Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Mitakashi, Tokyo, Japan.
J Reconstr Microsurg. 2011 Jan;27(1):29-36. doi: 10.1055/s-0030-1267380. Epub 2010 Oct 13.
Multidetector-row computed tomography angiography (MDCTA) can be used to visualize small vessels and has been used to search for perforators in deep inferior epigastric artery perforator flaps and anterolateral thigh flaps. Fibula osteocutaneous flaps are often used for mandibular reconstruction, but questions remain about the reliability of these flaps and the variety of their perforators. Eight patients who were candidates for mandibular or pedal reconstruction with a fibula osteocutaneous flap were prospectively evaluated with MDCTA and Doppler sonography. We evaluated the number, position, and course of perforators with MDCTA. The perforators were classified, and intraoperative findings were compared with those of Doppler sonography and MDCTA. MDCTA accurately identified the perforators and showed a satisfactory concordance with intraoperative findings. The high spatial resolution of MDCTA allows the perforators' origin, course, and type to be precisely described. Eighteen vessels were identified with MDCTA, and on average, 2.3 vessels were identified in the leg of each patient. The rate of concordance with operative findings was 87.5% for MDCTA. With MDCTA, flap perforators can be accurately evaluated before surgery in a manner not possible with traditional angiography or Doppler sonography. Reliable perforators can be chosen, and detailed operative plans can be made.
多层螺旋 CT 血管造影（MDCTA）可用于显示小血管，并已用于寻找深部腹壁下动脉穿支皮瓣和股前外侧皮瓣的穿支。腓骨皮瓣常用于下颌骨重建，但这些皮瓣的可靠性及其穿支的多样性仍存在疑问。8 例拟行腓骨皮瓣下颌骨或足部重建的患者前瞻性地接受了 MDCTA 和多普勒超声检查。我们用 MDCTA 评估了穿支的数量、位置和走行。对穿支进行分类，并将术中发现与多普勒超声和 MDCTA 进行比较。MDCTA 准确地识别了穿支，并与术中发现具有良好的一致性。MDCTA 的高空间分辨率可精确描述穿支的起源、走行和类型。MDCTA 共识别出 18 条血管，平均每位患者的腿部识别出 2.3 条血管。MDCTA 与手术发现的符合率为 87.5%。与传统血管造影或多普勒超声相比，MDCTA 可在术前准确评估皮瓣穿支，这是以前无法实现的。可以选择可靠的穿支，并制定详细的手术计划。
