Appplication Of Different Imaging Methods In Anterolateral Thigh Perforator Flap For Reconstruction Defect Individually After Head And Neck Cancer Resection

Objective Through comparative analysis the value of color Doppler flow imaging (CDFI) and CTA three-dimensional reconstruction in preoperative localization of the anterolateral thigh perforator flap (ALTPF), which is used for reconstruction of postoperative defect after head and neck cancer resection. And provide further reference for clinical application. Discussion clinical application of ALTPF which individualized design with imaging methods to reconstruct the defect in head and neck cancer surgery.Methods The author retrospectively reviewed 28 patients underwent reconstruction of postoperative defect after head and neck cancer resection by ALTPF from May 2010 to October 2015. According to the imaging methods of designing perforating artery, these patients were divided into two groups: CDFI-group (n=13) and CTA-group (n=15). The surgical results of all patients were evaluated for match numbers of the perforating vessels between preoperative localization and intraoperative, flap related complications and donor site morbidity.Results In the two groups, only one flap was complete necrosis, and the overall flap survival rate was 96.43%. CDFI-group had 9 cases are consistent between preoperative localization and intraoperative finding, match ratio is 69.23%.The other 4 cases did not probe perforating artery follow the locating point by preoperative design, in which 2 cases replaced by contralateral free ALTPF,1 case by free latissimus dorsal myocutaneous flap, and lease by pedicled pectoralis major myocutaneous flap. CTA-group had 15 cases are consistent between preoperative design and intraoperative finding, match ratio is 100.00%. CDFI-group reconstructed tongue defect 8 cases, floor of mouth defect 2 cases, buccal mucosa defect 3 cases. ALTPF producted in univalve flap 8 cases, folded flap 1 cases, double pedicle flap 2 cases. CTA-group reconstructed tongue defect 8 cases, floor of mouth defect 2 cases, buccal mucosa defect 2 cases, palate defect 1case, ripped facial defect 1 case, hypopharynx defect 1 case. ALTPF producted in univalve flap 8 cases, double pedicle flap 6cases, three pedicle flap 1cases.The use of preoperative perforator designing with CTA was a obvious higher accuracy in match ratio (15/15 vs 9/13, P=0.035), compared with CDFI. There was no difference in flap preparation time (59.85+12.38min vs 50.27+9.33min, P=0.367), flap related complications(5/13 vs 4/15,P=0.689) and donor site morbidity (0/14 vs 1/15, P=1.000) between CDFI-group and CTA-group.Conclusions (1) CDFI and CTA three-dimensional reconstruction can use to preoperative localization of the anterolateral thigh perforator flap. (2) CTA three-dimensional reconstruction has less human factors interference, and more intuitive visual. It is an optimizing scheme in locating perforator vessels of CDFI. (3) CTA three-dimensional reconstruction can display dynamic three-dimensional anatomical images, accurate position and design ALTPF, guide surgical procedures, and head and neck defects individually, in an ideal method of preoperative localization. (4) Different types of ALTPF under the guidance of imaging methods, can be used as one of the ideal choice of reconstruction head and neck cancer surgery different sub region defects individually.