Three-dimensional contrast-enhanced magnetic resonance angiography for anterolateral thigh flap outlining: A retrospective case series of 68 patients

Abstract

Flap transfer is increasingly used for repairing limb defects secondary to trauma or tumor, and appropriate preoperative planning plays a critical role. The present study aimed to examine the use of three-dimensional (3D) contrast-enhanced magnetic resonance angiography (CE-MRA) in evaluating the blood supply distribution and perforating branch pattern of anterolateral thigh (ALT) flaps. Bilateral donor lower limbs were scanned in 68 patients (136 limbs) using a Siemens Avanto 1.5 T magnetic resonance imaging scanner with a 3D fast low-angle shot sequence, following the thin-slab maximum intensity projection (TS-MIP) technique. The lateral femoral circumflex artery (LFCA) was visualized in all patients: 101 limbs (101/136, 74.3%) were type I; 20 limbs (20/136, 14.7%) were type II; 3 limbs (3/136, 2.2%) were type III; and 12 limbs (12/136, 8.8%) were type IV. Tertiary branches were identified in 94 limbs (94/136, 69.1%). Donor flaps were outlined according to MRA TS-MIP findings in 4 patients. All flaps survived uneventfully following the transfer. In donor flap outlining, 3D CE-MRA with the TS-MIP technique allowed an accurate, direct visualization of the branching pattern and distribution profile of the LFCA supplying the ALT flap.

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

“…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.…”

“…Most importantly, preoperative mapping information has been sought as a profound strategy to influence surgeons to optimize the reconstructive strategy and thus maximize operative success. 5,[8][9][10] Almost all available imaging modalities have been proposed for the preoperative evaluation of perforators, 5,11 including hand-held Doppler (HHD), color duplex sonography (CDS), digital subtraction angiography (DSA), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). Regarding the accuracy, there is emerging evidence supporting the use of CTA as a preferred method.…”

ZNF667 attenuates leukocyte‐endothelial adhesion via downregulation of P‐selectin in skin flap following remote limb ischemic preconditioning

“…We found that the microvessels of the distal areas had reappeared and that the tissue edema was reduced in the RIPC group. Although longer times are needed to process and measure the perforator arteries with a 3D model, CTA has been widely used to imagine the locations and paths of perforating vessels for flap harvest and transfer, since it can yield much more information than the two‐dimensional CT scans (Jiang et al, 2016; Smit et al, 2010). Here, the results were consistent with the above observation that the imaging of the microvessels and their branches are more clearly observed in flap subjected to RIPC.…”

Noncontrast Magnetic Resonance Imaging of Perforators for Preoperative Evaluation of Anterolateral Thigh Flaps

“… 17 Additional disadvantages of digital subtraction angiography include its radiation exposure and inability to visualize muscles, nerves, and fat. 16 , 18 Radiation exposure is also a limitation of CTA, which has been used to visualize the ALT in other studies. 10 …”