Felder John M, Tawaklna Kenan, Nageeb Emmanuel, Geraghty Patrick
Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States.
Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, United States.
J Plast Reconstr Aesthet Surg. 2025 Jul;106:148-155. doi: 10.1016/j.bjps.2025.05.004. Epub 2025 May 13.
Lower extremity (LE) free tissue transfer (FTT) in patients with peripheral vascular disease (PVD) is complicated by arterial calcification, which may occur in free flap pedicle vessels as well as recipient vessels. However, no studies have examined the likelihood of encountering calcification in common flap pedicles or the anatomical sequence in which this process occurs.
Computed tomography (CT) and x-ray (XR) imaging were obtained in PVD patients undergoing LE FTT. Using software designed for cardiac vessel calcium analysis, calcium volume was quantified in flap pedicles of the trunk, upper extremity, pelvis, and lower extremity on CT images. Descriptive statistics were used to identify flap vessels most affected by calcification. A novel scoring system (Qual Calc) was developed to predict the likelihood of flap pedicle calcification by examining the qualitative presence of vascular calcification on plain foot XR.
Trunk pedicles (subscapular) showed statistically significantly lower calcification rates and volumes than lower extremity pedicles. LE flap pedicles were most likely to be calcified, with the lateral femoral circumflex artery being the most frequently calcified. Qual Calc score was highly predictive of quantified calcium volume in workhorse flaps of the upper and lower extremity.
Arterial calcification proceeds anatomically from the lower extremity cephalad towards the chest. Flaps based on the subscapular system are least affected by calcification and represent a safer reconstructive choice than thigh-based flaps for limb salvage in vasculopathic patients. Simple foot x-rays can be used to predict flap pedicle calcification with a reasonable degree of accuracy.
外周血管疾病（PVD）患者的下肢游离组织移植（FTT）会因动脉钙化而变得复杂，这种钙化可能发生在游离皮瓣蒂血管以及受区血管中。然而，尚无研究探讨常见皮瓣蒂部出现钙化的可能性或这一过程发生的解剖顺序。
对接受下肢FTT的PVD患者进行计算机断层扫描（CT）和X线（XR）成像。使用专为心脏血管钙化分析设计的软件，对CT图像上躯干、上肢、骨盆和下肢皮瓣蒂部的钙含量进行量化。采用描述性统计来确定受钙化影响最大的皮瓣血管。通过检查足部平片XR上血管钙化的定性表现，开发了一种新的评分系统（定性钙化评分）来预测皮瓣蒂部钙化的可能性。
躯干蒂部（肩胛下动脉）的钙化率和钙含量在统计学上显著低于下肢蒂部。下肢皮瓣蒂部最容易发生钙化，其中旋股外侧动脉钙化最为常见。定性钙化评分对上下肢常用皮瓣的钙含量量化具有高度预测性。
动脉钙化在解剖学上从下肢向头侧发展至胸部。基于肩胛下系统的皮瓣受钙化影响最小，对于血管病变患者的肢体挽救而言，比基于大腿的皮瓣是更安全的重建选择。简单的足部X线检查可用于以合理的准确度预测皮瓣蒂部钙化。
