Angio Computed Tomography Preoperative Evaluation for Anterolateral Thigh Flap Harvesting

Abstract

The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction.

Further experience with the free soleus perforator flaps using CT-angiography as a planning tool – A preliminary study

“…Sensitivity and specificity were found to be less reliable in audible Dopplers and was dependent on the type of handheld Doppler used; moreover, the investigator's experience plays an important role when mapping the vessels (Tsukino et al, 2004;Yu and Youssef, 2006;Khan and Miller, 2007). To overcome these problems, CTA was proposed as a method independent from the experience of the investigator (Schaverien et al, 2008;Ribuffo et al, 2009;Rozen et al, 2009). In prospective studies, higher success rates with less complications were evident after planning perforator flaps using CTA (Rozen et al, 2008;Rozen et al, 2009).…”

Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance

“…In our opinion, ultrasound can be used as an adjunct technique but to access more precise data, a more advanced imaging technology is required. Angiographic CT has emerged as an outstanding noninvasive operator-independent option (Schaverien et al, 2008;Ribuffo et al, 2009;Rozen et al, 2009b). This imaging modality has become increasingly utilized in the delineation of the deep inferior epigastric artery perforator in breast reconstruction with a free rectus abdominis musculocutaneous (RAM) flap.…”

“…With advances in image acquisition and data analysis, more precise and detailed information about the vascular anatomy can be acquired using multidetector computed tomographic angiography (CTA) (Ribuffo et al, 2009). CTA has been shown to be highly accurate in demonstrating the intramuscular, subfascial, and subcutaneous segments of individual perforators, with reported high sensitivity and specificities (Rozen et al, 2008).…”

The Anteromedial Thigh Free Flap Anatomy

“…8,10,11,28 (13) The thinness and pliability of the anteromedial thigh flap skin (better than that of the anterolateral thigh flap) 12 allow surgeons to tailor the skin in the desired fashion, thanks to the dense plexus network. [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] (14) As with the anterolateral thigh flap ,47 (compared with which it seems to have a more dense dermal plexus), 32 it can be trimmed to the subdermal fat level, except for a limited area around the pedicle entry to the flap.…”

“…According to our experience, 6,25,38,39 and previous large clinical reports 7,21,40 on anterolateral thigh flap anatomy as well as on recent selective radiological studies of the descending branch, [41][42][43] we then suppose that the so-called medial descending branch is at the same time the artery, and the innominate perforator described by Song supplying the anteromedial thigh skin is the vessel that we call the "oblique" branch of the lateral circumflex femoral artery. Anyway, it is clear that its reliability is much more than the 46 percent described in the anatomical study as being a branch of the lateral circumflex femoral artery-in our combined clinical and dissection groups, a total of 75 of 108 cases (70 percent), with 10 clinical cases (83.3 percent), 39 cases in the anatomical study (81 percent), and 26 cases in the cadaver study (54.5 percent).…”