Improved three-dimensional CTA reconstruction of perforator area in the application of anterolateral thigh perforator flap and deep inferior epigastric artery perforator flap / 中华显微外科杂志

ABSTRACT

Objective:To investigate the clinical value of improved perforator area CTA three-dimensional reconstruction in design and harvest of anterolateral thigh perforator flap(ALTPF) and deep inferior epigastric artery perforator flap(DIEPF).Methods:Repairs of defects of oral and maxillofacial tumour resection with ALTPF for 8 patients and defects of breast tumour resection with DIEPF for 2 patients were performed from September 2021 to January 2022 in the Department of Hand and Microsurgery of Affiliated Hospital of Binzhou Medical College. According to the improved scanning parameters and drug administration protocol, patients underwent CTA scans of both thighs or abbomen before operation. The data of CTA were sent to GE AW 4.7 work station to produce three-dimensional reconstruction of perforator area and angiosome. The source artery and perforator were observed dynamically from the angiosome in the perforator area, and the specific data were measured. The perforator location was marked by HHD, and then according to the measurement data of CTA three-dimensional reconstruction marked the location, course of perforator and the course of source artery on the body surface. The data of source arteries and perforators explored during the operation were compared with preoperative three-dimensional reconstruction. The perforator locations of CTA were compared with the HHD. The harvest time and survival condition of flap were compared with the previous patients who only had the perforator location markers from HHD. The sizes of ALTPFs and DIEPFs were 4.0 cm×4.0 cm-15.0 cm×6.0 cm and 19.0 cm×7.5 cm-25.0 cm×10.0 cm, respectively. The survival of flaps and the healing of wound were observed in the postoperative follow-up in terms of appearance, texture, function of recipient site and the shape and function of the donor site.Results:Eight ALTPFs and 2 DIEPFs all survived without any adverse event. Both recipient and donor sites healed well without any complication. Seven femoral septocutaneous perforators, 2 musculocutaneous perforators and abdominal 3 perforators coursed directly, 2 tortuously perforators were seen from three-dimensional reconstruction. The types and origins of perforators explored during operation were basically consistent with three-dimensional reconstruction. The accuracy of CTA[(0.36±0.11) cm] was higher than HHD[(0.54±0.19) cm] for perforators location( t=-3.160, P<0.05). Compared with the previous group[(74.60±30.53) min], this group[(52.80±24.57) min] had a shorter time to cut out the flap of similar area( t=-9.179, P<0.05). In the previous group, one flap transfer was failed due to the thinner caliber of perforator and source artery. All the flaps survived with satisfactory outline and softness with good blood supply after 2-6 months of follow-up. The oral and maxillofacial functions were normal. The reconstructed breasts were symmetrical with the healthy side, and the shape was satisfactory. Only linear scars remained in the donor sites without dysfunction. Conclusion:The improved CTA three-dimensional reconstruction of perforator area can help to determine the detailed location, course and distribution of the perforators at the superficial fascia layer. It provides a reliable bases in the design and harvest of perforator flaps during operation, reduces the perioperative risks and has certain clinical values.