Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction

Shih-Yi Chen, Wen-Chiung Lin, Shou-Cheng Deng, Shun-Cheng Chang, Ju-Peng Fu, Niann-Tzyy Dai, Shao-Liang Chen, Tim-Mo Chen, Shyi-Gen Chen

Research output: Contribution to journalArticle

30 Citations (Scopus)

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. © 2010 Elsevier Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)1004-1011
Number of pages8
JournalEuropean Journal of Surgical Oncology
Volume36
Issue number10
DOIs
Publication statusPublished - 2010
Externally publishedYes

Fingerprint

Head and Neck Neoplasms
Thigh
Angiography
Perforator Flap
Morbidity
Free Tissue Flaps
Necrosis
Survival Rate
Tissue Donors

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

Cite this

Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. / Chen, Shih-Yi; Lin, Wen-Chiung; Deng, Shou-Cheng; Chang, Shun-Cheng; Fu, Ju-Peng; Dai, Niann-Tzyy; Chen, Shao-Liang; Chen, Tim-Mo; Chen, Shyi-Gen.

In: European Journal of Surgical Oncology, Vol. 36, No. 10, 2010, p. 1004-1011.

Research output: Contribution to journalArticle

Chen, Shih-Yi ; Lin, Wen-Chiung ; Deng, Shou-Cheng ; Chang, Shun-Cheng ; Fu, Ju-Peng ; Dai, Niann-Tzyy ; Chen, Shao-Liang ; Chen, Tim-Mo ; Chen, Shyi-Gen. / Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction. In: European Journal of Surgical Oncology. 2010 ; Vol. 36, No. 10. pp. 1004-1011.
@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. {\circledC} 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",

}

TY - JOUR

T1 - Assessment of the perforators of anterolateral thigh flaps using 64-section multidetector computed tomographic angiography in head and neck cancer reconstruction

AU - Chen, Shih-Yi

AU - Lin, Wen-Chiung

AU - Deng, Shou-Cheng

AU - Chang, Shun-Cheng

AU - Fu, Ju-Peng

AU - Dai, Niann-Tzyy

AU - Chen, Shao-Liang

AU - Chen, Tim-Mo

AU - Chen, Shyi-Gen

N1 - 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

PY - 2010

Y1 - 2010

N2 - 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. © 2010 Elsevier Ltd. All rights reserved.

AB - 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. © 2010 Elsevier Ltd. All rights reserved.

KW - Anterolateral thigh flap

KW - Computed tomographic angiography

KW - Head and neck cancer

KW - Perforator

KW - Reconstruction

KW - adult

KW - aged

KW - anterolateral thigh flap

KW - article

KW - cancer surgery

KW - clinical article

KW - clinical assessment

KW - computed tomographic angiography

KW - female

KW - graft necrosis

KW - head and neck cancer

KW - human

KW - intraoperative period

KW - male

KW - morbidity

KW - multidetector computed tomography

KW - operation duration

KW - postoperative complication

KW - preoperative period

KW - priority journal

KW - retrospective study

KW - survival rate

KW - thrombectomy

KW - vein thrombosis

KW - angiography

KW - cohort analysis

KW - comparative study

KW - computer assisted tomography

KW - evaluation study

KW - follow up

KW - graft rejection

KW - graft survival

KW - Head and Neck Neoplasms

KW - image quality

KW - middle aged

KW - pathology

KW - physiology

KW - plastic surgery

KW - preoperative care

KW - procedures

KW - radiography

KW - risk assessment

KW - surgical flaps

KW - thigh

KW - treatment outcome

KW - vascularization

KW - wound healing

KW - Adult

KW - Angiography

KW - Cohort Studies

KW - Female

KW - Follow-Up Studies

KW - Graft Rejection

KW - Graft Survival

KW - Humans

KW - Male

KW - Middle Aged

KW - Preoperative Care

KW - Radiographic Image Enhancement

KW - Reconstructive Surgical Procedures

KW - Retrospective Studies

KW - Risk Assessment

KW - Surgical Flaps

KW - Thigh

KW - Tomography, X-Ray Computed

KW - Treatment Outcome

KW - Wound Healing

U2 - 10.1016/j.ejso.2010.07.005

DO - 10.1016/j.ejso.2010.07.005

M3 - Article

VL - 36

SP - 1004

EP - 1011

JO - European Journal of Surgical Oncology

JF - European Journal of Surgical Oncology

SN - 0748-7983

IS - 10

ER -