Application of multidetector-row computed tomography angiography in soft tissue defect of lower extremities with perforator flap / 中华显微外科杂志

ABSTRACT

Objective Significant anatomical variability of perforator vessel can affect the perforator flap application in accuracy,randomness,and the final result of the repair.Multidetector-row computed tomography angiography(MDCTA) is an useful preoperative identification of perforator vessel,and which is discussed as a guidance to the clinical utilities of free-style perforator flap in lower extremity.Methods From February 2011 to December 2012,forty patients with soft tissue defects in lower extremity were treated.Preoperatively MDCTA was performed on all patients to assess features of the perforating branches,including their location,caliber,course,structure and relationship of neighboring tissues.Various perforator flaps for soft tissue reconstruction using dominant perforator vessels were designed.Moreover the coincidence rate between preoperative and intraoperative location of the perforator vessel was evaluated.Results All the flaps which consisted of 19pedicled propeller flaps and 21 free flaps survived postoperatively.Only 1 case which involved the descending genicular artery perforator flap presented with a 2 cm × 2 cm distal necrosis which healed after regular dressing.For 37 cases,the donor site were primarily closed while partial skin grafting was performed in 3 cases.The rate of coincidence between the preoperative and intraoperative location of perforating branches was 97.5％.Conclusion Preoperative MDCTA can provide precise anatomical information on the perforator vessel.For sofi tissue defects reconstruction in the lower extremity,MDCTA makes the flap design easier and more accurate,and the surgery simpler and safer,thereby reducing damage to donor site and achieving the best repair.