The vascular anatomy of peroneal artery perforators is highly variable, and thus there is a role for preoperative imaging. CTA can demonstrate cases where there is aberrant or non-preferred anatomy, or select the limb of choice for harvest.

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The vascular anatomy of the anterolateral thigh flap (ALTF) has many possible variations, and none of the currently used mapping techniques (eg, Echo Color Doppler) gives a thorough knowledge of all details. Among the last generation of angiographic diagnostic techniques, multi detector computed tomography, popularly known as Angio CT, has emerged as an outstanding noninvasive operator independent option, and has been described for deep inferior epigastric perforator and pedicled transverse rectus abdominis muscle planning. This study was conducted to evaluate its usefulness prior to ALTF harvesting.Nine consecutive patients were considered for oral or lower extremity reconstruction with the ALTF. After written informed consent was obtained from all patients, a preoperative Angio-CT study was performed for surgical planning. Accurate identification of septocutaneous or musculocutaneous perforator vessels was achieved and their location, course, and anatomic variations were reported and influenced surgery. Angio CT allows a complete vascular study of the donor area of the ALTF and evaluation of the best perforator vessels before surgery allows surgeons to get an ideal planning of the flap. This imaging method is currently proposed to every patient undergoing ALT flap reconstruction.

Computed tomographic angiography (CTA) has become increasingly adopted for preoperative imaging in perforator flap surgery, as it has been shown to improve operative outcomes and decrease operating times prior to deep inferior epigastric artery perforator (DIEP) flap and anterolateral thigh perforator flap surgery. Current technologies are readily available for the preoperative imaging of all perforator flaps, however only sporadic reports of the use of CTA for the imaging of other perforators have been described. We describe our experience with 325 CTAs performed for the preoperative imaging of perforators prior to 370 perforator flaps throughout several body regions. The scanning techniques, software reconstructions and technical issues are explored. In all cases, CTA was scored by the radiologist as at least "sufficient", and described as "optimal" in the majority of cases. Similarly, the surgeon described the correlation of imaging to operative findings as at least "good", and described the correlation as "optimal" in the majority of cases. As such, a standardized protocol for the use of CTA prior to perforator flap surgery is provided, which has been shown to be successful prior to a range of perforator flap operations.