Computed Tomography Angiography for the Chimeric Anterolateral Thigh Flap in the Reconstruction of the Upper Extremity

2016 ◽  
Vol 33 (03) ◽  
pp. 211-217 ◽  
Author(s):  
Yan Zhang ◽  
Xiaoyun Pan ◽  
Hong Yang ◽  
Ying Yang ◽  
Hai Huang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Upper Extremity ◽  
Computed Tomography Angiography ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Reece Moore ◽  
Donna Mullner ◽  
Georgina Nichols ◽  
Isis Scomacao ◽  
Fernando Herrera
Keyword(s):  
Computed Tomography ◽  
Doppler Ultrasound ◽  
Computed Tomography Angiography ◽  
False Positive ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Preoperative Imaging ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh ◽  
Alt Flap

Abstract Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature. Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed. Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA. Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

Computed tomography angiography imaging for the chimeric anterolateral thigh flap in reconstruction of full thickness buccal defect

2010 ◽  
Vol 81 (3) ◽  
pp. 142-147 ◽  
Author(s):  
Wen-Kuan Chiu ◽  
Wen-Chiung Lin ◽  
Shih-Yi Chen ◽  
Wei-Da Tzeng ◽  
Shao-Cheng Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Anterolateral Thigh Flap ◽  
Full Thickness ◽  
Anterolateral Thigh

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

2018 ◽  
Vol 35 (03) ◽  
pp. 221-228 ◽  
Author(s):  
Zhongjie Wang ◽  
Jiqiang He ◽  
Liming Qing ◽  
Zhengbing Zhou ◽  
Youming Zhang ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
False Negative ◽  
False Negative Rate ◽  
Chinese Patients ◽  
Trauma Patients ◽  
Anterolateral Thigh ◽  
Limb Trauma ◽  
Extremity Reconstruction ◽  
Better Than

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.

scholarly journals Aesthetic and Functional Outcomes of the Innervated and Thinned Anterolateral Thigh Flap in Reconstruction of Upper Limb Defects

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Carlos Alberto Torres-Ortíz Zermeño ◽  
Javier López Mendoza
Keyword(s):  
Upper Extremity ◽  
Free Flaps ◽  
Sensory Function ◽  
Anterolateral Thigh Flap ◽  
Level Of Evidence ◽  
Average Percentage ◽  
Aesthetic Result ◽  
Anterolateral Thigh ◽  
Good Cosmetic ◽  
Alt Flap

Background. The anterolateral thigh (ALT) flap has been widely described in reconstruction of the upper extremity. However, some details require refinement to improve both functional and aesthetic results. Methods. After reconstruction of upper extremity defects using thinned and innervated ALT flaps, functional and aesthetic outcomes were evaluated with the QuickDASH scale and a Likert scale for aesthetic assessment of free flaps, respectively. Results. Seven patients with a mean follow-up of 11.57 months and average flap thickness of 5 mm underwent innervation by an end-to-end neurorrhaphy. The average percentage of disability (QuickDASH) was 21.88% with tenderness, pain, temperature, and two-point discrimination present in 100% of cases, and the aesthetic result gave an overall result of 15.40 (good) with the best scores in color and texture. Conclusions. Simultaneous thinning and innervation of the ALT flap lead to a good cosmetic result and functional outcome with a low percentage of disability, which could result in minor surgical procedures and better recovery of motor and sensory function. Level of Evidence. IV.

Angio Computed Tomography Preoperative Evaluation for Anterolateral Thigh Flap Harvesting

2009 ◽  
Vol 62 (4) ◽  
pp. 368-371 ◽  
Author(s):  
Diego Ribuffo ◽  
Matteo Atzeni ◽  
Luca Saba ◽  
Arianna Milia ◽  
Maristella Guerra ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Preoperative Evaluation ◽  
Anterolateral Thigh Flap ◽  
Anterolateral Thigh

Preoperative Computed Tomography Angiography for ALT Flaps Optimizes Design and Reduces Operative Time

2021 ◽  
Author(s):  
Christopher M. Schneider ◽  
Patrick A. Palines ◽  
Daniel J. Womac ◽  
Charles T. Tuggle ◽  
Hugo St Hilaire ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Computed Tomography Angiography ◽  
Operative Time ◽  
Donor Site ◽  
Vascular Anatomy ◽  
Complication Rates ◽  
Anterolateral Thigh ◽  
Extremity Reconstruction ◽  
Alt Flap ◽  
Selection Of

Abstract Background Computed tomography angiography (CTA) has been widely used for perforator mapping in abdominal-based reconstruction, but it is less widespread in the anterolateral thigh (ALT) flap. However, CTA may be quite useful for ALT planning, as this flap has demonstrated substantial variability in intrapatient bilateral vascular anatomy. This study investigated whether standard use of preoperative CTA resulted in selection of the donor extremity with preferential perforator anatomy, and whether this affected operative time and postoperative outcomes. Methods A retrospective review of 105 patients who underwent proposed ALT flap reconstruction was performed. Seventy-nine patients received bilateral lower extremity CTAs, which were evaluated for dominant perforator anatomy (septocutaneous, musculoseptocutaneous, or musculocutaneous). Donor extremity selection was noted, and predicted perforator anatomy was compared with that encountered intraoperatively. Results Among the 73 patients who received bilateral imaging and ultimately received an ALT, congruent findings between imaging and surgical exploration were observed in 51 (69.8%) patients. Thirty (37.9%) patients had asymmetric perforator anatomy between their bilateral extremities on imaging. Among these, the leg with optimal perforator anatomy was selected in 70% of cases. There were no significant reductions among postoperative complication rates, but selection of the donor site with preferential anatomy was associated with a decrease in operative time (p = 0.049) among patients undergoing extremity reconstruction. Conclusion CTA is a useful tool for optimizing donor site selection for ALT flaps and reducing operative time. We believe that standard use of preoperative CTA in ALTs warrants further consideration.

Multidetector Computed Tomography (CT) Analysis of 168 Cases in Diabetic Patients with Total Superficial Femoral Artery Occlusion: Is It Safe to Use an Anterolateral Thigh Flap without CT Angiography in Diabetic Patients?

2017 ◽  
Vol 34 (01) ◽  
pp. 065-070 ◽  
Author(s):  
Youngchul Kim ◽  
Youngchul Suh ◽  
JoonPio Hong ◽  
Hyunsuk Suh
Keyword(s):  
Computed Tomography ◽  
Ct Angiography ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Anterolateral Thigh Flap ◽  
Diabetic Patients ◽  
Circumflex Femoral Artery ◽  
Anterolateral Thigh ◽  
Patients With Diabetes ◽  
Collateral Vessels

Background The superficial femoral artery (SFA) is the most common site of lower extremity atherosclerosis, and collateral vessels from the deep femoral artery (DFA) play an important compensatory role between the iliofemoral segment and the popliteal artery. We examined SFA occlusion and collateral vessel developments in patients with diabetes mellitus using computed tomography (CT) angiography. We also compared the collateral systems from the DFA and the descending branch of the lateral circumflex femoral artery (dbLCFA) in the case of SFA occlusion. Methods We retrospectively reviewed 1,316 sets of CT angiographic data collected from 673 patients with diabetes between 2008 and 2010. The degree of stenosis in each segment of the proximal and distal SFA and the number and size of collateral vessels originating from the DFA and dbLCFA were measured using established scoring systems. In cases where the SFA was occluded, the numbers of collateral vessels originating from the DFA and the dbLCFA vessel were compared. Results The mean occlusion rate of the SFA was 15.6%. We noted that collateral vessels from DFA and dbLCFA were the main circulatory route in cases of occlusions of the SFA. More collateral vessels developed from the DFA than from the dbLCFA. Overall, 0.6% of the patients had only collateral systems from the dbLCFA. Conclusion When planning to use anterolateral thigh free flaps in diabetic patients with suspected SFA total occlusion, thorough investigations of the peripheral vessels are essential.

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