Computed Tomography Angiography for the Chimeric Anterolateral Thigh Flap in the Reconstruction of the Upper Extremity

Zhang, Yan; Pan, Xiaoyun; Yang, Hong; Yang, Ying; Huang, Hai

doi:10.1055/s-0036-1597587

Cited by 20 publications

(25 citation statements)

References 13 publications

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“…In our study, we performed computed tomography angiography (CTA) or color Doppler sonography (CDS) to map perforators before applying an ALT perforator flap to repair soft tissue defects. According to our previous study [16], CTA had a higher sensitivity than CDS for detecting vessels. Therefore, we typically used CTA first to create clear 3D images of the vessels and surrounding structures, as well as to mark the skin.…”

Section: Discussionmentioning

confidence: 83%

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Kang

Pan

et al. 2020

J Orthop Surg Res

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Background: Despite advances in microsurgical techniques of flap transfer, complex upper extremity trauma reconstruction remains a challenge for surgeons. This study aimed to present the outcomes in using flaps in the subacute reconstruction of complex upper extremity injuries. Methods: From July 2013 to December 2016, 35 patients ranging in age from 23 to 69 years with complicated upper extremity traumatic injuries were treated using flap reconstruction in subacute period. The number and causes of injury were 12 machine crush injuries, 18 machine strangulation injuries, two chainsaw accidents, two traffic accidents, and one incident of heavy bruising. Thirty-five patients underwent flap procedures, including 24 anterolateral thigh flaps (68.57%), five latissimus dorsi flaps (14.29%), and six lateral arm flaps (17.14%). Flap sizes ranged from 3 × 4 to 42 × 16 cm 2. The mean time of flap reconstruction was 14 days (range 5-29). During postoperative follow-up, flap appearance, sensory recovery, scarring and satisfaction were assessed. Results: The overall flap survival rate was 94.3%.Two flaps developed partial necrosis, both of which were later treated with skin grafting. Traumatic wound infections occurred in three patients. All upper limb injuries were completely covered. The follow-up periods ranged from 18 to 62 months with an average of 2.9 months. All skin flap textures were soft with varying degrees of pigmentation. Flap sensory recovery was S 1 in three cases, S 2 in eight cases, S 3 in 15 cases, and S 4 in nine cases. There were no donor site complications other than three cases with scar hyperplasia. Conclusions: The severe upper limb soft tissue defects still achieved satisfactory function and appearance with negligible complications and low amputation rates during the subacute period.

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Section: Discussionmentioning

confidence: 83%

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Kang

Pan

et al. 2020

J Orthop Surg Res

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“…Identification of multiple perforators preoperatively is critical in cases of complex reconstructions requiring multiple independent skin paddles or for maximizing flap size. 31,32 Moreover, when the recipient site requires a long pedicle, preoperative CTA allows for the choice of a system with maximal length from LCFA takeoff to the most distal perforator supplying the ALT flap. This can similarly be useful in the setting of a distally based ALT flap wherein proximal thigh flap design and reach to the knee and tibia are essential.…”

Section: Discussionmentioning

confidence: 99%

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Cohen

Abdou

Nolan

et al. 2020

J Reconstr Microsurg

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Abstract Background The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof. Patients and Methods Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected. Results A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m2. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection. Conclusion ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.

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“…By contrast, C-CTA provided a satisfactory mapping efficiency, which was higher than that of T-CTA and any previously reported values. 6,8,12,19,22 Notably, by using the C-CTA technique, we report promising results for demonstrating the presence of perforators, especially the most used perforators (type B) and the most difficultto-detect perforators (type C). 6 More importantly, C-CTA could accurately predict the origin and course if the perforator was detected successfully.…”

Section: Discussionmentioning

confidence: 82%

“…The flaps were raised with a technique that was described previously. 19 Suprafascial dissection was Abbreviations: ALT, anterolateral thigh, A-P line, line between the anterior superior iliac spine and the superior lateral patella; BMI, body mass index; max, maximum; min, minimum; SD standard deviation.…”

Section: Collection Of Intraoperative Data and Comparison With Computmentioning

confidence: 99%

“…11 Recently, CTA was reported to be successfully used in preoperative assessment of ALT perforator flaps. 6,[12][13][14][15][16][17][18][19][20] However, it is still unknown if CTA could also show high predictive efficiency in some patient subgroups, such as the Chinese population, and if a new CTA-based method can be applied to identify perforator flaps that are difficult to detect with traditional methods.…”

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confidence: 99%

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Catheter-Based Computed Tomography Angiography in Anterolateral Thigh Perforator Mapping of Chinese Patients

Wang

et al. 2018

J reconstr Microsurg

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Background During reconstructive surgery, anterolateral thigh (ALT) flap harvest is challenging due to variation and uncertainty in perforator distribution. We performed a pilot study to identify the predictive value of catheter-based computed tomography angiography (C-CTA) and traditional CTA (T-CTA) in ALT perforator mapping for patients whose ALT perforators were difficult to identify. Methods Thirty-four consecutive T-CTA/C-CTA-mapped ALT flaps were evaluated for extremity reconstruction. The perforator location, origin, and course were compared between T-CTA/C-CTA imaging and intraoperative findings. The mapping efficiency of T-CTA and C-CTA was compared thoroughly. Results Among the 34 ALT thigh flaps, 117 (36) of the 130 perforators identified intraoperatively were visible on C-CTA (T-CTA) in a subgroup of Chinese limb trauma patients with limited activity. C-CTA showed a satisfactory efficiency in perforator mapping, which was much better than the efficiency of T-CTA. C-CTA also showed a much better sensitivity (90.00 vs. 27.69%), specificity (94.74 vs. 66.67%), and accuracy (91.07 vs. 36.69%), and a much lower false-positive (1.68 vs. 26.53%), and false-negative rate (10.00 vs. 72.31%). Moreover, C-CTA could accurately predict the origin and septocutaneous or intramuscular course in all identified perforators. All flaps were elevated successfully and survived. Conclusion C-CTA outperforms T-CTA in the preoperative perforator mapping of ALT flaps in a subgroup of Chinese limb trauma patients. C-CTA should be the method of choice for perforator mapping in patients whose ALT flaps are intended for extremity reconstruction.

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Computed Tomography Angiography for the Chimeric Anterolateral Thigh Flap in the Reconstruction of the Upper Extremity

Cited by 20 publications

References 13 publications

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Subacute reconstruction using flap transfer for complex defects of the upper extremity

Perforator Variability of the Anterolateral Thigh Flap Identified on Computed Tomographic Angiography: Anatomic and Clinical Implications

Catheter-Based Computed Tomography Angiography in Anterolateral Thigh Perforator Mapping of Chinese Patients

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