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.