الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 163 |  |  |
| | | from | 163 | | |
Abstract
One of the most adaptable and popular choices for soft tissue repair
is the free anterolateral thigh flap. The anterolateral thigh flap is typically
supplied by the descending branch of the lateral circumflex femoral artery.
Even within the same patient, the vascular architecture of the ALT flap
varies greatly between the thighs. The surgeon should be able to choose the
best extremity, flap design, and need for further flaps with the use of
preoperative knowledge of the flap’s vascular architecture, especially the
perforators course. This could lead to improved outcomes, reduced
morbidity, and explicit informed consent.
CTA has been a subject of several studies as an investigation to
predict vascular anatomy variability in ALT flap.
In this study we prospectively studied CTA images of 24 patients
before surgery and compared them to our intra operative findings.
The ages of the studied group varied from 6 to 72 years. There were
19 males and 5 females. Tobacco smoking was identified in 4 cases and 5
cases known to be diabetic patients.
The Body Mass Index (BMI) of the studied group varied from 22.1
to 32.1.
The cause of the soft tissue defects was trauma in 16 patients, tumors
in 3 patients, burn contractures in 2 patients, diabetic foot complications in
2 patients and congenital constriction band in 1 case.
The site of the defect was lower limb in 18 patients, hand in 3
patients and head and neck in 3 patients. Our survival rate was 91.7% in 24
cases. One case had partial loss. Another case had complete failure.
The size of flaps ranged from 10cm to 28cm regarding flap length
and from 4cm to 18cm regarding flap width.
We identified 67 perforators intra-operatively compared to 56
identified on CTA.
Regarding operative perforator diameter, 22 perforators were from
0.5 mm to 1 mm, 22 perforators were less than 0.5 mm, and 23 perforators
were wider than 1 mm in diameter. Among the 67 perforators 57 of them
took musculo-cutaneous (MC) course (85.1%) while 10 perforators had
septo-cutaneous course (SC) (14.9%).
Regarding perforator diameter measured in CTA, 37 perforators were
from 0.5 mm to 1 mm, 8 perforators were less than 0.5 mm, and 11
perforators were wider than 1 mm in diameter.
Radiologically, of the 56 identified perforators 42 showed musculocutaneous (MC) course (75%) and 14 perforators had septo-cutaneous
course (SC) (25%).
The diameter of flap pedicle varied from 1 to 3.5 mm and the length
of the vascular pedicle was 7.5 -15 cm.
Pedicle source was the descending branch (DB) of lateral circumflex
femoral artery in 63 perforators, transverse branch (TB) of lateral
circumflex femoral artery in 3 perforators and oblique branch (OB) of
lateral circumflex femoral artery in 1 perforator.
Operative findings showed moderate degree of agreement with CTA
regarding perforators number, perforator diameter and pedicle diameter.
Strong degree of agreement was noticed regarding perforators‟ course,
source vessel and pedicles‟ length.