探讨增强CT三维成像在扩张皮瓣修复小儿体表肿物切除后继发创面中的辅助作用。

选择2016年10月至2019年9月国家儿童医学中心　首都医科大学附属北京儿童医院烧伤整形科收治的29例体表肿物(血管瘤与脉管畸形、色素痣、皮脂腺痣)切除后需要通过扩张皮瓣修复继发创面的患儿。所有患儿均Ⅰ期行软组织扩张器置入术，扩张器完成注水扩张后对扩张部位行增强CT三维成像，获得供区皮瓣血管分支的三维图像来指导扩张皮瓣设计。Ⅱ期手术行体表肿物切除、扩张器取出、扩张皮瓣转移修复继发创面，供区直接拉拢缝合，带蒂皮瓣远位转移时则需择期手术断蒂。收集病例资料，统计扩张皮瓣数量及其分布情况，测量转移扩张皮瓣面积，观察扩张皮瓣增强CT三维成像显示的血管分布及造影剂碘海醇不良反应情况，观察皮瓣转移术后皮瓣成活情况；门诊随访4～12个月，观察转移扩张皮瓣的颜色和质地情况。

本组29例患儿共设计获取53个扩张皮瓣，其中头部7个、面颈部10个、躯干20个、四肢16个，18例患儿存在2个及以上的扩张皮瓣。转移扩张皮瓣面积为6 cm×5 cm～18 cm×12 cm，增强CT三维成像均显示扩张皮瓣和毗邻空间位置关系，检查过程未见不良反应，其中28个扩张皮瓣可见动脉分支供血或静脉回流。皮瓣转移术后所有扩张皮瓣成活良好，未见血运障碍。术后门诊随访4～12个月，扩张皮瓣颜色和质地与周围正常皮肤相近。

增强CT三维成像可辅助扩张皮瓣术前血管评估，有助于避免损伤血管主干，在扩张皮瓣修复小儿体表肿物切除后继发创面中具有一定的应用价值。

To explore the auxiliary role of the enhanced CT and three-dimensional imaging in repairing secondary wounds after resection of body surface masses with expanded flaps in children.

From October 2016 to September 2019, 29 children admitted to Department of Burns and Plastic Surgery, Beijing Children′s Hospital, Capital Medical University, National Center for Children′s Health who needed to repair secondary wounds with expanded flaps after resection of body surface masses (hemangioma and vascular malformation, pigmented nevus and sebaceous nevus)were selected. All children underwent soft tissue expander implantation in stage I. After the expander completed water injection expansion, enhanced CT and three-dimensional imaging were performed to obtain the information of the vascular branches of donor flaps to guide the design of the expanded flap. Then, the resection of body surface masses, the removal of expanders and the transfer of expanded flaps to repair the secondary wound were performed in the stage Ⅱ operation. The donor site was sutured directly. Flap pedicle division was performed electively when distant transfer. The medical records were collected, the number and distribution of expanded flaps were counted and the size of transferred flaps was measured. The vascular distribution of expanded flaps, adverse reactions of contrast agent iohexol during enhanced CT and three-dimensional imaging, the survival of flaps were observed. During outpatient follow-up of 4 to 12 months, the color and texture of the transferred expanded flap were observed.

A total of 53 expanded flaps in 29 children were harvested, induding 7 on the head, 10 on the face and neck, 20 on the trunk, and 16 on the limbs, 18 children had 2 or more expanded flaps. The size of transferred expanded flaps ranged from 6 cm×5 cm to 18 cm×12 cm. The anatomical structure of the expanded flap and the adjacent spatial position relationship were visually observed through enhanced CT and three-dimensional imaging, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 28 expanded flaps. All expanded flaps survived well without blood supply disorder after transfer. The children were followed up for 4 to 12 months. The flaps were similar to the surrounding normal skin in color and texture.

The enhanced CT and three-dimensional imaging can assist the vascular assessment of the expended flaps before operation, and help to avoid damaging vessel trunk. Thus, it has certain clinical application value in repairing secondary wounds after resection of body surface masses in children with expanded flaps.