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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  >  > Accepted Manuscript
Tian Yongsheng,Zhang Yuji,Wu Junbang,et al.A prospective clinical study of superselective digital subtraction angiography combined with color doppler ultrasound in anterolateral thigh flap reconstruction of extremity skin and soft tissue defects[J].Chin J Burns Wounds,2026,42(10):1-10.DOI: 10.3760/cma.j.cn501225-20260317-00110.
Citation: Tian Yongsheng,Zhang Yuji,Wu Junbang,et al.A prospective clinical study of superselective digital subtraction angiography combined with color doppler ultrasound in anterolateral thigh flap reconstruction of extremity skin and soft tissue defects[J].Chin J Burns Wounds,2026,42(10):1-10.DOI: 10.3760/cma.j.cn501225-20260317-00110.
shu

A prospective clinical study on the application of SS-DSA combined with CDU in ALTF reconstruction of extremity soft tissue defects

doi: 10.3760/cma.j.cn501225-20260317-00110
  • 1.

    Department of Wound Repair, Suzhou Ruihua Orthopedic Hospital of Soochow University, Suzhou 215104, China

  • 2.

    Department of Wound Repair, Suzhou Ruihua Orthopedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202532

Suzhou Applied Basic Research (Medical and Health) Science and Technology Innovation Project SYWD2024085

Suzhou "Strengthening Health through Science and Education" Project MSXM2025081

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    Abstract
  •   Objective  To investigate the clinical efficacy of superselective digital subtraction angiography (SS-DSA) combined with color Doppler ultrasound (CDU) in assisting anterolateral thigh flap (ALTF) reconstruction of extremity soft tissue defects.  Methods  This was a prospective case series study. From October 2024 to August 2025, 50 patients (37 males and 13 females, aged 35-76 years) with extremity soft tissue defects who met the inclusion criteria were treated at Suzhou Ruihua Orthopedic Hospital, and all underwent ALTF reconstruction. Preoperatively, CDU and SS-DSA were used to determine the number and locations of perforators in the flap donor site, as well as the characteristics of their source arteries. The findings from SS-DSA and CDU were integrated (i.e., combined method) to identify the dominant perforator and target source artery and to develop an individualized flap design. Thorough debridement was performed, and the post-debridement defect size ranged from 8 cm×6 cm to 32 cm×20 cm. The flaps were harvested and transferred to the recipient site. Under an operating microscope, end-to-end or end-to-side anastomosis was performed between the flap vessels and the recipient vessels, and then the wound was closed. The flap was designed to extend approximately 1 cm beyond the margins of the recipient-site defect. A total of 51 flaps were harvested from the 50 patients. Donor site wounds of flap were repaired by direct suture or full-thickness skin grafting. Intraoperatively, the number and locations of the observed perforators and their source arteries were recorded. Flap thickness and vascular pedicle length were also documented. Using intraoperative exploration as the gold standard, the sensitivity and positive predictive value among CDU, SS-DSA, and the combined method for perforator localization were compared. The distances between the perforator localization points determined by the three methods and the actual intraoperative perforator entry points (i.e., perforator localization error distance) were compared. The accuracy of the combined method in predicting the source artery of perforators was calculated. In performing SS-DSA perforator localization, the total procedure time, dose-area product (DAP), fluoroscopy time (FT), and estimated glomerular filtration rate (eGFR) before and after angiography were caculated. The puncture site was observed after angiography. Postoperatively, flap survival and healing of donor site wounds were observed.  Results  A total of 89 ALTF perforators were identified intraoperatively, including 47 oblique, 32 descending, 5 anterior, 3 transverse, and 2 ascending branches; 69 perforators were actually used, including 43 oblique, 19 descending, 5 anterior, and 2 ascending branches. The mean flap thickness was (1.4±0.5) cm, and the mean pedicle length was (13±3) cm. The sensitivities of CDU, SS-DSA, and the combined method were 86.52%, 85.39%, and 95.51%, respectively, and the corresponding positive predictive values were 87.50%, 87.36%, and 96.59%, respectively. The perforator localization error distance of the combined method was 0.31 (0.25, 0.37) cm, which was significantly shorter than those of CDU (0.66 (0.58, 0.74) cm) and SS-DSA (0.67 (0.58, 0.75) cm), respectively, with Z values of -7.82 and -7.45, respectively, both P values <0.05. The combined method achieved 100%(89/89) accuracy in predicting the source artery of perforators. The total procedure time of SS-DSA ranged from 19-47 min, the DAP was 102.05 (76.90, 128.50) Gy·cm², and the FT was 6.08 (4.42, 7.20) min. There was no statistically significant difference in eGFR between post-angiography and pre-angiography (P>0.05). No obvious complications were observed at the puncture site after angiography. Postoperatively, all flaps survived, and all donor site wounds healed well.  Conclusions  SS-DSA combined with CDU provides accurate perforator localization for anterolateral thigh flaps, facilitates individualized flap design, and demonstrates good safety, with satisfactory outcomes in the reconstruction of extremity soft tissue defects.

     

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