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Objective:To evaluate the clinical applicability of CT angiography (CTA) for locating the perforator vessels of anterolateral thigh flap(ALTF) and the effects of individualized ALTF designed by CTA for the reconstruction of the soft tissue defects of tongue after the resection of tongue carcinoma.Methods:21 patients with tongue squamous cell carcinoma underwent CTA for locating the perforator vessels of ALTFs and for the design of individualized ALTFs before operation.The patients underwent soft tissue defect reconstruction with individualized ALTFs after tumor removal.Results:All the operations came off as preoperative designed,the intraoperative findings of the blood vessel alignment were consistent with the preoperative CTA results.The size of flaps was 6.0 cm × 5.0 cm-11.0 cm× 8.5 cm.20 ALTFs survived,2 ALTFs appeared vascular crisis,1 remained survival and the other was necrotic after surgical exploration.During 6 ～ 60 momhs of follow-up,the survival condition of flaps and the wound healing condition were both satisfactory.1 patient died because of distant metastasis 18 months after operation.20 patients reminded free of carcinoma and satisfied with the reconstructive effects of chewing,swallowing and linguistic function.Conclusion:CTA can accurately locate perforator vessels for the design of individualized AFLT.AFLT designed by CTA is an ideal choice for the reconstruction of postoperative soft tissue defects after resection tongue carcinoma.
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Objective To explore the clinical effects of ankle anterior perforating flaps in reconstruction of the soft tissue defects on dorsum of foot.Methods A retrospective cases series study was done to analyze 11 patients with dorsal skin soft tissue defects:eight males and three females,with age ranging from 18-76 years (mean,43.5 years),treated from January 2009 to March 2017.The sizes of the soft tissues defects varied from 4.0 cm × 3.5 cm to 15.0 cm × 6.0 cm.According to the anatomical basis of ankle anterior perforating flaps,the sizes and shapes of the skin defects of the dorsal ankle,the flaps were designed and harvested in the anterior part of the lower leg to repair the dorsal skin soft tissue defects.The sizes of flaps ranged from 15.0 cm × 6.0 cm to 4.0 cm × 3.2 cm.The clinical effect was evaluated based on the flap survival,infection control,elasticity,color,appearance,scars of the donor sites,skin sensitivity and patient satisfaction.The extent of the flap swellings was also evaluated.Results All ten flaps survived after the surgery.Both the donor and recipient sites healed very well at Ⅰ stage.One case had flap distal phalanx necrosis.After changing the ointments on time,both the donor and recipient sites survived completely.Duration of follow-up was 3-24 months (mean,12 months).The flaps survived very well with good shape,and the color and elasticity were very close to the normal skin nearby.The scars of the donor sites were small and the functions of ankle and foot were satisfactory.Satisfaction extents of treatment efficacy were good in nine patients and general in two,with no unsatisfaction.Flap swelling classification were nine cases of degree Ⅱ and two cases of degree Ⅲ in early stage while 11 cases of degree Ⅰ in later stage.Conclusions The ankle anterior perforating flap has constant perforating blood vessels,reliable blood supply,high survival rate of flaps and hence is one of the simple,safe and optimal ways to repair the dorsal skin soft tissue defects.
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Introducción: Los colgajos de perforantes se han convertido en una opción de cobertura válida cada vez más utilizada en cirugía reconstructiva. Se caracterizan porque requieren de la identificación preoperatoria y disección intraoperatoria del vaso perforante. El objetivo del presente trabajo fue evaluar el Angio TC en el estudio preoperatorio de los vasos perforantes y su correlación con los hallazgos intraoperatorios. Material y Métodos: Análisis retrospectivo de todos los colgajos de perforantes realizados en la Unidad de Cirugía Plástica del Hospital Clínico de la Universidad de Chile entre junio de 2009 y junio de 2012. A todos los pacientes se les solicitó un Angio TC según el protocolo de la Universidad de Gent (Bélgica). Se utilizaron puntos de referencias específicos y un sistema de coordenadas para localizar el punto en el cual la perforante cruza la fascia superficial. La información entregada por el Angio TC se comparó con los hallazgos quirúrgicos. Resultados: A un total de 41 pacientes se les realizó Angio TC para la planificación de un colgajo de perforante durante el período en estudio, 40 fueron operados: 18 mujeres y 22 hombres, edad promedio de 46,6 +/- 5,7 años. Se realizaron los siguientes colgajos: Anterolateral de Muslo (ALT) = 14, Epigástrica Inferior (DIEP) = 18, Glútea Superior (SGAP) = 5, Tibial Posterior (PTAP) = 4 y Toracodorsal (TDAP) = 2. En todos ellos el Angio TC ubicó una o varias perforantes en forma precisa y 100 por ciento concordante con los hallazgos intraoperatorios. Conclusiones: El Angio TC es un examen con alto rendimiento en la identificación preoperatoria del vaso perforante y su trayecto. Es una herramienta de gran ayuda al momento de planificar la realización de este tipo de colgajos.
Introduction: Perforator flaps have become a coverage option validated and increasingly used in reconstructive surgery. These flaps require preoperative identification and intraoperative dissection of the perforator vessels. The aim of this study was to evaluate the use of Angio CT in the preoperative assessment of perforating vessels and its correlation with intraoperative findings. Material and Methods: We retrospectively reviewed all perforator flaps performed at the Division of Plastic Surgery, University of Chile Clinical Hospital between June 2009 and June 2012. All patients were asked for an Angio CT according to the protocol of the University of Gent (Belgium). Data points were used and a specific coordinate system to locate the point at which the perforator vessel fenestrate the deep fascia. The information provided in the Angio CT was compared with surgical findings. Results: A total of 41 patients underwent perforator flap planning during the study period. 40 underwent surgery: 18 women and 22 men, with a mean age of 46.6 ± 5.7 years. Flaps were performed as follows: anterolateral thigh (ALT) = 14, inferior epigastric (DIEP) = 18, superior gluteal (SGAP) = 5, posterior tibial (PTAP) = 4 and thoracodorsal (TDAP) = 2. In all cases the Angio CT identified one or more perforator vessel with a 100% concordance with intraoperative findings. Conclusions: CT Angio is a test with high performance in preoperative characterization of perforator vessels. It is a helpful tool that must be considered whenever planning this type of flaps.
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Humans , Male , Adult , Female , Middle Aged , Angiography/methods , Surgical Flaps/blood supply , Preoperative Care , Plastic Surgery Procedures/methods , Tomography, X-Ray Computed/methods , Retrospective StudiesABSTRACT
Objective To assess the deep inferior epigastric perforator (DIEP) vessels in patients with breast reconstruction flaps by contrast-enhanced ultrasound (CEUS) and three-dimensional ultrasound (3DUS) reconstruction techniques.Methods Conventional ultrasound,CEUS and 3DUS were used to evaluate DIEP vessels of breast reconstruction flaps in 43 patients before surgical procedures.The identification,localization and spatial relationship of DIEP vessels were analyzed with conventional ultrasound,CEUS and 3DUS methods.The findings of CEUS and 3DUS were compared to conventional ultrasound and surgical outcome.Results Compared to CDFI,40 cases (93％) were observed more clearly with CEUS,and were showed more accurately than conventional ultrasound.41 cases (95％) could be displayed wonderfully in 3D ultrasound.Perforators which were detected by ultrasound were confirmed in the surgery and the transferred flaps survived completely.Conclusions Perforators can be displayed more clearly and located more accurately by CEUS and 3DUS.CEUS and 3DUS could play a very important role in the preoperative navigation of the DIEP than conventional ultrasound.