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Background <p>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.</p> Methods <p>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.</p> Results <p>PCCT identified significantly more perforators (14.5 ± 2.1 vs. 10.2 ± 1.8, <i>p</i> &lt; 0.05) and smaller branch diameters (0.8 ± 0.1 mm vs. 1.2 ± 0.2 mm, <i>p</i> &lt; 0.05) compared to conventional CTA. The radiation dose was lower with PCCT (6.3 ± 1.1 mSv vs. 8.1 ± 0.9 mSv, <i>p</i> &lt; 0.05). The experimental group experienced shorter operation and flap harvesting times, with fewer complications than control group 2.</p> Conclusion <p>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.</p> Level of Evidence IV <p>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 <a href="http://www.springer.com/00266">www.springer.com/00266</a>.</p>

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Advancing Preoperative Planning in Perforator Flap Surgery with Photon-Counting Computed Tomography Angiography: Less Challenges with More Precision

  • 期刊论文

  • 发表日期：

    2025年5月6日

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  • Yining Lan,
  • Runzhu Liu,
  • Luqi Guo,
  • Chao Zhang,
  • Hailin Zhang,
  • Jiuzuo Huang,
  • Nanze Yu,
  • Feng Feng,
  • Fengzhou Du,
  • Wang Yun,
  • Xiao Long

摘要

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Level of Evidence IV

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.