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Three-dimensional restoration research driven by craniomaxillofacial dataset Jin Zewen, Zhang Xinkang, Wang Wensheng, Chen Xinrong Chinese Journal of Clinical Anatomy    2024, 42 (4): 378-381.   DOI: 10.13418/j.issn.1001-165x.2024.4.04 Abstract （3397）      PDF（pc） （1532KB）（15）       Knowledge map    Save Objective　To propose a learning-based automatic restoration method for craniomaxillofacial  defects, which learning from a self-constructed dataset to automatically generate the shape of the defective parts, and providing reference for the restoration of complex craniomaxillofacial  structures.　Methods　Based on the head CT data, 125 cases of skull data were reconstructed and annotated. Each case was categorized into 21 defect classes. Various techniques were used for data preprocessing, including image registration and threshold filtering. A novel craniomaxillofacial  automatic restoration technique was introduced to generate shapes for the defective portions.　Results　The proposed method achieves the state-of-the-art results on the CMF Defects dataset, which can reconstruct shapes that combine aesthetics and protective functionality.  Conclusions　Craniomaxillofacial bone have diverse shapes and complex anatomical structures. This study, combined with deep learning and data-driven methods, can effectively generate the generation of craniomaxillofacial bone defects, providing a reliable foundation for preoperative planning and intraoperative procedures in craniomaxillofacial restoration surgery. Reference | Related Articles | Metrics | Comments（0）

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Research status and prospect of 3D printing in spinal cord injury repair Kong Yueying, Wang Yilin, Zhao Hong, Tan Sijie, Huang Wenhua Chinese Journal of Clinical Anatomy    2024, 42 (4): 480-483.   DOI: 10.13418/j.issn.1001-165x.2024.4.22 Abstract （3068）      PDF（pc） （533KB）（23）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Condense scientific questions to study virtual anatomy in-depth  Liu Shuwei Chinese Journal of Clinical Anatomy    2024, 42 (4): 361-363.   DOI: 10.13418/j.issn.1001-165x.2024.4.01 Abstract （2907）      PDF（pc） （482KB）（24）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Lateralization and sex differences of hippocampal subregions volume in adolescents Liu Yuning, Teng Ye, Tang Qian, Lou Yunxia, Wang Yu, Tang Yuchun, Liu Shuwei Chinese Journal of Clinical Anatomy    2024, 42 (4): 364-371.   DOI: 10.13418/j.issn.1001-165x.2024.4.02 Abstract （2658）      PDF（pc） （7712KB）（189）       Knowledge map    Save Objective    To make a detailed subdivision of the hippocampus in adolescents and to analyze the lateralization and sex differences in the volume of each subregion, so as to provide anatomical basis for the study of hippocampal function and related psychiatric diseases.    Methods    A total of 101 healthy adolescent subjects were collected for 3.0T brain magnetic resonance imaging. After whole-brain segmentation and subregion segmentation of bilateral hippocampus by using FreeSurfer software, intracranial volume and each hippocampal subregion volume were obtained. The volumes of hippocampal subregions were standardized by intracranial volume using Cendes methods. Finally, the lateralization and sex differences of hippocampal subregion volumes after standardization were statistically analyzed.   Results Freesurfer software showed clear and good effect in automatic segmentation of hippocampal subregions. In terms of literalization, the HBT（head/body/tail) protocol showed that, except for the hippocampus tail, there were literalization in the volume of the hippocampus head, body and the whole hippocampus, right(R)>left(L). In FS60, there was no literalization in hippocampal tail, hippocampal fissure and subiculum; other subregions had literalization, the volume of CA1, CA3, CA4, GC-ML-DG, molecular layer, HATA, fimbria was R>L, while parasubiculum and presubiculum was L>R. In terms of sex difference, after data standardized by the Cendes method, there was sex difference in the volume of each part on the both sides of the HBT, and female (F)>male (M). For FS60, there was sex difference in parasubiculum, presubiculum, subiculum, CA4, GC-ML-DG, molecular layer, HATA, and hippocampal tail, F>M. Conclusions    The volumes of different hippocampal subregions in adolescents have different lateralization and sex differences properties, reflecting the heterogeneous structural characteristics of the hippocampus in this period. This study provides basis for the study of the formation of functional lateralization of the brain and related clinical psychiatric disorders. Reference | Related Articles | Metrics | Comments（0）

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Virtual anatomical modeling of the pelvis of a 3-year-old girl Yin Zhaozheng, Li Kun, Zhang Fengzhen, Zhao Jing, Yi Yuying, Li Lei, Chen Chengzhi, Wang Yu, Li Zhijun, Zhang Shaojie Chinese Journal of Clinical Anatomy    2024, 42 (4): 372-377.   DOI: 10.13418/j.issn.1001-165x.2024.4.03 Abstract （2536）      PDF（pc） （4928KB）（35）       Knowledge map    Save  Objective    To study the continuous ultra-thin slice anatomy and virtual three-dimensional model of the pelvic region in girls, to assist in anatomical research and simulated surgery.   Methods   The transverse section images were extracted from the perineum to the iliac crest area from the Digital Medical Center of Inner Mongolia Medical University. Adobe Photoshop software was used to interactively segment the region of interest from the images. Format conversion and segmentation were performed to process on the images. A digital 3D model of the region was extracted and reconstructed by using the Digihuman Reconstruction System.    Results    The high-resolution sectional anatomical images of the female pelvic region were obtained and the important structures were annotated. The digital 3D model of the virtual female pelvic region was established successfully, which accurately displayed the anatomical relationships between various structures providing a reliable three-dimensional model for pelvic surgery simulation systems.   Conclusions The virtual 3D reconstruction and visualization of the female pelvic region can display realistic and three-dimensional representation of the area and its adjacent structures, providing morphological basis for anatomy, imaging diagnosis, and virtual surgery in this region. Reference | Related Articles | Metrics | Comments（0）

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Preliminary study on the application of tissue transparency technology in organ visualization Tang Qian, Hou Lanwei, Liu Yuning, Lou Yunxia, Teng Ye, Zhou Wenjuan, Liu Shuwei Chinese Journal of Clinical Anatomy    2024, 42 (4): 393-398.   DOI: 10.13418/j.issn.1001-165x.2024.4.06 Abstract （2492）      PDF（pc） （4311KB）（66）       Knowledge map    Save Objective   To explore the adaptability of clear, unobstructed brain imaging cocktails and computational analysis (CUBIC) tissue transparency techniques in different organs of mice, and explore the compatibility of tissue transparency technology with nuclear staining and virus tracer neuron labeling technology.   Methods   （1） The brains, hearts and livers of freshly injected mice were extracted and dissected. Tissue blocks of 1.0cm×1.5cm×0.5cm were taken respectively, clear, unobstructed brain imaging cocktails and computational analysis-L (CUBIC-L) and clear, unobstructed brain imaging cocktails and computational analysis-R (CUBIC-R) tissue cleaning solution were used for transparency treatment. （2） The whole brain of mice was treated with transparency, and the nucleus of mouse brain neurons was stained with propidium iodide (PI). Three-dimensional nuclear volume images of the left and right hemispheres and cerebellar brainstem were obtained by light sheet fluorescence microscopy (LSFM). （3） Adeno-associated virus (AAV) -U6-enhanced green fluorescent protein (EGFP) was microinjected into the hippocampus and substania nigra of rat brain, respectively, to label neurons at specific anatomical sites. The rat brain after virus transfection was treated transparently. LSFM performs 3D stereoscopic imaging.    Results   The brain tissue, liver tissue and heart tissue all showed a transparent gel-like state after transparent treatment. However, the removal efficiency of different tissue blocks was different, and the removal efficiency of brain tissue was the highest, followed by liver tissue and heart tissue. LSFM could perform whole-volume three-dimensional imaging of transparent and nucleated brain tissue. AAV can clearly mark neurons in different parts, after transparent processing, the spatial distribution of these neurons could be observed, and the physical projection of neurons in different parts could also be observed.   Conclusions   CUBIC tissue transparency technology has universal application in brain tissue, heart tissue and liver tissue of mice, and the transparency efficiency of brain tissue is the highest. CUBIC tissue transparency method has good compatibility with nuclear staining and virus tracer neuron labeling technology. Reference | Related Articles | Metrics | Comments（0）

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Study on the accurate T-stage diagnosis and prediction of cervical cancer based on MRI and anatomical measurement Zou Yuxin, Wang Ruiwei, Wu Zhe, Hou Wenjing, Xu Shanshan, Fan Rutao, Wang Yanzhou, Wu Yi Chinese Journal of Clinical Anatomy    2024, 42 (4): 382-392.   DOI: 10.13418/j.issn.1001-165x.2024.4.05 Abstract （2470）      PDF（pc） （6087KB）（11）       Knowledge map    Save Objective   To determine whether the measurement of three-dimensional morphological parameters based on magnetic resonance imaging (MRI) can accurately predict the T-stage diagnosis of cervical cancer (CC) tumors or not after three-dimensional reconstruction.   Methods  Preoperative MRI images from 108 patients with pathologically confirmed cervical cancer were retrospectively collected and divided into four groups: T1, T2, T3 and T4. T1 and T2 were further divided into four subgroups: T1a, T1b, T2a and T2b. The Amira2019 software was used to segment and 3D reconstruct the tumor, uterus, vagina, bladder, urethra, and rectum. The surface area, volume, longitudinal diameter, anterior posterior diameter, transverse diameter, longest diameter, roughness, texture uniformity and degree of vaginal invasion of tumor were measured. The statistical differences were evaluated by using Kruskal-Wallis test, [χ2]-test, receiver operating characteristic (ROC) curve, etc., and the cut-off values for different T-stages were calculated based on Youden's index.  Results  There were statistical differences in the surface area, volume, longitudinal diameter, anterior posterior diameter, transverse diameter, longest diameter and degree of vaginal invasion of tumor between T1-T4 and T1a-T2b (P<0.05), while there was no statistical difference in roughness and texture uniformity between T1-T4 and T1a-T2b (P<0.001). Among them, the longitudinal average diameters of T1-T4 tumors were 2.82 cm, 3.78 cm, 4.82 cm and 6.61 cm (P<0.001), respectively, with cut-off values of 3.17 cm , 4.24 cm and 6.57 cm (AUC=0.699, 0.73, 0.708). The longitudinal average diameters of T1a-T2b tumors were 2.31 cm, 2.84 cm, 3.63 cm and 4.09 cm (P=0.008), respectively, with cut-off values of 2.32 cm, 3.12 cm and 3.94 cm (AUC=0.597, 0.689, 0.561).    Conclusions   The morphological parameters of cervical cancer tumors on MRI include surface area, volume, longitudinal diameter, anterior posterior diameter, transverse diameter, longest diameter, and degree of vaginal invasion of tumor, which are valuable diagnostic factors for predicting T-stage in cervical cancer patients. This study contributes to the accurate diagnosis, prognostic evaluation, and treatment decision-making of cervical cancer. Reference | Related Articles | Metrics | Comments（0）

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The anterolateral thigh flap continue to discover new world  Tang Maolin, Cui Huairui Chinese Journal of Clinical Anatomy    2024, 42 (5): 500-503.   DOI: 10.13418/j.issn.1001-165x.2024.5.02 Abstract （2402）      PDF（pc） （586KB）（51）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Comparative study of two different lumbar fusion under microendoscope Zhang Yang, Wang Peng, Bai Ming, Wang Junfeng, Li Shuwen, Li Zhijun, Wu Yimin Chinese Journal of Clinical Anatomy    2024, 42 (4): 453-456.   DOI: 10.13418/j.issn.1001-165x.2024.4.16 Abstract （2402）      PDF（pc） （2339KB）（15）       Knowledge map    Save Objective   To analyze and compare the clinical efficacy of two different lumbar interbody fusion techniques under microendoscope in the treatment of single level lumbar degenerative diseases. Methods    A total of 136 patients who met the criteria in our hospital from December 2020 to December 2023 were selected for retrospective study. Seventy-five patients received microendoscopic tranforaminal lumbar interbody fusion (ME-TLIF) and 61 patients received microendoscopic posterior lumbar interbody fusion (ME-PLIF). The perioperative data and the incidence of neurological complications were compared between the two groups. Pain (VAS) and function (ODI) scores within and between groups were compared before and after surgery. Suk criteria were used to evaluate postoperative fusion.   Results   The indexes of intraoperative blood loss, postoperative drainage volume and operation time in ME-PLIF group were better than those in ME-TLIF group. There were 3 cases of neurological complications in the ME-PLIF group and no neurological complications in the ME-TLIF group. Postoperative VAS and ODI scores in the same group were significantly different from those before surgery (P<0.05); Postoperative VAS and ODI scores were not significantly changed between groups (P>0.05). There was no difference in the fusion rate between the two groups at the last follow-up.  Conclusions  ME-PLIF technique has more advantages in reducing operation time, intraoperative and postoperative blood loss, and is easier to learn and master. During the operation, attention should be paid to adequate lateral decompression to prevent the occurrence of neurological complications. Reference | Related Articles | Metrics | Comments（0）

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Localization of perforating branch  and optimal design of anterolateral thigh flap Wei Zairong Chinese Journal of Clinical Anatomy    2024, 42 (5): 523-528.   DOI: 10.13418/j.issn.1001-165x.2024.5.06 Abstract （1955）      PDF（pc） （1579KB）（42）       Knowledge map    Save Anterolateral thigh flap (ALTF) was first reported by Chinese scholars, and after 40 years of in-depth research by domestic and foreign scholars, it has been continuously innovated, and is known as "universal flap". Up to now, there were nearly 20 perforator mapping methods to assist ALTF localization of perforating branch, and there were nearly 20 flap design and incision schemes. Based on the applied anatomy of ALTF, perforator mapping methods and optimal design, this paper summarized the selection of perforator mapping methods and various flap optimization design of ALTF engaged in by the author for more than 10 years in order to further improve its clinical application value. Reference | Related Articles | Metrics | Comments（0）

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Personalized reconstruction of maxillofacial defects using anterolateral thigh flap Jiang Canhua, Fu Xinyao, Zhu Feiya Chinese Journal of Clinical Anatomy    2024, 42 (5): 529-534.   DOI: 10.13418/j.issn.1001-165x.2024.5.07 Abstract （1948）      PDF（pc） （3135KB）（42）       Knowledge map    Save Reference | Related Articles | Metrics | Comments（0）

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Hierarchical anatomy and 3D localization of perforator branch morphology Zhou Xiaobing, Zhang Xing, Yao Jie, Wang Qian, Xiong Zhenghua, Ding Maochao Chinese Journal of Clinical Anatomy    2024, 42 (5): 575-580.   DOI: 10.13418/j.issn.1001-165x.2024.5.15 Abstract （1900）      PDF（pc） （7686KB）（28）       Knowledge map    Save Objective   To construct a standard method of hierarchical anatomy and localization of perforating vessels based on digital anatomy technology, so as to provide reference for morphological research of perforating vessels.    Methods   Five donated adult fresh specimens were performed via systemic arterial: two of them with red latex-carboxymethyl cellulose suspension and the left three with lead oxide-red latex-carboxymethyl cellulose suspension. After specimen perfusion, the former was used for gross level anatomy, while the latter was scanned by multiple row spiral CT (MDCT), and then the image workstation (MIMICS, Materialise, Belgium) was used to establish a digital anatomical model of the flap, followed by gross hierarchical dissection.   Results   The blood vessels of the specimen are well filled, with continuous and smooth edges, and no cavitation or interruption. The subdermal vascular network, cutaneous nerves and their nutrient vascular chains were clearly visible. The main trunk of blood vessels, large and small branches of the three-dimensional image were clear, with stunning 3D effect and without tooth-like artifacts.   Conclusions   ① The three elements of digital early treatment are  alkalization, temperature control and suspension ratio.   ② The digital anatomical model of the flap established by Mimics can provide precise hierarchical anatomy and 3D tracking and positioning of the perforator.   Reference | Related Articles | Metrics | Comments（0）

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Individualized precision design of anterolateral thigh perforator flaps: a clinical effectiveness analysis of 1079 cases over ten years Tang Juyu, Sun Nianzhe, Wu Panfeng, Yu Fang, Zeng Lei, Qing Liming, Xiao Yongbing, Pan Ding, Liu Rui, Fu Jinfei, He Jiqiang, Li Cheng Chinese Journal of Clinical Anatomy    2024, 42 (5): 510-516.   DOI: 10.13418/j.issn.1001-165x.2024.5.04 Abstract （1898）      PDF（pc） （2704KB）（43）       Knowledge map    Save Objectives   To investigate the clinical efficacy of individualized precision design using anterolateral thigh perforator flaps for reconstructing various complex tissue defects.    Methods   A retrospective analysis was conducted on 1079 patients who underwent reconstruction using individualized precision-designed anterolateral thigh perforator flaps at our department from January 2013 to January 2023. The descending branches of the lateral circumflex femoral artery were utilized as the vascular pedicle (including 65 pediatric cases) in 1013 cases, transverse branches in 40 cases, oblique branches (including 1 pediatric case) in 26 cases, and descending branch of the medial circumflex femoral artery or femoral artery perforators as the pedicle in 9 cases. Procedures included 441 cases of free flap transplantation, 27 cases of pedicle transfer, 511 cases of basic types of special form perforator flaps, and 100 cases of derivatives. Defects repaired included 787 cases in the lower limbs, 264 cases in upper limbs, 17 cases in trunk, 4 cases in head-neck region and 7 cases in multiple sites. Postoperative clinical outcomes and complication rates of various individualized precision designs of anterolateral thigh perforator flaps were statistically analyzed and compared.   Results   Among the 1079 cases of anterolateral thigh perforator flaps, 1063 cases survived postoperatively, with 14 cases undergoing vascular exploration due to vascular crisis, yielding an overall success rate of 98.52%. Comparison of success rates among free anterolateral thigh perforator flaps, pedicled flaps, basic types and derivatives of special form perforator flaps revealed no significant differences in success rates (P>0.05). Complications included venous crisis in 35 cases (3.24%), arterial crisis in 22 cases (2.04%), infection in 19 cases (1.76%), delayed wound healing in 6 cases (0.56%), complete necrosis in 16 cases (1.48%), and partial necrosis in 35 cases (3.24%). In terms of venous crisis, the incidence rate of perforator flaps in basic types group was lower than that in derivatives group (P<0.001). Regarding wound infection, the incidence rate in pedicled flap group was higher than that of basic types group (P = 0.007). For delayed wound healing, the incidence rate of perforator flaps in traditional free flaps group was higher than that in basic types group (P = 0.04). In terms of partial flap necrosis, the incidence rate in pedicled flap group was higher than that of basic types group (P=0.008).    Conclusions   Individualized precision design of anterolateral thigh perforator flaps could achieve favorable clinical outcomes and merit further clinical application and promotion. Reference | Related Articles | Metrics | Comments（0）

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Analysis of related factors of postoperative necrosis in 1260 cases of free anterolateral thigh flap transplantation Tao Xianyao, Xue Mingyu, Mi Jingyi, Shi Haifeng, Lu Zhengfeng, Zhao Gang, Qiang Li, Zhou Xiao, Zhang Zhihai, Xu Yajun, Rui Yongjun Chinese Journal of Clinical Anatomy    2024, 42 (5): 517-522.   DOI: 10.13418/j.issn.1001-165x.2024.5.05 Abstract （1871）      PDF（pc） （574KB）（37）       Knowledge map    Save  Objective    To summarize the influencing factors of free anterolateral thigh flap necrosis in our hospital, and to discuss and analyze the related influencing factors.   Methods   A total of 1260 free anterolateral femoral flaps operated in our hospital from June 2014 to June 2024 were collected, and 23 related influencing factors were analyzed, including patient characteristics, preoperative factors, intraoperative factors, postoperative factors. Univariate analysis and multivariate logistic regression analysis were performed on these influencing factors and the results of flap necrosis.   Results    1260 free anterolateral thigh flaps survived in 1167 cases (92.6%) and necrotic in 93 cases (7.4%). Statistical analysis showed that the number of venous anastomosis, flap infection, subflap hematoma, vascular crisis were closely related to the necrosis of the free anterolateral femoral flap.   Conclusions   Venous vascular anastomosis (≥2) can increase blood return and make the flap more viable, and thorough debridement, precise hemostasis and adequate drainage during surgery can reduce the occurrence of flap infection and hematoma, reduce flap necrosis, and timely detection and treatment of arteriovenous crisis after surgery can improve the survival rate of flap. Reference | Related Articles | Metrics | Comments（0）

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Digital anatomical study of the lateral circumflex femoral artery and its branching patterns Zhang Xing, Wu Panfeng, Li Cheng, Zhou Xiaobing, Tang Juyu Chinese Journal of Clinical Anatomy    2024, 42 (5): 535-542.   DOI: 10.13418/j.issn.1001-165x.2024.5.08 Abstract （1865）      PDF（pc） （7597KB）（76）       Knowledge map    Save Objective　To provide vascular anatomical evidence for the design and harvesting of anterolateral thigh perforator flaps.　Methods　Thirty-four fresh adult cadavers underwent whole-body vascular angiography, CT scanning, 3D reconstruction, and specimen dissection for comprehensive analysis. The branches, course, and distribution areas of the lateral circumflex femoral artery were observed. Anatomical validation was then performed in accordance with the design and harvesting steps of the flap surgery, using 3D reconstructed images.　Results　A total of 408 anterolateral thigh skin perforators were observed in 65 effective specimens (an average of 6.3 per side), of which 391 originated from the lateral circumflex femoral artery system, accounting for 95.8% (391/408). The distribution among the branches of the lateral circumflex femoral artery was as follows: ascending branch 9.1% (37/408), transverse branch 16.4% (67/408), descending branch 60.8% (248/408), and oblique branch 9.6% (39/408). The external diameters of the perforator origin were (0.7±0.3) mm, (0.9±0.4) mm, (1.1±0.5) mm, and (0.8±0.3) mm, respectively. Seventeen perforators originated from the deep femoral artery, medial circumflex femoral artery, femoral artery, or superficial circumflex iliac artery, accounting for 4.2%, with an external diameter of (0.7±0.3) mm at the origin.　Conclusions　(1)The descending branch of the lateral circumflex femoral artery remains the primary source vessel for anterolateral thigh perforator flaps. (2)High-level skin perforators mainly originate from the transverse and ascending branches of the lateral circumflex femoral artery. (3)Oblique branches often originate from the common trunk of the ascending and transverse branches, possess a certain external diameter and pedicle length, and can be used as the pedicle for flap harvesting. (4)In cases where the perforators originating from the lateral circumflex femoral artery are thin or absent, flaps can be harvested from high-level skin perforators originating from the medial circumflex femoral artery, femoral artery, or other source vessels. Reference | Related Articles | Metrics | Comments（0）

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A retrospective clinical study of 41 cases of distally based anterolateral thigh flaps based on a new classification Du Qingyan, Zang Mengqing, Zhu Shan, Tong Dedi, Li Shanshan, Chen Zixiang, Liu Yuanbo Chinese Journal of Clinical Anatomy    2024, 42 (5): 549-554.   DOI: 10.13418/j.issn.1001-165x.2024.5.10 Abstract （1755）      PDF（pc） （4969KB）（15）       Knowledge map    Save Objective   To investigate the characteristics and surgical attentions of the distally-based anterolateral thigh (dALT) flap in order to improve the success rate of operation.   Methods   A retrospective analysis of 41 patients treated from November 2010 to February 2023 to repair soft tissue defects around the knee joint with dALT flaps. The dALT flap was classified into type I, type II, or type III based on the origin (the descending, oblique, or transverse branch) of the chosen perforator. The vascular pedicle length, repaired defect location, and flap outcome of different types were compared.    Results    The type Ⅰ flap had a shorter vascular pedicle that primarily reached closer regions (distal third of the thigh and anterior/lateral knee) (62.5%,15/24). Type Ⅱ and type Ⅲ flaps had longer pedicles that mostly reached more distal regions (medial/posterior knee and proximal third of the leg) (84.7%, 11/13; 100.0%, 4/4). However, the type Ⅲ flaps had higher complication rate (50.0%) and flap necrosis rate (25.0%).   Conclusions   To achieve more desirable outcomes using the dALT flap, preoperative assessment of vascular pedicle length and proper intraoperative maneuvers that avoid compromising the reverse blood circulation are necessary.  Reference | Related Articles | Metrics | Comments（0）

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Clinical application of anterolateral thigh perforator propeller flaps and alternative solutions Du Qingyan, Zang Mengqing, Zhu Shan, Li Shanshan, Chen Zixiang, Liu Yuanbo Chinese Journal of Clinical Anatomy    2024, 42 (5): 543-548.   DOI: 10.13418/j.issn.1001-165x.2024.5.09 Abstract （1752）      PDF（pc） （2449KB）（16）       Knowledge map    Save Objective    To explore the clinical applications of the anterolateral thigh (ALT) perforator propeller flap and its alternatives in repairing different regions.   Methods   Between November 2009 and December 2023, a total of 45 patients were prepared for the harvest of the ALT propeller flap and reviewed. The clinical application and alternatives of the ALT perforator propeller flap were summarized.   Results    Of the 45 patients, 39 cases of (86.7%) ALT perforator propeller flap were harvested as planned; six (13.3%) were converted to other perforator propeller flap due to lack of suitable perforators in the ALT region. Among them, the source blood vessels of other perforating branch of propeller flap included femoral rectus branch in 2 cases.  one case from the transverse branch of the lateral circumflex femoral artery, one case of the femoral artery, one case of the profunda femoris artery, and one case of the superior lateral genicular artery, respectively. Two flaps developed obstruction of venous congestion, one survived after conservative treatment, and one had distal flap necrosis, which was salvaged with a peroneal artery perforator propeller flap. Conclusions    The ALT perforator propeller flap can be used to reconstruct defects located from the groin to the knee. When the perforators in the ALT region are not available, perforators from the rectus femoris branch, femoral artery, superior lateral genicular artery, or profunda femoris artery can be used as the pedicle for harvesting a perforator propeller flap which can be used for defect reconstruction. Reference | Related Articles | Metrics | Comments（0）

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Anterolateral thigh flap: omnipotent flap and implement of reconstruction-Experience of more than 1,000 clinical applications for 38 years Zhang Chun Chinese Journal of Clinical Anatomy    2024, 42 (5): 504-509.   DOI: 10.13418/j.issn.1001-165x.2024.5.03 Abstract （1707）      PDF（pc） （10362KB）（45）       Knowledge map    Save Anterolateral thigh flap is known as "omnipotent flap" because of its excellent anatomical characteristics and wide applicability. This article is a summary of the clinical application of more than 1,000 cases of anterolateral femoral flap in 38 years. We share the author's experience of learning, researching and applying the anterolateral thigh flap, introduce the process of expanding the application range of the flap and discovering the high perforating branch, and summarize the operative indications and skills. It is hoped to make a modest contribution to the research, development and promotion of anterolateral thigh flap. Reference | Related Articles | Metrics | Comments（0）

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Application of free anterolateral thigh perforator flap for diabetic foot ulcer reconstruction Sun Xiangdong, Abudusaimijiang Aximu, Qiao Weilong, Maijimi Simayi, Wang Xianyan, Li Chengzhi Chinese Journal of Clinical Anatomy    2024, 42 (5): 570-574.   DOI: 10.13418/j.issn.1001-165x.2024.5.14 Abstract （1696）      PDF（pc） （3119KB）（16）       Knowledge map    Save Objectives　To investigate the clinical application effect of the anterolateral thigh perforator flap for diabetic foot ulcer reconstruction.　Methods　A retrospective analysis was performed for the medical records of 35 patients from March 2020 to March 2024 who were treated with free anterolateral thigh perforator flap for diabetic foot ulcer reconstruction, the average age of the patients was 62 years old (45 to70 years), wound size was 5.0cm×6.5cm~24.0 cm×8.0cm. Wound location: 11 cases of forefoot, 9 cases of dorsum of feet, 9 cases of soles of feet, and 6 cases of heels. In all patients, infection was controlled by first-stage debridement and VSD negative pressure drainage.  The wound was repaired by free transplantation of anterolateral thigh perforator flap in the second stage.　Results　All patients had varying degrees of arteriosclerosis in the donor site, 3 cases had arterial occluded with flap, 1 case was salvaged, and 2 cases had failed and amputation. One case had venous crisis, effusion under the flap, partial necrosis, wound healing after dressing change, and the rest of the flaps survived completely, with a survival rate of 91.4% (32/35) and the limb salvage rate of 94.3% (33/35). Six months after operation, all patients were able to walk independently, and the AOFAS score of foot and ankle function was 73-95 points, with a median average of 87 points. After  6-18 months follow-up, no recurrence was observed.　Conclusions　The anterolateral thigh perforator flap is used to repair diabetic foot ulcers, which can reduce the recurrence and amputation rates, and obtain satisfactory function and appearance.  Reference | Related Articles | Metrics | Comments（0）

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Bilateral femoral anterolateral free myocutaneous flap transplantation for the repair of large chest wall defect Yu Junyi, Song Dajiang, Li Zan, Zhou Bo, Lv Chunliu, Tang Yuanyuan, Yi Liang, Luo Zhenhua, Zhang Rui, Yang Lichang Chinese Journal of Clinical Anatomy    2024, 42 (5): 555-559.   DOI: 10.13418/j.issn.1001-165x.2024.5.11 Abstract （1688）      PDF（pc） （3487KB）（26）       Knowledge map    Save Objective    To summarize the clinical results and experience of combined transplantation of bilateral free anterolateral thigh myocutaneous flaps to repair large full-thickness chest wall defects after radical resection of tumor.    Methods    From January 2011 to December 2018, 22 patients who needed full-thickness chest wall reconstruction by using using bilateral femoral anterolateral free myocutaneous flap combined with titanium alloy scaffold or bone cement were admitted to our unit. The area of chest wall defect ranged from 300 cm2 to 700 cm2 (median area was 360 cm2). A total of 44 myocutaneous flaps were designed and harvested, with skin area of (173.55±67.78) cm2 and muscle area of (158.68±94.93) cm2. The flaps were transferred to the chest wall defect, and the arteries were anastomosed in end-to-end manner. According to the number of available arteries in the recipient area, the arterial blood supply of the two musculocutaneous flaps was reconstructed by outer-supercharging or inner-supercharging. During venous anastomosis, different anastomosis strategies were adopted according to the number and pattern of different veins in the vascular pedicle and recipient area.  Results   All 44 myocutaneous flaps from 22 patients survived, while 1 myocutaneous flap had partial necrosis at the distal end, and the wound healed after debridement. All 44 wounds at the donor sites of bilateral thighs healed smoothly, leaving only linear scars. Patients were followed up for 6 to 36 months (18.27±8.62 months), and no local recurrence was found. Bone metastasis was found in one breast cancer patient. The texture of the reconstructed chest wall was good, the patient's breathing was normal, the muscle strength and joint activity of both lower limbs were not affected, and the patient's satisfaction was high.   Conclusions   The combined transplantation of bilateral free anterolateral thigh myocutaneous flaps can cover the chest wall defects well. At the same time, according to the different vascular anatomy, the myocutaneous flaps can protect the function of the donor site to the greatest extent, which is a reliable method for chest wall reconstruction. Reference | Related Articles | Metrics | Comments（0）