Preoperative imaging evaluation in anterolateral thigh flap: comparison of computed tomography angiography and handheld Doppler

Abstract

Objective To assess the accuracy of preoperative computed tomography angiography(CTA) and handheld Doppler (HHD) perforator body surface mapping for the point of anterolateral thigh (ALT) flap perforators through the deep fascia. Methods From March, 2014 to March, 2015, 19 patients underwent both CTA and HHD to donor site flap perforator exploration and body surface mapping before ALT flap transfer surgery, and the accuracy, sensitivity and specificity of CTA and HHD perforator body surface mapping were compared with the actual intraoperative findings. Results All of the ALT flaps survived except 1 case necrose cause by serious infection of recipient site. The 55, 55, 58 perforators were detected by CTA, HHD and actual intraoperative findings, respectively. The accuracy, sensitivity and specificity of CTA and HHD perforator body surface mapping were 89.23%, 91.38%, 71.43% and 74.24%, 82.76% and 12.50%, respectively. The distance of between the actual intraoperative findings and CTA, HHD were (11.13 ± 5.89), (13.73 ± 15.50) mm (t=-1.13, P>0.05). Conclusion This study demonstrates that CTA is a reliably and effective technology in preoperative flap perforator exploration and body surface mapping, which is more effective and accurate than HHD. Key words: Lateral femoral circumflex artery, Perforator; Anterolateral thigh perforator flap; Computer tomography angiography; Handheld Doppler