Abstract:

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.

Key words: skin and soft tissue defects, limbs, free flap transplantation, CT angiography, three-dimensional reconstruction