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J Reconstr Microsurg 2019; 35(03): 221-228
DOI: 10.1055/s-0038-1672129
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Zhongjie Wang
1   Department of Neurology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Xiaoping Yi
2   Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Jiqiang He
3   Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China
,
Liming Qing
3   Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China
,
Zhengbing Zhou
3   Department of Hand and Microsurgery, Xiangya Hospital of Central South University, Changsha, People's Republic of China
,
Youming Zhang
2   Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Zhiming Zhu
2   Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Chunhui Zhou
2   Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Hui Xie
2   Department of Radiology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Xuejun Li
1   Department of Neurology, Central South University, Xiangya Hospital, Changsha, People's Republic of China
,
Chishing Zee
4   Department of Radiology, Keck Medical Center of USC, Los Angeles, California, United States
,
Bihong T. Chen
5   Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, California, United States
› Author Affiliations
Further Information

Publication History

16 April 2018

09 August 2018

Publication Date:
02 October 2018 (online)

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Abstract

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.

Keywords

CT angiography - catheter-based CTA - anterolateral thigh flap - perforator mapping - reconstructive surgery - limb trauma - digital subtraction angiography

Supplementary Material

Letter to this article:

Catheter-Based Computed Tomography Angiography in Anterolateral Thigh Perforator Mapping of Chinese Patients: Statistical EstimatesJ Reconstr Microsurg 2019; 35(03): e1-e1
DOI: 10.1055/s-0039-1691786

 

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