Lan Yining, Liu Runzhu, Guo Luqi, Zhang Chao, Zhang Hailin, Huang Jiuzuo, Yu Nanze, Feng Feng, Du Fengzhou, Yun Wang, Long Xiao
Department of Plastic and Reconstructive Surgery, Chinese Academy of Medical Science Peking Union Medical College Hospital, No. 41 Damucang Hutong, Xicheng District, Beijing, China.
Eight-year MD Program, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuaifuyuan, Dongcheng District, Beijing, China.
Aesthetic Plast Surg. 2025 May 6. doi: 10.1007/s00266-025-04861-5.
Perforator flaps are crucial in plastic surgery, providing versatility in complex reconstructions. However, anatomical variations pose challenges in flap dissection and anastomosis. Conventional computed tomography angiography (CTA) is standard for preoperative planning but has limitations in evaluating small arteries. A novel technique, photon-counting computed tomography (PCCT), offers enhanced spatial resolution with lower radiation exposure.
From December 2023 to September 2024, a pilot study was conducted at Peking Union Medical College Hospital in Beijing. Seven patients undergoing perforator flap reconstructions received preoperative PCCT angiography (experimental group). Five patients underwent conventional CTA scans (control group 1), and another five had flap reconstructions guided by traditional imaging methods (control group 2). Three flap types were analyzed: deep inferior epigastric perforator flap, anterolateral thigh perforator flap, and superficial circumflex iliac artery perforator flap. Imaging efficacy, radiation dose, and surgical outcomes were compared.
PCCT identified significantly more perforators (14.5 ± 2.1 vs. 10.2 ± 1.8, p < 0.05) and smaller branch diameters (0.8 ± 0.1 mm vs. 1.2 ± 0.2 mm, p < 0.05) compared to conventional CTA. The radiation dose was lower with PCCT (6.3 ± 1.1 mSv vs. 8.1 ± 0.9 mSv, p < 0.05). The experimental group experienced shorter operation and flap harvesting times, with fewer complications than control group 2.
PCCT angiography enhances preoperative assessment of perforator vessels by detecting more and smaller perforators while reducing radiation exposure, thereby improving surgical planning and outcomes in perforator flap reconstructions.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
穿支皮瓣在整形手术中至关重要，为复杂重建提供了多样性。然而，解剖变异给皮瓣解剖和吻合带来了挑战。传统的计算机断层血管造影（CTA）是术前规划的标准方法，但在评估小动脉方面存在局限性。一种新技术，光子计数计算机断层扫描（PCCT），提供了更高的空间分辨率和更低的辐射暴露。
2023年12月至2024年9月，在北京协和医院进行了一项试点研究。7例接受穿支皮瓣重建的患者接受了术前PCCT血管造影（实验组）。5例患者接受了传统CTA扫描（对照组1），另外5例患者采用传统成像方法进行皮瓣重建（对照组2）。分析了三种皮瓣类型：腹壁下深穿支皮瓣、股前外侧穿支皮瓣和旋髂浅动脉穿支皮瓣。比较了成像效果、辐射剂量和手术结果。
与传统CTA相比，PCCT识别出的穿支明显更多（14.5±2.1对10.2±1.8，p<0.05），分支直径更小（0.8±0.1mm对1.2±0.2mm，p<0.05）。PCCT的辐射剂量更低（6.3±1.1mSv对8.1±0.9mSv，p<0.05）。实验组的手术和皮瓣切取时间更短，并发症比对照组2更少。
PCCT血管造影通过检测更多更小的穿支增强了对穿支血管的术前评估，同时减少了辐射暴露，从而改善了穿支皮瓣重建的手术规划和结果。
证据水平IV：本杂志要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或作者在线指南www.springer.com/00266 。
