Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York, New York.
Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia.
J Reconstr Microsurg. 2020 Oct;36(8):616-624. doi: 10.1055/s-0040-1713668. Epub 2020 Jul 8.
The anterolateral thigh (ALT) flap is a useful flap with minimal donor site morbidity. Preoperative computed tomographic angiography (CTA) for lower extremity reconstruction can determine vessel integrity and plan for recipient vascular targets. This study reviews lower extremity CTAs to further characterize ALT vascular anatomy and associated clinical implications thereof.
Lower extremity CTA studies were retrospectively reviewed, and information on ALT cutaneous perforator location, origin, and course was collected.
A total of 58 lateral circumflex femoral artery (LCFA) systems in 31 patients were included. Average age was 38.8 ± 15.9 years with mean body mass index of 27.2 ± 5.7 kg/m. The majority of patients were females (23, 74.2%). The LCFA most commonly originated from the profunda femoris artery (87.3%), followed by the distal common femoral artery (9.1%). On average, there were 1.66 ± 0.69 cm perforators per extremity, with an average of 5.38 cm between adjacent perforators. Perforators originated from the descending branch of the LCFA in 89.6% of studies. Perforator caliber was <1 mm (29, 30.2%), 1 to 2 mm (55, 57.3%), or >2 mm (12, 12.5%). Mean distance from the most proximal perforator to the anterior superior iliac spine was 20.4 ± 4.82 cm. Perforators were musculocutaneous (46.9%), septocutaneous (34.4%), or septomyocutaneous (18.8%). In 58.1% of patients, only one thigh had easily dissectable septocutaneous and/or septomyocutaneous perforators, in which case preoperative CTA aided in donor thigh selection.
ALT flap cutaneous perforator anatomy varies considerably. Using CTA, we report on rates of septocutaneous, myocutaneous, and septomyocutaneous perforators and underscore its utility in perforator selection.
股前外侧皮瓣（ALT）是一种有用的皮瓣，供区并发症发生率低。下肢重建术的术前计算机断层血管造影（CTA）可确定血管完整性并为受区血管目标制定计划。本研究回顾了下肢 CTA，以进一步描述 ALT 血管解剖结构及其相关的临床意义。
回顾性分析下肢 CTA 研究，并收集了 ALT 皮穿支的位置、起源和走行信息。
共纳入 31 例患者的 58 个外侧旋股动脉（LCFA）系统。患者平均年龄为 38.8±15.9 岁，平均体重指数为 27.2±5.7kg/m2。大多数患者为女性（23 例，74.2%）。LCFA 最常起源于股深动脉（87.3%），其次是股总动脉远端（9.1%）。平均每条肢体有 1.66±0.69 个穿支，相邻穿支之间的平均距离为 5.38cm。在 89.6%的研究中，穿支起源于 LCFA 的降支。穿支直径<1mm（29 例，30.2%）、1-2mm（55 例，57.3%）或>2mm（12 例，12.5%）。最靠近近端穿支的髂前上棘距离为 20.4±4.82cm。穿支为肌皮穿支（46.9%）、间隔皮穿支（34.4%）或间隔肌皮穿支（18.8%）。在 58.1%的患者中，只有一条大腿有易于解剖的间隔皮穿支和/或间隔肌皮穿支，在这种情况下，术前 CTA 有助于供区大腿的选择。
ALT 皮瓣皮穿支解剖结构差异较大。我们使用 CTA 报告了间隔皮穿支、肌皮穿支和间隔肌皮穿支的发生率，并强调了其在穿支选择中的应用。
