Three‐Dimensional Digitalized Virtual Planning of Free Anterior Tibial Artery Perforator Flap for Repairing Soft Tissue Defects in Extremities

Abstract

Background Traditional research methods have limited the application of anterior tibial artery perforator flap due to incomplete knowledge of the perforator. This study aimed to investigate the feasibility of three‐dimensional digitalized virtual planning of free anterior tibial artery perforator flap for repairing soft tissue defects in extremities. Methods A total of 11 patients with soft tissue defects in extremities were included. The patient underwent computed tomography angiography (CTA) of bilateral lower limbs, and then the three‐dimensional models of bones, arteries, and skin were constructed. Septocutaneous perforators with appropriate length and diameter were selected to design anterior tibial artery perforator flaps in software, and the virtual flaps were superimposed onto the patient's donor site in a translucent state. During the operation, the flaps were dissected and anastomosed to the proximal blood vessel of the defects as designed. Results Three‐dimensional modeling showed clear anatomical relationships between bones, arteries, and skin. The origin, course, location, diameter, and length of the perforator obtained during the operation were consistent with those observed preoperatively. Eleven anterior tibial artery perforator flaps were successfully dissected and transplanted. Postoperative venous crisis occurred in one flap, partial epidermis necrosis occurred in another flap, while the remaining flaps completely survived. One flap was treated with debulking operation. The remaining flaps maintained aesthetic appearance, which did not affect the function of the affected limbs. Conclusions Three‐dimensional digitalized technology can provide comprehensive information on anterior tibial artery perforators, thus assisting in planning and dissecting patient‐specific flaps for repairing soft tissue defects in extremities.

Computed tomography angiography-guided precise flap surgery: a new strategy for flap selection, mapping and harvesting

“…Vascular supply at donor and recipient sites can vary significantly by individual [ 1 ]. In our clinical practice, we have found that computed-tomography angiography (CTA) not only accurately locates vascular structures but also provides high-throughput data on soft-tissue structures at the recipient and donor sites, which can aid in the selection of an optimal flap [ 2 , 3 ]. Therefore, we have developed a new surgical strategy, precise flap surgery based on CTA, to guide optimal flap selection and preparation.…”

Evaluation of Feasibility of Medial Plantar Artery Flap With Computed Tomography Angiography in Diabetic Patients: A Pilot Radioanatomic Study

“…The treatment of diabetic foot infections involves the surgical removal of the source of infection, isolation of causative pathogens, initiation of antibiotic treatment, optimization of host factors, and other adjunctive treatments [6][7][8][9][10]. Despite a better understanding of the pathophysiology and treatment of diabetic foot infection, one of the challenges encountered by the physicians treating these patients is wound healing [11][12][13][14][15][16][17]. Despite the recent advancements in wound dressing technologies and products, the wound healing process remains slow.…”

“…Despite the recent advancements in wound dressing technologies and products, the wound healing process remains slow. Surgical interventions, such as skin grafting and flap coverage, can expedite wound coverage [11][12][13][14][15][16][17][18].…”