Utility of multi-detector row computed tomography angiography versus Doppler in localization of perforators of anterolateral thigh flaps

Abstract

Aim: Anterolateral thigh (ALT) flap is widely used in reconstruction of various defects. Preoperative imaging facilitates perforator mapping, overcoming intraoperative uncertainty. The purpose of this study was to investigate the utility of multi-detector row computed tomography angiography (MDCTA) and a handheld Doppler in locating ALT perforators.

Methods: Twenty patients were randomized into two groups. Group 1 patients received MDCTA and Doppler studies whereas Group 2 received only a Doppler study. The number, location, course, and source of all cutaneous and sizable perforators were compared with intraoperative findings. Surgeons’ stress levels during flap harvest and flap harvest time were compared.

Results: MDCTA findings correlated well with intraoperative findings for perforator type and segmental distribution with 100% concordance. Doppler alone had a 52% rate of concordance. The sensitivity and specificity for MDCTA in demonstrating the presence of perforators were 85.71% and 97.22%, respectively; whereas for Doppler alone the sensitivity and specificity were 80% and 87.91%, respectively. In demonstrating perforator source, MDCTA showed a sensitivity of 100% and specificity of 91.66%, with 100% accuracy. Sensitivity and specificity for sizable perforators were 90% each, with 88.88% accuracy. Doppler studies were unable to provide this information. Comparison of surgeon stress levels showed no differences between the two groups, although the time for flap harvest was significantly shorter in Group 1.

Conclusion: MDCTA compared to Doppler is more sensitive, specific, and accurate with respect to location, course, and source of perforators.

Keywords

Anterolateral thigh / multi-detector row computed tomography angiography / perforator

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