P<0.001). Conclusions The AI software based on pulmonary artery CTA diagnosis of pulmonary embolism has good consistency with diagnostic images of radilogists, and can save a lot of reconstruction and diagnostic time. It has the value of daily diagnosis work and worthy of clinical promotion.
Objective To investigate the effectiveness of the digital technology in repairing tiny hand wounds with superficial lateral sural artery perforator flap. Methods Between August 2013 and October 2016, 10 cases of tiny hand wounds were treated with the superficial lateral sural artery perforator flap. There were 6 males and 4 females, aged 19 to 47 years (mean, 31.2 years). The causes included crushing injury by machine in 6 cases, traffic accident injury in 3 cases, and electric burning injury in 1 case. The location of the soft tissue defect was the first web in 2 cases, the thumb pulp in 3 cases, the index finger pulp in 1 case, the dorsal palms in 3 cases, and the dorsum of finger in 1 case. The time from injury to hospitalization was 4 hours to 10 days (mean, 3.5 days). The size of wound was from 4 cm×3 cm to 8 cm×7 cm. All defects were associated with exposure of tendon and bone. CT angiography (CTA) from aortaventralis to bilateral anterior and posterior tibial arteries was performed before operation, and the appropriate donor site as well as perforator was selected. Then the CTA data were imported into the Mimics15.0 software to reconstruct the three dimensional structure of the perforator artery, bone, and skin; according to flap size, the flap design and harvesting process were simulated. The flap was obtained on the basis of preoperative design during operation. The size of flaps varied from 5 cm×4 cm to 10 cm×8 cm. The donor site was sutured directly in 9 cases and repaired with skin grafting in 1 case. Results Superficial medial sural artery peforator was cut in 3 patients whose superficial lateral sural artery was too narrow, and the flaps were obtained to repair defects smoothly in the others. Venous crisis occurred in 1 flap, which survived after exploration of the vessel, thrombus extraction, and thrombolysis; the other flaps survived successfully. All wounds and incisions healed by first intention. All cases were followed up 3-18 months (mean, 10 months). The flaps had good shape. At last follow-up, the results were excellent in 6 cases, good in 3 cases, and fair in 1 case according to total active motion (TAM). Conclusion The preoperative individualized design of the superficial lateral artery perforator flap can realize through CTA digital technology and Mimics15.0 software; it can reduce the operation risk and is one of better ways to repair the tiny hand wounds.
ObjectiveTo explore the feasibil ity to repair defect on the neck and chest with the rectus abdominis flap which pedicle is lengthened by measuring the width, thickness, and the intercostal space of the inferior costicartilage using CT angiography (CTA). MethodsThirty cases receiving CTA and three-dimensional reconstruction between July and December 2013 were included in the study. Of 30 cases, 17 were male and 13 were female, aged 44-70 years (mean, 56 years). The width and thickness of the 3rd to 7th costicartilages and the distance of the 3rd to 6th intercostal spaces were measured, and the lengthened pedicle was calculated after the 4th to 7th costicartilage was cut off. Between July 2012 and November 2013, the lengthened pedicle of the rectus abdominis flap was cl inically used to repair the defect on the neck and chest in 4 cases. ResultsThe pedicle of the rectus abdominis flap was about 6 cm in length. When the left 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.07, 7.99, 12.50, and 17.48 cm respectively; when the right 7th, 6th, 5th, and 4th costicartilages were cut off, the average pedicle was lengthened by 4.63, 10.82, 16.64, and 22.05 cm respectively. In 4 flaps which were cl inically used to repair defects, 3 flap completely survived, 1 flap had partial necrosis. Three patients were followed up 6 months, and the appearance and texture of the flap were satisfactory; 1 patient failed to be followed up. ConclusionResecting the inferior costicartilage can prolong the pedicle of the rectus abdominis flap, therefore it can be used to repair defect on the upper chest and the neck.
ObjectiveTo explore the effect of snapshot freeze (SSF) on the image quality of coronary artery in 64 multislice spiral CT for patients with high heart rate. MethodsWe retrospectively analyzed the clinical data of 98 patients with an mean heart rate of ≥ 70 beats/min who underwent coronary CT angiography examination between August 2013 and February 2014. According to the inclusion criteria, 60 patients were included in our study. The image quality of standard reconstruction (STD) and motion-corrected (MC) reconstruction based on SSF platform were analyzed. The image quality was classified into 4 grades, and the image quality of coronary segments named according to AHA standard was evaluated. Then, we compared the image quality between the two different reconstruction methods. ResultsAltogether 180 coronary arteries and 795 coronary segments were evaluated. Before MC reconstruction, there were 133 (73.89%) arteries and 287 (36.10%) segments had pseudomorph, while after MC reconstruction, those two numbers were 89 (49.44%) and 150 (18.87%) (P<0.05). The right coronary artery (RCA) had a higher rate of pseudomorph and a lower image quality score[91.67% (55/60), 3.32±0.40] than left anterior descending artery[60.00% (36/60), 3.69±0.42] and left circumflex artery[70.00% (42/60), 3.44±0.55], especially the S2[90.00% (54/60), 2.45±0.85]. Overall image quality was higher with the use of MC reconstruction on per-artery level (P<0.05) and most of the per-segment level (P<0.05) compared with STD, especially for RCA and its segments (P<0.05). ConclusionSSF improves image quality of coronary artery in patients with high heart rate, especially for RCA.
Objective To investigate the accuracy of color Doppler ultrasound (CDU) and CT angiography (CTA) in the preoperative evaluation of perforator vessels in free posterior interosseous artery perforator (PIAP) flaps. Methods Between January 2020 and December 2023, 19 patients with hand skin and soft tissue defects caused by trauma were admitted. There were 11 males and 8 females, with a median age of 45 years (range, 26-54 years). The interval between injury and admission was 5-11 days (mean, 7.2 days). The skin and soft tissue defects were located on the dorsum of the hand in 8 cases and on the fingers in 11 cases. The size of defect ranged from 4.0 cm×2.5 cm to 7.5 cm×3.5 cm. After locating the perforator vessels through CDU and CTA before operation, the free PIAP flaps were designed to repair hand defects, with the size of 4.5 cm×3.0 cm-7.5 cm×4.0 cm. The defects of donor sites were directly sutured. The number and diameter of perforator vessels in the posterior interosseous artery detected by CDU and CTA were compared. The differences in localization of perforator vessels using CDU and CTA and their clinical effects were also compared to calculate the accuracy and recognition rate. During follow-up, the survival of the skin flap was observed, and the Vancouver scar scale (VSS) score was used to evaluate the healing of the donor site, while the visual analogue scale (VAS) score was used to evaluate the patient’s satisfaction with the appearance of the skin flap. Results The number and the diameter of PIAP vessels was 5.8±1.2 and (0.62±0.08) mm assessed by CDU and 5.2±1.0 and (0.60±0.07) mm by CTA, showing no significant difference between the two methods (P>0.05). The number, course, and distribution of perforator vessels of the PIAP vessels observed during operation were basically consistent with those detected by preoperative CDU and CTA. Compared with intraoperative observation results, the recognition rates of dominant perforating vessels by CDU and CTA were 95.0% (18/19) and 89.5% (17/19), respectively, and the accuracy rates were 100% (19/19) and 84.2% (16/19), with no significant difference between the two methods (P>0.05). All flaps survived after operation, and all wounds and incisions at donor sites healed by first intention. All patients were followed up 6-13 months (mean, 8.2 months). At last follow-up, the skin flaps had elasticity and soft texture, with the patient satisfaction VAS score of 9.2±0.8. The donor sites had no obvious scar hyperplasia with the VSS score of 11.7±0.9. Conclusion CDU and CTA accurately identify the dominant perforator vessels and provide reliable information for vessel localization, facilitating precise flap harvesting and minimizing donor site injury. However, CDU offers superior visualization of distal end of perforator vessels in the forearm compared to CTA.
ObjectiveTo study the value of CT angiography (CTA) in the surgical treatment of bone tumors with the temporary balloon blocking technique. MethodsA retrospective analysis was made on the clinical data of 36 bone tumor patients between April 2008 and October 2013. There were 22 males and 14 females, aged from 25 to 83 years (mean, 46 years). The tumor located at the sacrococcygeal region in 17 cases, at the ilium in 12 cases, at the pubis in 5 cases, and at the proximal femur in 2 cases. Before surgery, CTA was performed to measure the external diameter of aortaventralis and arteria iliac communis, and the distance between the low renal artery and the abdominal aortic bifurcation as well as mark the anatomical relationship between the low renal artery, the abdominal aortic bifurcation and bony landmarks of vertebral body. According to these data, suitable balloon was chosen and the balloon positioning was guided in the surgery to completely excise tumor assisted by balloon blocking technique. ResultsThe CTA results showed that the external diameter of aortaventralis and arteria iliaca communis was (1.545±0.248) cm and (1.060±0.205) cm respectively, and the distance between the low renal artery and the abdominal aortic bifurcation was (10.818±1.165) cm. The three-dimensional reconstruction showed that the opening of the low renal artery was mainly located at L1 (16/36, 44.4%) and the abdominal aortic bifurcation mainly located at L4 (22/36, 61.1%). Effective block of abdomial aorta was performed; the blood pressure obviously increased in 3 cases after balloon inflation, and pulse of the left dorsal artery of the foot decreased in 1 case after removal of balloon, which were relieved after expectant treatment. The operation time was 118-311 minutes; the intraoperative blood loss was 200-1 800 mL, 21 patients were given blood transfusion, and the amount of blood transfusion was 400-1200 mL; and the aortic clamping time was 40-136 minutes. All patients were followed up 5-44 months (mean, 21 months). According to Enneking standard, the results were excellent in 9 cases, good in 20 cases, fair in 5 cases, and poor in 2 cases at 3 months after operation. There were 10 cases of dysfunction of urination and defecation, 2 cases of tumor recurrence, and 3 cases of death after surgery. ConclusionCTA and three-dimensional reconstructions technique can accurately measure the external diameter of aortaventralis and arteria iliaca communis and the distance between low renal artery and abdominal aortic bifurcation and offer great help to choose appropriate balloon and locate the balloon during surgery. The balloon blocking technique under the assistance of CTA can obviously reduce intraoperative blood loss and tumor recurrence, supply a clear view in surgery and shorten the operation time.