Sinove Y, Kyriopoulos E, Ceulemans P, Houtmeyers P, Hoebeke P, Monstrey S
Plastic, Reconstructive and Esthetic Surgery, University Hospital Gent, Gent, Belgium.
Handchir Mikrochir Plast Chir. 2013 Aug;45(4):217-22. doi: 10.1055/s-0032-1333271. Epub 2013 Mar 6.
Recently, perforator flap surgery has been introduced in phalloplasty procedures. Especially the anterolateral thigh (ALT) flap has found its application as a pedicled flap for the penile reconstruction. Adequate shaping of the flap and the need of transferring the shaped flap on its pedicle to the pubic area requires precise localisation and preoperative evaluation of the perforators. Also preoperative measurement of the subcutaneous fat tissue is necessary to allow adequate patient selection and optimal shaping of the phallus. The objective of this report is to demonstrate the usefulness of a multidetector CT scan (MDCT) in the preoperative planning of patients undergoing an ALT flap phalloplasty.
Between September 2009 and July 2011, 13 patients were operated for ALT phalloplasty and had preoperative perforator mapping with the MDCT. An algorithm was set up to select the best perforator. Indocyanine green angiography was used in 5 patients to confirm the perforator selection. A mathematical formula was developed to calculate the necessary flap width from the flap thickness.
Accurate identification of the main perforators was achieved in all patients with a very satisfactory concordance between the MDCT scan and surgical findings. Indocyanine green angiography confirmed the MDCT perforator selection in all cases. The flap size could be determined preoperatively in all patients by measuring the thickness of the subcutaneous fat layer.
Preoperative evaluation of ALT perforators and the subcutaneous fat tissue layer is feasible with an MDCT scan and provides precise data to make an adequate patient and perforator selection and determine the exact flap size.
最近，穿支皮瓣手术已被引入阴茎再造手术中。特别是股前外侧（ALT）皮瓣已被用作带蒂皮瓣进行阴茎重建。皮瓣的充分塑形以及将塑形后的皮瓣通过其蒂转移至耻骨区域的需求，要求对穿支血管进行精确的定位和术前评估。此外，术前测量皮下脂肪组织对于进行充分的患者选择和阴茎的最佳塑形也是必要的。本报告的目的是证明多层螺旋CT扫描（MDCT）在ALT皮瓣阴茎再造手术患者的术前规划中的作用。
2009年9月至2011年7月期间，13例患者接受了ALT阴茎再造手术，并在术前通过MDCT进行了穿支血管定位。建立了一种算法来选择最佳穿支血管。5例患者使用吲哚菁绿血管造影来确认穿支血管的选择。开发了一个数学公式，根据皮瓣厚度计算所需的皮瓣宽度。
所有患者均准确识别出主要穿支血管，MDCT扫描与手术结果之间的一致性非常令人满意。吲哚菁绿血管造影在所有病例中均证实了MDCT对穿支血管的选择。通过测量皮下脂肪层的厚度，所有患者均可在术前确定皮瓣大小。
通过MDCT扫描对ALT穿支血管和皮下脂肪组织层进行术前评估是可行的，并能提供精确的数据，以进行充分的患者和穿支血管选择，并确定确切的皮瓣大小。
