Three-Dimensional Computed Tomography Angiography Fusion Imaging for Posterior Interosseous Artery Perforator Location of Forearm Flap: A Retrospective Study of 23 Patients

Abstract

Background

Flap surgery necessitates accurate identification of perforator locations for optimal outcomes. Color Doppler Sonography (CDS) has been a routine examination in preoperative planning, but its limitations in providing a comprehensive map of perforators relationships prompts exploration of alternative imaging modalities. This study introduces the application of a novel technique, three-dimensional computed tomography angiography fusion imaging (3D-CTA-FI), for precise interosseous artery perforator locating in forearm flap surgery.

Method

A retrospective investigation including 23 patients receiving forearm flap surgery of posterior interosseous artery perforator was conducted, and two-phase computed tomography angiography (CTA) protocol was adopted in this study. Utilizing Mimics software, 3D models of vascular structures were meticulously reconstructed. Surgical procedures were guided by the 3D-CTA-FI, and accuracy of CDS and 3D-CTA-FI was evaluated by comparing visual and actual perforator positions.

Results

All flaps were viable, and patients were discharged uneventfully. In our study, 3D-CTA-FI portrayed accurate depictions of vascular pedicles and perforators. The mean discrepancy between indicated and actual perforator positions was 2.9 ± 1.7 mm (Group 1) and 2.4 ± 1.7 mm (Group 2), accompanied by excellent consistency rates of 47.8% and 60.9%, respectively.

Conclusions

Three-dimensional computed tomography angiography fusion imaging (3D-CTA-FI) provides detailed information of perforators in posterior interosseous artery perforator flap surgery, and its application in clinical practice is feasible and beneficial.