Application of MDCTA in free Flow-through anterolateral thigh flap for reconstructing the combined limb soft tissue with main vascular defect

Abstract

Objective To evaluate the clinical value of MDCTA (Multi-detector computed tomographic angiography) in reconstruction of the soft tissue defect of the limbs combined with the main vascular defects by using Flow-through anterolateral thigh flap. Methods From September, 2013 to May, 2016, 12 cases of limb soft tissue with main vascular defects were examined by MDCTA. The length of vascular defect was measured. The length of bridging vessel needed to design a Flow-through anterolateral thigh flap was measured. The points of anterolateral thigh flap perforator were positioned. The relationship between the perforation and the trunk vascular pedicle was defined. The outcomes were evaluated based on Berton scores for upper extremities and John-Wruh scores for lower extremities. Results The length of the main vascular defects, the positions of flap perforators and the configuration of vascular pedicles were successfully imaged through MDCTA. The length of the main vascular defects were 5-12 cm, which was consistent with the intraoperative findings. The length of bridging vessel for the defects were 7-14 cm, which was enough for the vascular defects. There were not vessel grafts. Twenty perforators were imaged by MDCTA preoperatively, and 22 perforators were found during the operations, which means 2 perforators were not imaged. All flaps survived completely. All patients were followed-up from 6 to 21 months (average, 11 months) . According to the Berton scores for upper extremities and John-Wruh scores for lower extremities, the excellent/good were 6 in 8 cases and 4 in 4 cases, respectively. Conclusion MDCTA can be used to evaluate the pedicle conditions of the free Flow-through anterolateral thigh flap for the reconstructions. It is worthy to be popularized in clinical application. Key words: Anterolateral thigh flap, Flow-through flap; Extremities; Vascular defect; MDCT angiography; Repair