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

Zhongjie Wang; Xiaoping Yi; Jiqiang He; Liming Qing; Zhengbing Zhou; Youming Zhang; Zhiming Zhu; Chunhui Zhou; Hui Xie; Xuejun Li; Chishing Zee; Bihong T. Chen

doi:10.1055/s-0038-1672129

Journal of Reconstructive Microsurgery, Inhaltsverzeichnis

J Reconstr Microsurg 2019; 35(03): 221-228
DOI: 10.1055/s-0038-1672129

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Autor*innen

Zhongjie Wang

¹Department of Neurology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Xiaoping Yi

²Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Jiqiang He

³Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China
Liming Qing

³Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China
Zhengbing Zhou

³Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China
Youming Zhang

²Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Zhiming Zhu

²Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Chunhui Zhou

²Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Hui Xie

²Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Xuejun Li

¹Department of Neurology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
Chishing Zee

⁴Department of Radiology, Keck Medical Center of USC, Los Angeles, California, United States
Bihong T. Chen

⁵Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California, United States

Abstract

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.

Keywords

CT angiography - catheter-based CTA - anterolateral thigh flap - perforator mapping - reconstructive surgery - limb trauma - digital subtraction angiography

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Referenzen

References
1 Song YG, Chen GZ, Song YL. The free thigh flap: a new free flap concept based on the septocutaneous artery. Br J Plast Surg 1984; 37: 149-159
2 Chiu WK, Lin WC, Chen SY. , et al. Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect. ANZ J Surg 2011; 81 (03) 142-147
3 Cigna E, Chen HC, Ozkan O, Sorvillo V, Maruccia M, Ribuffo D. The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study. Plast Reconstr Surg 2014; 133 (02) 420-429
4 Lee YC, Chen WC, Chou TM, Shieh SJ. Anatomical variability of the anterolateral thigh flap perforators: vascular anatomy and its clinical implications. Plast Reconstr Surg 2015; 135 (04) 1097-1107
5 Pratt GF, Rozen WM, Chubb D, Ashton MW, Alonso-Burgos A, Whitaker IS. Preoperative imaging for perforator flaps in reconstructive surgery: a systematic review of the evidence for current techniques. Ann Plast Surg 2012; 69 (01) 3-9
6 Garvey PB, Selber JC, Madewell JE, Bidaut L, Feng L, Yu P. A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps. Plast Reconstr Surg 2011; 127 (04) 1505-1514
7 Rozen WM, Ashton MW, Pan WR. , et al. Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study. Microsurgery 2009; 29 (01) 16-23
8 Jiang C, Lin P, Fu X. , et al. Three-dimensional contrast-enhanced magnetic resonance angiography for anterolateral thigh flap outlining: A retrospective case series of 68 patients. Exp Ther Med 2016; 12 (02) 1067-1074
9 De Beule T, Van Deun W, Vranckx J, de Dobbelaere B, Maleux G, Heye S. Anatomical variations and pre-operative imaging technique concerning the anterolateral thigh flap: guiding the surgeon. Br J Radiol 2016; 89 (1063): 20150920
10 Syed F, Spector ME, Cornelius R, Srinivasan A. Head and neck reconstructive surgery: what the radiologist needs to know. Eur Radiol 2016; 26 (10) 3345-3352
11 Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg 2010; 63 (09) e674-e682
12 Onoda S, Azumi S, Hasegawa K, Kimata Y. Preoperative identification of perforator vessels by combining MDCT, Doppler flowmetry, and ICG fluorescent angiography. Microsurgery 2013; 33 (04) 265-269
13 Ensat F, Babl M, Conz C. , et al. The efficacy of color duplex sonography in preoperative assessment of anterolateral thigh flap. Microsurgery 2012; 32 (08) 605-610
14 Chen SY, Lin WC, Deng SC. , et al. Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. Eur J Surg Oncol 2010; 36 (10) 1004-1011
15 Kim EK, Kang BS, Hong JP. The distribution of the perforators in the anterolateral thigh and the utility of multidetector row computed tomography angiography in preoperative planning. Ann Plast Surg 2010; 65 (02) 155-160
16 Ribuffo D, Atzeni M, Saba L. , et al. Clinical study of peroneal artery perforators with computed tomographic angiography: implications for fibular flap harvest. Surg Radiol Anat 2010; 32 (04) 329-334
17 Ribuffo D, Atzeni M, Saba L, Milia A, Guerra M, Mallarini G. Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting. Ann Plast Surg 2009; 62 (04) 368-371
18 Rozen WM, Ribuffo D, Atzeni M. , et al. Current state of the art in perforator flap imaging with computed tomographic angiography. Surg Radiol Anat 2009; 31 (08) 631-639
19 Zhang Y, Pan X, Yang H, Yang Y, Huang H, Rui Y. Computed tomography angiography for the chimeric anterolateral thigh flap in the reconstruction of the upper extremity. J Reconstr Microsurg 2017; 33 (03) 211-217
20 McConnell MF, Garvey PB, Amini B, Haygood TM, Madewell JE, Costelloe CM. VIDEO: preoperative CT angiography for anterolateral thigh flap reconstructions. Am J Roentgenol 2017; 208 (03) W127
21 Yu P. Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction. Head Neck 2004; 26 (09) 759-769
22 Miyamoto S, Fujiki M, Kawai A, Chuman H, Sakuraba M. Anterolateral thigh flap for axillary reconstruction after sarcoma resection. Microsurgery 2016; 36 (05) 378-383
23 Lu JC, Zelken J, Hsu CC. , et al. Algorithmic approach to anterolateral thigh flaps lacking suitable perforators in lower extremity reconstruction. Plast Reconstr Surg 2015; 135 (05) 1476-1485

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