目的 探究CT血管成像（CTA）三维重建在指导四肢软组织大面积缺损患者游离皮瓣穿支定位及设计中的应用价值。 方法 回顾性收集2022年3月至2025年6月中国人民解放军海军第九七一医院收治的51例进行游离皮瓣移植修复的四肢软组织大面积缺损患者的临床资料，所有患者术前均行CTA检查，并在三维重建指导下进行血管成像及穿支定位分析，据此进行皮瓣设计，评估穿支血管定位准确率、皮瓣成活率、创面Ⅰ期愈合率、肢体感觉和功能恢复情况以及不良反应发生情况。 结果 所有患者穿支血管定位均准确，定位准确率为100%；所有患者皮瓣均存活，皮瓣存活率为100%；除1例创面愈合不良外其余患者均达到创面Ⅰ期愈合，Ⅰ期愈合率为98.04%；末次随访时51例患者的供区英国医学研究会（BMRC）感觉功能评定为：S2+级3例、S3级20例、S3+级28例，受区为：S2级4例、S2+级7例、S3级17例、S3+级23例；术后1、3个月，患者Fugl-Meyer（FM）评定量表评分均较术前显著升高，术后3个月，患者FM评定量表评分较术后1个月升高（P < 0.05）；术后发生动脉危象1例，经对症处理后皮瓣顺利成活。 结论 四肢皮肤软组织缺损游离皮瓣移植修复术前进行CTA三维重建展现出较高的穿支血管定位准确性，能够为个体化皮瓣设计提供积极指导，且术后患者创面愈合良好、感觉和肢体功能恢复良好、不良反应发生率较低。

Objective To explore the application value of three-dimensional reconstruction of CT angiography （CTA） in guiding the localization and design of free flap perforations for patients with skin and soft tissue defects of the extremities. Methods The clinical data of 51 patients with limb and soft-tissue defects who underwent free flap transplantation repair at the 971 Hospital of the Navy from March 2022 to June 2025 were retrospectively collected. All patients underwent CTA examination prior to the operation. Vascular imaging and perforation location analysis were performed under the guidance of three-dimensional reconstruction. Based on this， flap design was carried out to assess the accuracy of perforation vessel location， flap survival rate， first-stage wound healing rate， limb sensation and function recovery， as well as the occurrence of adverse reactions. Results The positioning of perforated vessels in all patients was completely accurate （100%）. All the flaps of the patients survived （100%）. Except for one case with poor wound healing， the remaining patients achieved primary wound healing， and the primary healing rate was 98.04%. At the last follow-up， in the sensory function assessment of the British Medical Research Council （BMRC） in the donor area， there were 3 cases at grade S2+， 20 cases at grade S3， and 28 cases at grade S3+； in the recipient area， there were 4 cases at grade S2， 7 cases at grade S2+， 17 cases at grade S3， and 23 cases at grade S3+. One month and three months after the operation， the scores of the Fugl-Meyer （FM） assessment scale of the patients were significantly higher than before. Three months after the operation， the score of the FM assessment scale of the patients was higher than that one month after the operation， and the differences were statistically significant （P < 0.05）. One case of arterial crisis occurred after the operation. After symptomatic treatment， the flap survived successfully. Conclusions Before free flap transplantation and repair of skin and soft tissue defects of the extremities， three-dimensional CTA reconstruction can accurately locate the perforating vessels of the donor site and effectively guide the design of the flap. After the operation， patients experience good wound healing， satisfactory recovery of sensation and limb function， and a low incidence of adverse reactions.