Volume 39 Issue 2
Feb.  2023
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Zhang YH,Cui WJ,Song KX,et al.A prospective study of the perforator evaluation and eccentric design of anterolateral thigh flap based on superficial fascial perforators assisted by modified computed tomography angiography[J].Chin J Burns Wounds,2023,39(2):141-149.DOI: 10.3760/cma.j.cn501225-20220902-00376.
Citation: Zhang YH,Cui WJ,Song KX,et al.A prospective study of the perforator evaluation and eccentric design of anterolateral thigh flap based on superficial fascial perforators assisted by modified computed tomography angiography[J].Chin J Burns Wounds,2023,39(2):141-149.DOI: 10.3760/cma.j.cn501225-20220902-00376.

A prospective study of the perforator evaluation and eccentric design of anterolateral thigh flap based on superficial fascial perforators assisted by modified computed tomography angiography

doi: 10.3760/cma.j.cn501225-20220902-00376
Funds:

Clinical Specialty Key Construction Foundation of Shandong Province of China SLCZDZK-0303

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  •   Objective  To explore the preoperative whole perforator evaluation and intraoperative eccentric design of anterolateral thigh flap (ALTF) based on superficial fascial perforators by modified computed tomography angiography (CTA), and the clinical effects were observed.  Methods  A prospective observational study was adopted. Twelve patients with oral and maxillofacial tumors and 10 patients with open injury of the upper limb with large soft tissue defects were hospitalized in the Department of Hand & Microsurgery and Department of Oral & Maxillofacial Surgery of Affiliated Hospital of Binzhou Medical University from January 2021 to July 2022, with 12 males and 10 females, aged from 33 to 75 years, an average age of 56.6 years. The wounds of the patients with oral and maxillofacial tumors were reconstructed by ALTF after the extensive tumor resection and radical cervical lymph node dissection in the same stage; the wounds of the patients with skin and soft tissue defect on the upper limb were covered by ALTF in stage Ⅱ after debridement in stage Ⅰ. After debridement, the area of wound was 3.5 cm×3.5 cm-25.0 cm×10.0 cm and the area of the required flap area was 4.0 cm×4.0 cm-23.0 cm×13.0 cm. Modified CTA scan was performed on the donor site of ALTF before the operation, with the parameters of modified CTA being set to mainly reduce the tube voltage and tube current, and increase the contrast dose and the dual phase scan. The acquired image data were sent to GE AW 4.7 workstation and adopted the volume reconstruction function for visual reconstruction and evaluation of the whole perforator. The information of perforator and source artery was marked on the body surface before operation according to the above evaluation. During the operation, an eccentric flap centered on the visible superficial fascia whole perforator was designed and cut according to the desired flap area and shape. The donor sites of the flap were repaired by direct sutures or full-thickness skin grafts. The total radiation dose was compared between the modified CTA scan and the traditional CTA scan. The distribution of outlet point of perforator of double thighs, the length and direction of superficial fascia perforators based modified CTA were recorded. The type, number, and origin of the target perforator, distribution of of outlet point of perforator, and the diameter, course, and branch of the source artery observed before the operation were compared with those observed during the operation. The healing of donor site wound and the survival of flaps in recipient site were observed after operation. The texture and appearance of flap, oral and upper limb functions, and the functions of femoral donor sites were followed up.  Results  The total radiation dose of modified CTA scan was lower than that of the traditional CTA scan. A total of 48 perforators of double thighs were observed, among which, 31 (64.6%) perforators went outward and downward, 9 (18.8%) perforators went inward and downward, 6 (12.5%) perforators went outward and upward, and 2 (4.2%) perforators went inward and upward, and the average length of superficial fascia perforators was 19.94 mm. The preoperative observed type, number, and source of the perforator, the distribution of the outlet point of the perforator, diameter, course, and branches of the source artery were basically consistent with the intraoperative exploration. The types of 15 septocutaneous (including musculoseptocutaneous) perforators and 10 musculocutaneous perforators observed before the operation was consistent with intraoperative exploration. The distance between the mark of the surface perforator point and the actual exit point of the perforator during operation was (0.38±0.11) mm. All flaps survived without vascular crisis. The donor site wounds of 5 cases of skin grafting and 17 cases of direct suturing wounds healed well. The postoperative follow-up was 2 months to 1 year, with an average of 8.2 months, the flaps were soft and slightly bloated; the function of diet and mouth closing was accessible in patients with oral and maxillofacial tumors, the speech function was mildly impaired in patients with tongue cancer, but they could complete basic oral communication; the wrist and elbow joints and forearm rotation function were not significantly limited in patients with upper limb soft tissue injuries; there was no obvious tightness in the donor sites, and the function of the hip and knee joints was not limited.  Conclusions  The whole perforator and even the subcutaneous perforator of the donor site of ALTF can be evaluated by modified CTA, and the flap can be used in oral or maxillofacial reconstruction and repair of skin and soft tissue defects of upper limbs to achieve good results. By clarifying the type, number, and source of the perforator, the distribution of the outlet point of the perforator, diameter, course, and branches of the source artery before the operation, the eccentric design of the ALTF based on the superficial fascia perforator was realized. This study has strong guiding value.

     

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  • [1]
    芮永军.股前外侧皮瓣在中国的研究进展[J].中华显微外科杂志,2020,43(4):313-325.DOI: 10.3760/cma.j.cn441206-20200628-00277.
    [2]
    张月恒,宋坤修,刘小智,等.改良穿支体区CTA三维重建在股前外侧穿支皮瓣及腹壁下动脉穿支皮瓣中的应用[J].中华显微外科杂志,2022,45(5):521-527.DOI: 10.3760/cma.j.cn441206-20220319-00056.
    [3]
    RaoP,LuoS,WangL,et al.Computed tomography angiography-aided individualized anterolateral thigh flap design in the reconstruction of oral and maxillofacial soft tissue defects[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2022,134(2):143-150.DOI: 10.1016/j.oooo.2021.12.130.
    [4]
    唐举玉,魏在荣,张世民,等.穿支皮瓣的临床应用原则专家共识[J].中华显微外科杂志,2016,39(2):105-106.DOI: 10.3760/cma.j.issn.1001-2036.2016.02.001.
    [5]
    CignaE,ChenHC,OzkanO,et al.The anteromedial thigh free flap anatomy: a clinical, anatomical, and cadaveric study[J].Plast Reconstr Surg,2014,133(2):420-429.DOI: 10.1097/01.prs.0000437258.85951.a1.
    [6]
    LakhianiC,LeeMR,Saint-CyrM.Vascular anatomy of the anterolateral thigh flap: a systematic review[J].Plast Reconstr Surg,2012,130(6):1254-1268.DOI: 10.1097/PRS.0b013e31826d1662.
    [7]
    YuP,YoussefA.Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap[J].Plast Reconstr Surg,2006,118(4):928-933.DOI: 10.1097/01.prs.0000232216.34854.63.
    [8]
    MooreR,MullnerD,NicholsG,et al.Color Doppler ultrasound versus computed tomography angiography for preoperative anterolateral thigh flap perforator imaging: a systematic review and meta-analysis[J].J Reconstr Microsurg,2022,38(7):563-570.DOI: 10.1055/s-0041-1740958.
    [9]
    赵振华,杨建峰,王伯胤,等.MRA、CTA与DSA在股前外侧皮瓣移植术前应用的对比研究[J].中华整形外科杂志,2015,31(3):172-175.DOI: 10.3760/cma.j.issn.1009-4598.2015.03.004.
    [10]
    唐茂林,刘元波.穿支皮瓣的解剖学研究进展[J].中华整形外科杂志,2018,34(9):785-790.DOI: 10.3760/cma.j.issn.1009-4598.2018.09.022.
    [11]
    KhoongYM,HuangX,GuS,et al.Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL].Burns Trauma,2021,9:tkab042[2022-10-19].https://pubmed.ncbi.nlm.nih.gov/34926708/.DOI: 10.1093/burnst/tkab042.
    [12]
    SchneiderCM,PalinesPA,WomacDJ,et al.Preoperative computed tomography angiography for ALT flaps optimizes design and reduces operative time[J].J Reconstr Microsurg,2022,38(6):491-498.DOI: 10.1055/s-0041-1740122.
    [13]
    朱洪章,杨有优,朱庆棠,等.穿支皮瓣术前血管评估的研究进展[J].中华显微外科杂志,2016,39(4):415-418.DOI: 10.3760/cma.j.issn.1001-2036.2016.04.035.
    [14]
    WangZ,YiX,HeJ,et al.Catheter-based computed tomography angiography in anterolateral thigh perforator mapping of Chinese patients[J].J Reconstr Microsurg,2019,35(3):221-228.DOI: 10.1055/s-0038-1672129.
    [15]
    吴攀峰,唐举玉,卿黎明,等.数字化技术辅助旋股外侧动脉降支分叶穿支皮瓣重建足跟软组织缺损[J].中华显微外科杂志,2022,45(1):33-37.DOI: 10.3760/cma.j.cn441206-20201028-00370.
    [16]
    胡涛涛,常树森,魏在荣,等.改良三纵五横法在股前外侧穿支皮瓣修复术前穿支定位中的应用研究[J].中国修复重建外科杂志,2021,35(8):1027-1032.DOI: 10.7507/1002-1892.202103074.
    [17]
    Saint-CyrM,WongC,SchaverienM,et al.The perforasome theory: vascular anatomy and clinical implications[J].Plast Reconstr Surg,2009,124(5):1529-1544.DOI: 10.1097/PRS.0b013e3181b98a6c.
    [18]
    陶友伦,庄跃宏,张世民,等.穿支皮瓣血流动力学模型的建立及研究进展[J].中华医学杂志,2015,95(11):870-872.DOI: 10.3760/cma.j.issn.0376-2491.2015.11.017.
    [19]
    WatanabeM,MurakamiR,MiyauchiR,et al.Utility of preoperative multidetector-row computed tomographic angiography after sublingual nitroglycerin with three-dimensional reconstruction in planning of the anterolateral thigh flap[J].Plast Reconstr Surg,2020,145(2):407e-411e.DOI: 10.1097/PRS.0000000000006507.
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