Abstract
Purpose: To evaluate the utility of 64-multidetector computed tomographic (CT) angiography with 3D reformations for preoperative vascular anatomy evaluation, lateral femoral circumflex artery and course of perforator vessels assessment in anterolateral thigh flap planning. Material and Methods: Informed consent and institutional review board approval were obtained. Seven patients underwent 64-multidetector CT angiography to identify the lateral femoral circumflex artery perforators prior to oncologic and post-traumatic reconstruction surgery (3/7 patients analyzed bilaterally). Preoperative color Doppler US evaluation was performed. Surgical findings were correlated to imaging using a 0-3 scale Image Relevance Score (IRS) of the multidetector CT. Results: Perforator arteries suitable for surgery were identified in 7/7 patients. Surgical findings were consistent with CT findings for perforator caliber and course. CT identified several anatomical variants. In 1 patient preoperative imaging was performed with no difference in management (IRS=0); in 3 patients moderate intraoperative difficulties were found with increase of operative time (IRS=1); in 2 patients major intraoperative difficulties were encountered, with need for intraoperative change of surgical technique (IRS=2). In the remaining patient CT findings avoided surgical failure (IRS=3). Conclusion: 64-multidetector CT angiography accurately mapped vessels for preoperative evaluation of lateral femoral circumflex artery perforators in anterolateral thigh flap planning in 7 patients.
Highlights
The anterolateral thigh flap (ALTF) was popularized for clinical applications by Song et al and later modified by Koshima [1,2]
Surgical findings were consistent with computed tomographic (CT) findings for perforator caliber and course
In 1 patient preoperative imaging was performed with no difference in management (IRS=0); in 3 patients moderate intraoperative difficulties were found with increase of operative time (IRS=1); in 2 patients major intraoperative difficulties were encountered, with need for intraoperative change of surgical technique (IRS=2)
Summary
The anterolateral thigh flap (ALTF) was popularized for clinical applications by Song et al and later modified by Koshima [1,2]. Advantages of ALTF include reduced donor site morbidity, long pedicle with excellent vessel diameter, availability of different tissues with a large amount of skin and vascular adaptability [5]. ALTF is used in various anatomic sites in oncologic and traumatic settings [4,5,6,7,8]. This flap is technically difficult requiring intricate perforator dissection. Most cutaneous vessels are located in a circle with a 3 cm radius centered at this point and usually the most proximal perforators is chosen because of its relatively large diameter
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