A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps

Garvey, Patrick B. and Selber, Jesse C. and Madewell, John E. and Bidaut, Luc M. and Feng, Lei and Yu, Peirong (2011) A prospective study of preoperative computed tomographic angiography for head and neck reconstruction with anterolateral thigh flaps. Plastic and Reconstructive Surgery, 127 (4). pp. 1505-1514. ISSN 0032-1052

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Item Type:Article
Item Status:Live Archive

Abstract

Background: During anterolateral thigh flap harvest, inadequate perforators may necessitate modification of the flap design, exploration of the contralateral thigh, or additional flap harvest. Computed tomographic angiography may facilitate perforator mapping and optimize flap design. The authors performed this pilot study to determine the predictive power of computed tomographic angiography in anterolateral thigh flap planning and execution. Methods: Sixteen consecutive computed tomographic angiography-mapped anterolateral thigh flaps for head and neck reconstruction were studied. Perforator location, origin, caliber, and course were compared between computed tomographic angiography and intraoperative findings. The relationship of patient characteristics, imaging studies, and intraoperative factors to flap design and surgical outcomes was analyzed. Results: Among the 16 anterolateral thigh flaps, 40 of 54 perforators identified intraoperatively were visible on computed tomographic angiography, resulting in 74 percent sensitivity. Intraoperative perforator location averaged 0.35 cm from the computed tomographic angiography-predicted location. The overall ability of computed tomographic angiography to predict perforator size was 67.5 percent. Its overall accuracy in predicting whether a perforator took a septocutaneous or intramuscular course before perforating the deep fascia was 77.5 percent. Preoperative angiography resulted in surgeons modifying the operative plan in 37 percent of cases and 57 percent of double-island flap cases. All flaps were elevated successfully and survived. Conclusions: Computed tomographic angiography identified larger perforators better than smaller ones and proximal perforators better than distal ones. It accurately predicted the location and origin of visible perforators and less accurately predicted the size and course of visible perforators. Most importantly, the information it provided influenced surgeons to modify their reconstructive strategy, resulting in a higher level of recipient-site specificity. Copyright © 2011 by the American Society of Plastic Surgeons.

Keywords:aged, angiography, article, computer assisted tomography, female, free tissue graft, head, human, male, neck, plastic surgery, sensitivity and specificity, thigh, vascularization, Aged, Free Tissue Flaps, Humans, Reconstructive Surgical Procedures, Tomography, X-Ray Computed
Subjects:F Physical Sciences > F350 Medical Physics
Divisions:College of Science > School of Computer Science
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ID Code:24127
Deposited On:30 Oct 2016 11:13

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