Algorithmic Approach to Anterolateral Thigh Flaps Lacking Suitable Perforators in Lower Extremity Reconstruction

Lu, Johnny Chuieng-Yi; Zelken, Jonathan; Hsu, Chung-Chen; Chang, Nai-Jen; Lin, Chih‐Hung; Wei, Fu‐Chan; Lin, Chih-Hung

doi:10.1097/prs.0000000000001168

Cited by 38 publications

(39 citation statements)

References 3 publications

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“…However, we note that all these studies were conducted in Western populations, 5,6 except for two studies conducted in the Chinese population. 19,23 Based on our experience, it is impossible to show a satisfactory efficiency by using T-CTA to perform preoperative ALT perforator mapping in some Chinese patients, especially those with limited activity due to lower extremity trauma as shown in the present study.…”

Section: Discussionmentioning

confidence: 65%

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

Wang

et al. 2018

J reconstr Microsurg

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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.

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Section: Discussionmentioning

confidence: 65%

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

Wang

et al. 2018

J reconstr Microsurg

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“…As such, an absence of perforators on one limb does not reliably indicate a similar absence of perforators on the contralateral limb. Prior to exploring the contralateral thigh, however, salvage flap options such as the ipsilateral anteromedial thigh or tensor fascia lata flaps should be considered . Through the initial medial incision made for ALT harvest, the dissection can be continued medially or superiorly to identify any anteromedial thigh or tensor fascia lata vessels, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Through the initial medial incision made for ALT harvest, the dissection can be continued medially or superiorly to identify any anteromedial thigh or tensor fascia lata vessels, respectively. These act as useful fallback options in the event of perforator absence or injury to the ALT perforators, but provide less skin coverage than the ALT flap …”

Section: Discussionmentioning

confidence: 99%

Anatomic symmetry of anterolateral thigh flap perforators: a computed tomography angiographic study

Chan

Ferris

et al. 2019

ANZ Journal of Surgery

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Background: The anterolateral thigh flap is a workhorse reconstructive flap. Versatility in design is a key strength but perforator anatomy can be variable. Inability to locate perforators prompts consideration of contralateral thigh exploration. However, such exploration would be futile if the absence of perforators proves symmetrical. This study assesses the symmetry of anterolateral thigh flap vasculature using computed tomography angiography (CTA). Methods: A retrospective analysis of 20 bilateral thigh CTAs was performed. Each limb was assessed for number, course, location and size of perforators. Only vessels >0.5 mm in size at origin were included. Location was standardized between patients using perforator distance/thigh length ratio. Results were analysed using Wilcoxon signed-rank test. Results: In each thigh, the average number of perforators was 3.58 and average perforator distance/thigh length ratio was 0.358 AE 0.08. Between both limbs of the same patient, the mean difference in number of perforators was 0.55 (P = 0.002), and difference in average perforator size was 0.3 mm (P < 0.001). Average perforator location differed by a mean of 3% of thigh length (P < 0.001) between thighs. Conclusion: While average vessel size and location appear similar, there does not appear to be symmetry in the number of perforators. Surgical exploration of the contralateral thigh in an absence of perforators should be considered. In patients where abnormal anatomy is expected, mapping with CTA could be considered to reduce morbidity associated with unsuccessful surgical exploration and dissection.

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“…Flap survival rates reported in the literature are approximately 95% and above in large case series in which revision surgery was performed on patients with signs of vascular compromiso [1,2]. Evidence has shown that early detection of vascular insufficiency coupled with timely reoperation allows to rescue the flap and avoid flap failure.…”

Section: Introductionmentioning

confidence: 97%

“…Both NIRS and clinical evaluation were slower than SDF at identifying vascular compromise. During VO the Doppler signal does not disappear; while in TVO the signal disappeared at 1.8 (1)(2)(3)(4)(5) seconds. This study shows that evaluation of microcirculation with Microscan SDF is a viable alternative that may allow detection of flap venous and total vascular occlusion earlier than Doppler, NIRS and clinical evaluation.…”

Section: Introductionmentioning

confidence: 99%

Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels

Yáñez¹,

Rodríguez²,

Cifuentes³

et al. 2017

Anaplastology

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Algorithmic Approach to Anterolateral Thigh Flaps Lacking Suitable Perforators in Lower Extremity Reconstruction

Abstract: Therapeutic, III.

Cited by 38 publications

References 3 publications

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

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

Anatomic symmetry of anterolateral thigh flap perforators: a computed tomography angiographic study

Noninvasive Flap Monitoring using Sidestream Dark Field Microscan: A Method for Real-Time Observation of Submilimmetric Vessels

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