Thomas Benjamin, Falkner Florian, Didzun Oliver, Panayi Adriana C, Ghanad Iman, Hundeshagen Gabriel, Gazyakan Emre, Kneser Ulrich, Bigdeli Amir K
BG Klinik Ludwigshafen, Department of Hand, Plastic, and Reconstructive Surgery, Burn Centre at Heidelberg University, Ludwig-Guttmann-Str. 13, 67071 Ludwigshafen, Germany.
Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Klinikum Kassel, Teaching Hospital of Philipps University Marburg, Mönchebergstraße 41-43, 34125 Kassel, Germany.
Life (Basel). 2025 Apr 7;15(4):620. doi: 10.3390/life15040620.
Planning and harvesting anterolateral thigh flaps (ALT) requires precise perforator selection and accurate tissue perfusion assessment. Unfortunately, variable perforator anatomy and perfusion patterns often result in extensive exploratory dissection. We aimed to assess the impact of preoperative color-coded duplex sonography (CCDS) and intraoperative indocyanine green fluorescence angiography (ICGFA) on perforator selection and operative morbidity. Fifty-three ALTs were performed with preoperative CCDS and intraoperative ICGFA. Flaps had one, two, or three suitable perforators. Additional perforators were either included, or ligated following temporary clamping with ICGFA-based perfusion assessment. If perfusion was sufficient, further dissecting of additional perforators of unfavorable course was abstained from. The impact on perforator selection and operative outcomes was studied. Seven flaps were raised on a single, 34 on 2, and 12 on 3 perforators. There was no flap loss. Comparing the subgroups of fully dissected versus partially clamped and subsequently ligated perforators revealed significantly shorter harvest times in the latter (268 ± 71 versus 216 ± 47 min, = 0.006). The unnecessary dissection of 21 additional perforators in 16 cases was avoided. Combining preoperative CCDS and intraoperative ICGFA aids in designing ALTs and guarantees the intraoperative selection of suitable perforators. This allows for significant reductions in operative time and donor-site morbidity by limiting unnecessary dissection.
计划和切取股前外侧皮瓣（ALT）需要精确选择穿支血管并准确评估组织灌注情况。不幸的是，穿支血管解剖结构和灌注模式的差异常常导致广泛的探查性解剖。我们旨在评估术前彩色编码双功超声（CCDS）和术中吲哚菁绿荧光血管造影（ICGFA）对穿支血管选择和手术并发症的影响。采用术前CCDS和术中ICGFA进行了53例ALT手术。皮瓣有1支、2支或3支合适的穿支血管。对于额外的穿支血管，根据基于ICGFA的灌注评估，在临时夹闭后要么予以保留，要么结扎。如果灌注充足，则避免进一步解剖走行不佳的额外穿支血管。研究其对穿支血管选择和手术结果的影响。7例皮瓣基于1支穿支血管切取，34例基于2支穿支血管切取，12例基于3支穿支血管切取。无皮瓣坏死。比较完全解剖的穿支血管亚组与部分夹闭并随后结扎的穿支血管亚组，发现后者的切取时间明显更短（268±71分钟对216±47分钟，P = 0.006）。避免了16例患者中21支额外穿支血管的不必要解剖。术前CCDS与术中ICGFA相结合有助于设计ALT皮瓣，并保证术中选择合适的穿支血管。通过限制不必要的解剖，这可显著缩短手术时间并降低供区并发症。
