Comparative Study Of Color Doppler Flow Imaging And Computed Tomography Angiography Applied In Transplantation Of Anterolateral Thigh Perforator Flap

Background:Anterolateral thigh perforator flap(ALTPF)is a commonly used method for the clinical repair of defects of skin and soft tissue.Anatomical variation of perforator often brings some difficulties for clinicians to obtain flaps successfully.However,the application of imaging techniques such as color Doppler flow imaging(CDFI),computed tomography angiography(CTA)and other methods for location of perforator can be helpful for surgeons more accurately understand the number and distribution of perforating vessels,which makes surgery more safe and convenient.But there is no unified conclusion about which technique is more suitable.Objective: To provide theoretical support for the application of CDFI and CTA in ALTPF transplantation we have compared the role of CDFI and CTA in ALTPF transplantation.Methods: Forty patients with ALTPF in our hospital from December 2014 to May 2017 were selected and divided into two groups: the CDFI group and the CTA group(20 cases in each group).The preoperative and postoperative location of perforation and design of flap was performed by CDFI or CTA,respectively.The parameters are as follows: area of skin defect,preparation time of flap,distance of ilium to patella(of the distance of ipsilateral anterior superior iliac spine to the outer edge of patella),coincidence rate of preoperative compared to intraoperative,complications of flaps,complications of donor sites,maximum flow velocity and mean velocity of descending branch of lateral circumflex femoral artery(LCFA).The coincidence rate,complications of donor sites and flaps were analyzed.Sex,left or right side,and age were compared among the two groups.Location of the perforating line piercing through the fascia lata was performed in the axis distribution.The color,dermatoglyphics,texture of flaps,capillaries filling test and presence of vascular crisis were observed postoperatively.Results: The coincidence rate of CDFI group was 92.31% and that of CTA group was 87.50%.There was no significant difference between the two groups with P=0.284.The occurrence rate of complications of flaps in CDFI group was none and in CTA group was 5% with P=0.317.The occurrence rate of complications of donor sites in CDFI group was 10% and in CTA group was 5% with P=0.553.The difference was not statistically significant.There was no significant difference in the maximal flow rate and average flow rate of LCFA between male and female with P value was 0.326 and 0.619,respectively.There was no significant difference in the left and right side between the two groups with P value was 0.682 and 0.711,respectively.There was no significant difference between patients less than 40 years and those over 40 years with P value was 0.846 and 0.474,respectively.Here 1 case was lower than normal value in skin temperature,1 case was higher in CDFI group.And there was 1 case higher in skin temperature in CTA group.The others were in the normal range.No vascular crisis appeared and all of the flaps survived.Conclusion: CDFI can provide more accurate location for perforator and performed certain advantages in distinguishing the trunk vessels of perforator.CTA can provide three-dimensional structure of perforating branch,which could display of the adjacent relationship between the perforating branch and the surrounding structure more intuitively and accurately,but with a certain degree of ionizing radiation.Both the both could be applied to the preoperative design of pre-anterolateral perforator flap to meet the reconstruction of skin and soft tissue defects in different regions.