Three-dimensional reconstruction methods in visualization and application of arteria saphena flaps

Abstract

Objective To discuss the digital technique used in visualization of arteria saphena flaps and its clinical applications.Methods Two adult fresh cadaveric specimens,one male and one female,were subjected to radiographic CT scanning before and after perfusion with lead oxide-gelatine mixture,with collimation of 0.625 mm (120 kV,110 mA,512 ×512 matrix).Through Amira 5.4.1 software,the 2D CT images in.dicom format were transformed into 3D models of the entire region.Structures of the arteria saphena were observed and visible digital models of the arteria saphena flap were established through 3D computerized reconstruction by Amira 5.4.1 software.Next 6 patients with soft-tissue defects and bone exposure at the tibial region underwent contrast-enhanced CT angiography of the lower limb by a 64-row multi-slice spiral CT machine after median cubital vein injection with Ultravist (3.5 mL/s).The 2D CT images in.dicom format of the patients were transformed into individualized 3D reconstruction models of the arteria saphena flap using Mimics 14.0 software.The digital design of the individualized arteria saphena flap was used in clinic.Results All the 6 patients were followed up for an average of 18 months (from 8 to 24 months).The 3D reconstruction visible models established from the CT datasets perfectly displayed anatomy of the arteria saphena flap.In the 6 cases the main trunk and branches of the blood vessels in the designed flap were consistent with the surgical findings.The average distance from the starting point of the arteria saphena to the knee clearance was 119.2 ± 9.6 mm and the average diameter of the arteria saphena at the starting point was 1.5 ± 0.3 mm.The areas of flap ranged from 8.0 cm × 5.0 cm to 20.0 cm × 8.0 cm.All flaps survived well.The knee flexion was 120° to 140° and the knee extension 0° to 10°.Conclusion The 3D reconstruction models can provide perfect dynamic visualization of the anatomy of the arteria saphena which can be successfully used in clinic in individualized design of the arteria saphena flap to be transplanted for a specific patient. Key words: Imaging, three-dimensional; Models, anatomic; Surgical flaps