Email Alert | RSS

Journal of Peking University(Health Sciences) ›› 2020, Vol. 52 ›› Issue (1): 119-123. doi: 10.19723/j.issn.1671-167X.2020.01.019

Previous Articles     Next Articles

Application of computer-assisted design for anterolateral thigh flap in oral and maxillofacial reconstruction

Shun-ji WANG1,Wen-bo ZHANG1,Yao YU1,Xiao-yan XIE2,Hong-yu YANG3,Xin PENG1,△()   

  1. 1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Oral and Maxillofacial Radiology, Peking University School and Hospital of Stomatology, Beijing 100081, China
    3. Center of Stomatology, Peking University Shenzhen Hospital, Shenzhen 518036, Guangdong, China
  • Received:2019-10-14 Online:2020-02-18 Published:2020-02-20
  • Contact: Xin PENG E-mail:pxpengxin@263.net
  • Supported by:
    Supported by the Key Research and Development Program of Ningxia Hui Autonomous Region(2018BEG02012)

RICH HTML

   

PDF (PC)

Abstract:

Objective: To investigate the feasibility and accuracy of using digital technology to design anterolateral thigh flap (ALTF) in oral and maxillofacial defect reconstruction. Methods: Ten cases underwent oral and maxillofacial defects reconstruction with ALTFs in Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from June 2019 to Oct. 2019 were enrolled. There were 7 males and 3 females with the mean age of 47.1 years. Preoperative high frequency color Doppler ultrasound examination was performed to detect the perforators of ALTF. CT data of the thigh was imported in DICOM (digital imaging and communications in medicine) format to the Proplan CMF 3.0 software (Materalise, Belgium), then virtual harvest of ALTF was performed according to the points of perforators detected by high frequency color Doppler ultrasound and the virtual flap volume was calculated by Proplan CMF 3.0 software. ALTF was harvested followed by preoperative virtual design, and the actual flap volume of ALTF was measured by the draining method during the surgery. Finally, the accuracy rate of using high frequency color Doppler ultrasound to detect perforators of ALTFs was calculated, and the differences between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume of ALTF by the draining method were compared using paired samples T test. Results: Fifteen perforators in the flaps area of 10 patients who underwent oral and maxillofacial defects reconstruction with ALTFs were detected by high frequency color Doppler ultrasound, and 16 perforators were identified during the surgery, with the accuracy rate of 87.5%. The flaps size ranged from 5 cm×7 cm to 8 cm×15 cm, all the 10 flaps survived. The donor sites were primarily closed without skin graft, and no surgery complication was found on the donor site. The mean flap volume measured by Propaln CMF 3.0 software was 71.4 cm 3 (range: 36.1-188.4 cm 3), and the mean volume measured by the draining method was 70.7 cm 3 (range: 38.3-172.5 cm 3). There was no significant difference between the virtual flap volume measured by Propaln CMF 3.0 software and the actual volume measured by draining method (t=0.318; P=0.758). Conclusion: Preoperative virtual design of ALTF has good feasibility and accuracy and can be used to guide the harvest of ALTF during operation.

Key words: Oral and maxillofacial reconstruction, Anterolateral thigh flap, Computer-assisted design, Virtual design

CLC Number: 

  • R782.2

Figure 1

Preoperative virtual design and intraoperative volume measurement of ALTF Detecting the perforator of anterolateral thigh flap (ALTF) with color duplex sonography (A), virtual harvest of ALTF (B), calculating the volume of the flap (C), flap harvest: the surface size confirmed by the calculation (D), and the volume confirmed by draining method (E and F)."

Table 1

Discription of the 10 patients"

Case Gender Age/years Site of lesion Pathology
1 Male 39 Maxilla Chondrosarcoma
2 Female 67 Maxilla Squamous cell carcinoma
3 Male 9 Maxilla Osteosarcoma
4 Female 56 Maxilla Adenoid cystic carcinoma
5 Male 76 Maxilla Malignant fibrous histiotoma
6 Male 51 Maxilla Osteomyelitis
7 Male 44 Maxilla Osteomyelitis
8 Male 30 Tongue Squamous cell carcinoma
9 Female 52 Maxilla Ameloblastoma
10 Male 47 Tongue Squamous cell carcinoma

Table 2

Discription of the preoperative and intraoperative perforator and flap volume"

Case Preoperative
perforator		 Intraoperative
perforator		 Preoperative
volume/cm3		 Intraoperative
volume/cm3
1 1 1 39.9 46.7
2 1 1 36.1 38.3
3 1 1 45.0 47.1
4 1 1 40.8 42.5
5 1 1 37.4 39.4
6 2 2 61.7 59.5
7 2 2 57.1 55.0
8 1 1 188.4 172.5
9 3 4 75.4 78.0
10 2 2 131.7 128.5
[1] De Vicente JC, De Villalain L, Torre A , et al. Microvascular free tissue transfer for tongue reconstruction after hemiglossectomy: a functional assessment of radial forearm versus anterolateral thigh flap[J]. J Oral Maxillofac Surg, 2008,66(11):2270-2275.
[2] Wei FC, Jain V, Celik N , et al. Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps[J]. Plast Reconstr Surg, 2002,109(7):2219-2230.
[3] Wolff KD, Kesting M, Thurmuller P , et al. The anterolateral thigh as a universal donor site for soft tissue reconstruction in maxillofacial surgery[J]. J Craniomaxillofac Surg, 2006,34(6):323-331.
[4] Hanasono MM, Skoracki RJ, Yu P . A prospective study of donor-site morbidity after anterolateral thigh fasciocutaneous and myocutaneous free flap harvest in 220 patients[J]. Plast Reconstr Surg, 2010,125(1):209-214.
[5] Engel H, Huang JJ, Lin CY , et al. A strategic approach for tongue reconstruction to achieve predictable and improved functional and aesthetic outcomes[J]. Plast Reconstr Surg, 2010,126(6):1967-1977.
[6] Revenaugh PC, Haffey TM, Seth R , et al. Anterolateral thigh adipofascial flap in mucosal reconstruction[J]. JAMA Facial Plast Surg, 2014,16(6):395-399.
[7] Koshima I, Fukuda H, Yamamoto H , et al. Free anterolateral thigh flaps for reconstruction of head and neck defects[J]. Plast Reconstr Surg, 1993,92(3):421-430.
[8] Di Candia M, Lie K, Kumiponjera D , et al. Versatility of the anterolateral thigh free flap: the four seasons flap[J]. J Plast Surg, 2012,12:194-206.
[9] Yun IS, Lee DW, Lee WJ , et al. Correlation of neotongue volume changes with functional outcomes after long-term follow-up of total glossectomy[J]. J Craniofac Surg, 2010,21(1):111-116.
[10] Foley BD, Thayer WP, Honeybrook A , et al. Mandibular reconstruction using computer-aided design and computer-aided manufacturing: an analysis of surgical results[J]. J Oral Maxillofac Surg, 2013,71(2):e111-e119.
[11] Leiggener C, Messo E, Thor A , et al. A selective laser sintering guide for transferring a virtual plan to real time surgery in com-posite mandibular reconstruction with free fibula osseous flaps[J]. Int J Oral Maxillofac Surg, 2009,38(2):187-192.
[12] Yu Y, Zhang WB, Liu XJ , et al. Three-dimensional accuracy of virtual planning and surgical navigation for mandibular reconstruction with free fibula flap[J]. J Oral Maxillofac Surg, 2016,74(7):1503 e1-1503 e10.
[13] Yu Y, Zhang WB, Wang Y , et al. A revised approach for mandibular reconstruction with the vascularized iliac crest flap using virtual surgical planning and surgical navigation[J]. J Oral Maxillofac Surg, 2016,74(6):1285 e1-1285 e11.
[14] Zhang WB, Yu Y, Wang Y , et al. Improving the accuracy of mandibular reconstruction with vascularized iliac crest flap: Role of computer-assisted techniques[J]. J Craniomaxillofac Surg, 2016,44(11):1819-1827.
[15] Roser SM, Ramachandra S, Blair H , et al. The accuracy of virtual surgical planning in free fibula mandibular reconstruction: comparison of planned and final results[J]. J Oral Maxillofac Surg, 2010,68(11):2824-2832.
[16] Lam L, Samman N . Speech and swallowing following tongue cancer surgery and free flap reconstruction:a systematic review[J]. Oral Oncol, 2013,49(6):507-524.
[17] Matsui Y, Shirota T, Yamashita Y , et al. Analyses of speech intelligibility in patients after glossectomy and reconstruction with fasciocutaneous/myocutaneous flaps[J]. Int J Oral Maxillofac Surg, 2009,38(4):339-345.
[18] Rhemrev R, Rakhorst HA, Zuidam JM , et al. Long-term functional outcome and satisfaction after radial forearm free flap reconstructions of intraoral malignancy resections[J]. J Plast Reconstr Aesthet Surg, 2007,60(6):588-592.
[19] Zhang WB, Wang Y, Liu XJ , et al. Reconstruction of maxillary defects with free fibula flap assisted by computer techniques[J]. J Craniomaxillofac Surg, 2015,43(5):630-636.
[20] 莫勇军, 谭海涛, 杨克勤 , 等. 数字化技术辅助股前外侧皮瓣移植修复四肢软组织缺损24例[J]. 中华显微外科杂志, 2015,38(6):592-595.
[21] Shen Y, Huang J, Dong M J , et al. Application of computed tomography angiography mapping and located template for accurate location of perforator in head and neck reconstruction with anterolateral thigh perforator flap[J]. Plast Reconstr Surg, 2016,137(6):1875-1885.
[22] Eder M, Raith S, Jalali J , et al. Three-dimensional prediction of free-flap volume in autologous breast reconstruction by CT angiography imaging[J]. Int J Comput Assist Radiol Surg, 2014,9(4):541-549.
[23] 邵学垒, 马三成, 夏德林 , 等. 数字三维成像技术在颌面部软组织整复术前的皮瓣设计应用[J]. 临床耳鼻咽喉头颈外科杂志, 2017,31(24):1875-1879.
[24] 唐举玉, 卿黎明, 贺继强 , 等. 数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣设计的初步应用[J]. 中华显微外科杂志, 2016,39(2):123-126.
[25] 段家章, 何晓清, 徐永清 , 等. 数字化技术在股前外侧皮瓣修复手足创面中的应用[J]. 中国修复重建外科杂志, 2015,29(7):807-811.
[26] 芮永军, 张雁, 杨红 , 等. 术前不同定位方法在股前外侧穿支皮瓣应用的对比分析[J]. 中华显微外科杂志, 2015,38(1):33-37.
[1] Ying HUANG,Zhi-yuan WU,Xing-hong ZHOU,Zhi-gang CAI,Jie ZHANG. Category of facial symmetry perception after maxillary reconstruction using anterolateral thigh flap [J]. Journal of Peking University (Health Sciences), 2023, 55(4): 708-715.
[2] Jia LUO,Yu ZHANG,Hong-yan CUI,Ning ZHU,Hui-dan SHEN,Ping DI,Ye LIN. Digital workflow coupling conic retention for the immediate restoration of adjacent posterior implants [J]. Journal of Peking University (Health Sciences), 2020, 52(5): 964-970.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
No Suggested Reading articles found!
Copyright © Journal of Peking University (Health Sciences), All Rights Reserved.
Powered by Beijing Magtech Co. Ltd