Chen Frank R, Kerluku Jona, Mintz Douglas, Burge Alissa J, Chen Aaron Z, MacMahon Aoife, Osei Daniel A, Fufa Duretti T
Weill Cornell Medical College, New York, N.Y.
The Hospital for Special Surgery Department of Radiology, The Hospital for Special Surgery, New York, N.Y.
Plast Reconstr Surg Glob Open. 2020 Oct 22;8(10):e3174. doi: 10.1097/GOX.0000000000003174. eCollection 2020 Oct.
The anterolateral thigh (ALT) flap is a commonly utilized perforator-based flap in reconstructive surgery. Although previous studies have used various angiographic techniques to preoperatively image ALT perforators, none have investigated the efficacy of noncontrast magnetic resonance imaging (MRI). Our study investigates the efficacy of our institutional fat suppression noncontrast MRI sequence to characterize the number, location, and course of dominant skin perforators in the ALT for preoperative planning.
We queried our institutional database for 100 noncontrast thigh MRIs from July 2013 to July 2018 that included an axial fat suppression sequence with visualization from the lesser trochanter to the distal musculotendinous junction of the rectus femoris. Perforator course, size, and location relative to bony landmarks were determined.
Of the 100 examinations, 70 included bilateral thighs for a total of 170 thighs for perforator analysis. An estimated 277 perforators were identified, of which 101 were septocutaneous (36.5%) and 176 were musculocutaneous (63.5%). An average of 1.63 perforators were visualized in each thigh (min, 1; max, 4). The average perforator diameter at exit from the anterior thigh compartment fascia was 2.5 mm (SD, 0.5). Perforator exit location along the anterior superior iliac spine- or lesser trochanter-patella line could be determined for n = 57 perforators and mapped into 3 predictable clusters.
At least 1 perforator was found in each of 170 thighs imaged. Perforator course, size, and location measured with noncontrast MRI are consistent with prior literature. Noncontrast MRI is a low-morbidity imaging modality that may serve as an effective tool in preoperative planning of the ALT flap.
股前外侧（ALT）皮瓣是重建手术中常用的基于穿支血管的皮瓣。尽管先前的研究使用了各种血管造影技术对ALT穿支血管进行术前成像，但尚无研究探讨非增强磁共振成像（MRI）的有效性。我们的研究旨在探讨我院脂肪抑制非增强MRI序列在术前规划中对ALT主要皮肤穿支血管的数量、位置和走行进行特征描述的有效性。
我们查询了我院2013年7月至2018年7月期间的100例非增强大腿MRI数据库，这些MRI包括从股骨小转子到股直肌远端肌腱结合部的轴向脂肪抑制序列。确定穿支血管的走行、大小以及相对于骨性标志的位置。
在100例检查中，70例包括双侧大腿，共170条大腿用于穿支血管分析。共识别出约277条穿支血管，其中101条为肌间隔皮支（36.5%），176条为肌皮支（63.5%）。每条大腿平均可见1.63条穿支血管（最小值为1；最大值为4）。大腿前侧间隙筋膜穿出点处穿支血管的平均直径为2.5mm（标准差为0.5）。对于57条穿支血管，可以确定其沿髂前上棘或小转子-髌骨线的穿出位置，并映射为3个可预测的簇。
在170条成像大腿中，每条大腿至少发现1条穿支血管。通过非增强MRI测量的穿支血管走行、大小和位置与先前文献一致。非增强MRI是一种低发病率的成像方式，可作为ALT皮瓣术前规划的有效工具。
