@article{db4fd0ca5271438ea9544e6ff56aeadb,
title = "Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction",
abstract = "Background: The anterolateral thigh (ALT) flap is a frequent choice for free flap transfer in head and neck cancer reconstruction because of its versatility. Preoperative mapping of the perforator pedicles of an ALT flap is still a challenge because of variations in vasculature. Although computed tomographic angiography (CTA) is used increasingly to evaluate the peripheral vasculature, the use of this method for evaluating the perforators of an ALT flap has not been described in detail. Methods: From September 2008 to March 2009, 32 patients underwent preoperative CTA before free ALT flap transfer for head and neck cancer reconstruction. The perforators were marked on a 64-section multidetector CT image for each patient. The preoperatively mapped perforators were compared with the actual intraoperative findings. Flap success rates and associated morbidity and complications were recorded. Results: Preoperative CTA identified major variations in perforators. Eighty-four were found by preoperative CTA; 64 of these were mapped to be explored during the operation, and 13 additional perforators were identified during surgery. The accuracy rate of identifying the branching origin of the ALT perforators was 98% (63/64). All of the ALT flaps survived except for one with necrosis (survival rate 97%). There was no donor site morbidity. Conclusions: Preoperative mapping of perforators by CTA proved valuable in free ALT flap transfer and shortened the operation time significantly. This modality provides useful information for head and neck cancer reconstruction in difficult cases, especially in patients with large or through-and-through defects that might need multiple perforators in flap design. {\textcopyright} 2010 Elsevier Ltd. All rights reserved.",
keywords = "Anterolateral thigh flap, Computed tomographic angiography, Head and neck cancer, Perforator, Reconstruction, adult, aged, anterolateral thigh flap, article, cancer surgery, clinical article, clinical assessment, computed tomographic angiography, female, graft necrosis, head and neck cancer, human, intraoperative period, male, morbidity, multidetector computed tomography, operation duration, postoperative complication, preoperative period, priority journal, retrospective study, survival rate, thrombectomy, vein thrombosis, angiography, cohort analysis, comparative study, computer assisted tomography, evaluation study, follow up, graft rejection, graft survival, Head and Neck Neoplasms, image quality, middle aged, pathology, physiology, plastic surgery, preoperative care, procedures, radiography, risk assessment, surgical flaps, thigh, treatment outcome, vascularization, wound healing, Adult, Angiography, Cohort Studies, Female, Follow-Up Studies, Graft Rejection, Graft Survival, Humans, Male, Middle Aged, Preoperative Care, Radiographic Image Enhancement, Reconstructive Surgical Procedures, Retrospective Studies, Risk Assessment, Surgical Flaps, Thigh, Tomography, X-Ray Computed, Treatment Outcome, Wound Healing",
author = "Shih-Yi Chen and Wen-Chiung Lin and Shou-Cheng Deng and Shun-Cheng Chang and Ju-Peng Fu and Niann-Tzyy Dai and Shao-Liang Chen and Tim-Mo Chen and Shyi-Gen Chen",
note = "被引用次數：16 Export Date: 21 March 2016 CODEN: EJSOE 通訊地址: Chen, S. G.; Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, Cheng-Gung Road, Taipei 11490, Taiwan; 電子郵件： shyigen@ms26.hinet.net 參考文獻: McCrory, A.L., Magnuson, J.S., Free tissue transfer versus pedicled flap in head and neck reconstruction (2002) Laryngoscope, 112, pp. 2161-2165; Hurvitz, K.A., Kobayashi, M., Evans, G.R., Current options in head and neck reconstruction (2006) Plast Reconstr Surg, 118, pp. 122e-133e; Smith, R.B., Sniezek, J.C., Weed, D.T., Wax, M.K., Utilization of free tissue transfer in head and neck surgery (2007) Otolaryngol Head Neck Surg, 137, pp. 182-191; Kimata, Y., Uchiyama, K., Ebihara, S., Nakatsuka, T., Harii, K., Anatomic variations and technical problems of the anterolateral thigh flap: A report of 74 cases (1998) Plast Reconstr Surg, 102, pp. 1517-1523; Rozen, W.M., Ashton, M.W., Pan, W.R., Anatomical variations in the harvest of anterolateral thigh flap perforators: A cadaveric and clinical study (2009) Microsurgery, 29, pp. 16-23; Yu, P., Youssef, A., Efficacy of the handheld Doppler in preoperative identification of the cutaneous perforators in the anterolateral thigh flap (2006) Plast Reconstr Surg, 118, pp. 928-933; Tsukino, A., Kurachi, K., Inamiya, T., Tanigaki, T., Preoperative color Doppler assessment in planning of anterolateral thigh flaps (2004) Plast Reconstr Surg, 113, pp. 241-246; Masia, J., Clavero, J.A., Larranaga, J.R., Alomar, X., Pons, G., Serret, P., Multidetector-row computed tomography in the planning of abdominal perforator flaps (2006) J Plast Reconstr Aesthet Surg, 59, pp. 594-599; Hamdi, M., Van Landuyt, K., Van Hedent, E., Duyck, P., Advances in autogenous breast reconstruction: The role of preoperative perforator mapping (2007) Ann Plast Surg, 58, pp. 18-26; Ribuffo, D., Atzeni, M., Saba, L., Milia, A., Guerra, M., Mallarini, G., Angio computed tomography preoperative evaluation for anterolateral thigh flap harvesting (2009) Ann Plast Surg, 62, pp. 368-371; Song, Y.G., Chen, G.Z., Song, Y.L., The free thigh flap: A new free flap concept based on the septocutaneous artery (1984) Br J Plast Surg, 37, pp. 149-159; Yu, P., Characteristics of the anterolateral thigh flap in a Western population and its application in head and neck reconstruction (2004) Head Neck, 26, pp. 759-769; Chen, Z., Zhang, C., Lao, J., An anterolateral thigh flap based on the superior cutaneous perforator artery: An anatomic study and case reports (2007) Microsurgery, 27, pp. 160-165; Kawai, K., Imanishi, N., Nakajima, H., Aiso, S., Kakibuchi, M., Hosokawa, K., Vascular anatomy of the anterolateral thigh flap (2004) Plast Reconstr Surg, 114, pp. 1108-1117; Choi, S.W., Park, J.Y., Hur, M.S., An anatomic assessment on perforators of the lateral circumflex femoral artery for anterolateral thigh flap (2007) J Craniofac Surg, 18, pp. 866-871; Khan, U.D., Miller, J.G., Reliability of handheld Doppler in planning local perforator-based flaps for extremities (2007) Aesthetic Plast Surg, 31, pp. 521-525; Hallock, G.G., Doppler sonography and color duplex imaging for planning a perforator flap (2003) Clin Plast Surg, 30, pp. 347-357; Rozen, W.M., Phillips, T.J., Ashton, M.W., Stella, D.L., Gibson, R.N., Taylor, G.I., Preoperative imaging for DIEA perforator flaps: A comparative study of computed tomographic angiography and Doppler ultrasound (2008) Plast Reconstr Surg, 121 (SUPPL. 1), pp. 1-8; Wei, F.C., Jain, V., Celik, N., Chen, H.C., Chuang, D.C., Lin, C.H., Have we found an ideal soft-tissue flap? An experience with 672 anterolateral thigh flaps (2002) Plast Reconstr Surg, 109, pp. 2219-2226; Jones, N.F., Vogelin, E., Markowitz, B.L., Watson, J.P., Reconstruction of composite through-and-through mandibular defects with a double-skin paddle fibular osteocutaneous flap (2003) Plast Reconstr Surg, 112, pp. 758-765; Wein, R.O., Lewis, A.F., Synchronous reconstruction of the floor of mouth and chin with a single skin island fibular free flap (2008) Microsurgery, 28, pp. 223-226; Rozen, W.M., Ashton, M.W., Whitaker, I.S., Wagstaff, M.J., Acosta, R., The financial implications of computed tomographic angiography in DIEP flap surgery: A cost analysis (2009) Microsurgery, 29, pp. 168-169",
year = "2010",
doi = "10.1016/j.ejso.2010.07.005",
language = "English",
volume = "36",
pages = "1004--1011",
journal = "European Journal of Surgical Oncology",
issn = "0748-7983",
publisher = "W.B. Saunders Ltd",
number = "10",
}
