Three- and Four-Dimensional Computed Tomographic Angiography and Venography of the Anterolateral Thigh Perforator Flap

Abstract

Using a novel dynamic three-dimensional imaging technique, perfusion of the arterial and venous system of the thoracodorsal artery perforator flap was elucidated. Although the flap is inherently thin, it can be safely thinned between the superficial and deep adipose layers. This study identified important advantages of the thoracodorsal artery perforator flap for use in reconstruction.

Comparison of surgical result of anterolateral thigh flap in reconstruction of through-and-through cheek defect with/without CT angiography guidance

“…The perforator complexes, which are linked by a dense network of branches from the subdermal, subcutaneous, and suprafascial plexuses, can also vary from person to person, and may also vary from one side to the other in the same person. In Schaverien's study (Schaverien et al, 2008), three distinct morphological patterns of the perforator and its branching pattern were identified. In the type I perforator complex, the branches of the perforator course through the adipose layer to reach the subdermal plexus without a component at the suprafascial layer, which can be seen in the type II and III complexes.…”

“…In our opinion, ultrasound can be used as an adjunct technique but to access more precise data, a more advanced imaging technology is required. Angiographic CT has emerged as an outstanding noninvasive operator-independent option (Schaverien et al, 2008;Ribuffo et al, 2009;Rozen et al, 2009b). This imaging modality has become increasingly utilized in the delineation of the deep inferior epigastric artery perforator in breast reconstruction with a free rectus abdominis musculocutaneous (RAM) flap.…”

Der anterolaterale Oberschenkellappen

“…Aus diesem Grund hat beispielsweise die Gruppe um Yu [28] dieses Verfahren wieder verlassen und wendet stattdessen eine präoperative Markierung basierend auf Erkenntnissen aus anatomischen und klinischen Studien, genannt das ABC-System, an. Die CT-Angiographie bietet zwar eine detaillierte Darstellung der anatomischen Verhältnisse [17,19], ist jedoch unserer Meinung nach aufgrund der nicht unerheblichen Strahlenbelastung als kritisch zu werten. Die Farbduplexsonographie hingegen ist ein zuverlässiges Verfahren zur Perforatordarstellung beim ALT, deren Vorzüge von verschiedenen Autoren propagiert wurden [3,9,22].…”

Late Complications of Deep Venous Thrombosis: Painful Swollen Extremities and Non Healing Ulcers

“…This anatomy is complex and pressurization can affect the viability of the overlying dermis. Plastic surgeons have recognized and studied this venous anatomy (Schaverien, Saint-Cyr et al 2008). In this work there are excellent figures with the anatomy of the epidermal and subdermal venous anatomy and emphasizes the role of the perforating vein and the complex of subdermal veins in the outcome of "anterolateral thigh perforator flap".…”

“…The actual distribution of venous blood and pressure is distributed through this system and related to the configuration of each pressurized subdermal vein complex. Three different complexities have been described as the perforating vein (P) exits the deep fascia to enter a sub dermal vein (Hern and Mortimer 1999;Schaverien, Saint-Cyr et al 2008). Terminal Branches distribute the pressurized blood over this distribution.…”