Anteromedial thigh septocutaneous perforator flap as a first choice for head and neck reconstruction: A clinical algorithm based on perforator-pedicle relationship

Ma, Chunyue; Gao, Wen; Abdelrehem, Ahmed; Zhu, Dan; Zhu, Yaxin; Sun, Jian; Shen, Yi

doi:10.1016/j.oraloncology.2022.105738

Cited by 6 publications

(4 citation statements)

References 25 publications

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“…Therefore, it was necessary to simulate the intraoperative body position performance in the clinical practice, so as to improve the accuracy of CTA examination. In conclusion, CTA under the UNet algorithm had a definite advantage over B-mode US in perforator localization of ALTF, which was similar to the findings of Ma et al [ 27 ].…”

Section: Discussionsupporting

confidence: 89%

See 1 more Smart Citation

Computed Tomography Angiography and B‐Mode Ultrasonography under Artificial Intelligence Plaque Segmentation Algorithm in the Perforator Localization for Preparation of Free Anterolateral Femoral Flap

Shen

Huang

et al. 2022

Contrast Media & Molecular Imaging

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This research was aimed to investigate the accuracy of U-shaped network (UNet)-based computed tomography angiography (CTA) and B-mode ultrasonography (US) in the perforator localization of free anterolateral thigh flap (ALTF). Based on UNet, a fusion of deep supervision mechanism, squeeze-and-excitation module, and attention mechanism was introduced to optimize the algorithm. Then, a CTA segmentation model, DA-UNet, was established. The segmentation performance of DA-UNet and other algorithms was compared under the same conditions. 30 patients who were planned to receive ALTF surgery were selected as the research objects. According to different preoperative localization methods, they were divided into group A (CTA) and group B (B-mode US), 15 cases in each group. Combined with the actual situation during surgery, the diagnostic accordance rate, sensitivity (Sen), specificity, and the distance between the perforator location and the actual location were compared between the two groups. The Dice coefficient, Jaccard index, Sen, the area under curve (AUC), and average Hausdorff distance (AVD) of the DA-UNet segmentation algorithm were 80.70%, 69.97%, 77.56%, 0.887, and 2.48, respectively. These results were significantly better than those of other algorithms ( P < 0.05 ). In group A, the diagnostic accordance rate, Sen, and specificity of patients were 96.55%, 90.52%, and 73.58%, respectively, which were higher than 91.53%, 81.36%, and 15.60% of patients in group B significantly ( P < 0.05 ). There was no statistical difference in the distance between the perforator location and the actual location ( P > 0.05 ). It showed that the accuracy of CTA under the UNet-based DA-UNet segmentation model in the perforator localization of ALTF was better than that of B-mode US. Thus, a reference could be provided for the preparation of free ALTF and its clinical application.

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Section: Discussionsupporting

confidence: 89%

“…In conclusion, CTA under the UNet algorithm had a de nite advantage over B-mode US in perforator localization of ALTF, which was similar to the ndings of Ma et al [27].…”

Section: Discussionsupporting

confidence: 87%

Computed Tomography Angiography and B‐Mode Ultrasonography under Artificial Intelligence Plaque Segmentation Algorithm in the Perforator Localization for Preparation of Free Anterolateral Femoral Flap

Shen

Huang

et al. 2022

Contrast Media & Molecular Imaging

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“…In this retrospective study, we collected information for all the patients undergoing PAPFs for postoncologic head and neck reconstructions in our institution. Computed tomography angiography (CTA) was performed preoperatively to find appropriate perforators in every PAPF candidate, as has been described 16 . Handheld Doppler ultrasound was used to confirm vascular locations intraoperatively.…”

Section: Methodsmentioning

confidence: 99%

“…Computed tomography angiography (CTA) was performed preoperatively to find appropriate perforators in every PAPF candidate, as has been described. 16 Handheld Doppler ultrasound was used to confirm vascular locations intraoperatively. The clinicopathologic data were gathered via chart review.…”

Section: Methodsmentioning

confidence: 99%

Profunda Artery Perforator Flaps From the Posteromedial Region of the Thigh for Head and Neck Reconstruction

Gao

Zhu

et al. 2022

Otolaryngol.--head neck surg.

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Objective Profunda femoris artery perforator flaps (PAPFs) have not been widely used in head and neck reconstructions. The feasibility and outcomes of PAPFs for various head and neck reconstructions need to be investigated. Study Design Retrospective analysis. Setting A single-institution review. Methods PAPFs were utilized in head and neck reconstructions from 2019 to 2021. Local anatomy, surgical technique, and complications were discussed. Chimeric PAPF applications with muscle components were described for coverage of extensive multiunit defects. Additionally, aesthetic and functional outcomes were compared with anterolateral thigh perforator flaps. Results A total of 33 cases were included. The average age was 54.2 years (range, 30-74). The most common underlying pathology was oral squamous cell carcinoma (n = 26, 78.8%), while the mean ± SD body mass index was 25.4 ± 2.8 kg/m2. Middle perforators (n = 14, 42.4%) were the most commonly utilized ones. The perforator-based chimeric/composite applications were used in 9 (27.3%), with the muscular components consisting of gracilis (n = 3, 9.1%), adductor magnus (n = 5, 15.2%), or semimembranosus muscles (n = 1, 3.0%). Venous thromboses of the PAPFs were found in 2 (6.1%), though salvaged. The occurrence of postoperative 90-day morbidity (complication) was related to mandibulectomy/maxillectomy ( P = .020). Postoperative validated questionnaires showed a trend of intermediate to high scores, indicating noninferior outcomes in several categories, when compared with the anterolateral thigh perforator flap counterparts. Conclusion PAPFs are a good reconstructive alternative for intermediate to large head and neck reconstructions. Besides, PAPFs can provide sufficient tissue volume and versatility of potentially incorporating adjacent muscle components.

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Application of tensor fascia lata perforator flap in head and neck reconstruction

Wang,

Ma,

Shen

et al. 2024

International Journal of Oral and Maxillofacial Surgery

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Anteromedial thigh septocutaneous perforator flap as a first choice for head and neck reconstruction: A clinical algorithm based on perforator-pedicle relationship

Cited by 6 publications

References 25 publications

Computed Tomography Angiography and B‐Mode Ultrasonography under Artificial Intelligence Plaque Segmentation Algorithm in the Perforator Localization for Preparation of Free Anterolateral Femoral Flap

Computed Tomography Angiography and B‐Mode Ultrasonography under Artificial Intelligence Plaque Segmentation Algorithm in the Perforator Localization for Preparation of Free Anterolateral Femoral Flap

Profunda Artery Perforator Flaps From the Posteromedial Region of the Thigh for Head and Neck Reconstruction

Application of tensor fascia lata perforator flap in head and neck reconstruction

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