The Distribution of the Perforators in the Anterolateral Thigh and the Utility of Multidetector Row Computed Tomography Angiography in Preoperative Planning

This prospective study searches for the clinical relevance of preoperative multidetector row computed tomography (MDCT) angiography (CTA) for anterolateral thigh (ALT) free flap.Preoperative CTA data were collected in 100 patients between November 2004 and April 2008, and data from 139 limbs were evaluated for the number, type, and location of the ALT perforators. This information was used as operative roadmap and correlated with intraoperative findings in 58 patients.The MDCT revealed an average number of perforators of 2.28 per unilateral ALT (range, 0-4) and projected that 23% of the limb have at least 1 septocutaneous perforator. When the reference line connecting the anterior superior iliac spine ASIS and patella was divided into 10 equal parts, most of the perforators were concentrated in 4/10 to 7/10 and the most common was on the proximal 5/10. Two-thirds of septocutaneous perforators were present in the proximal half. Fifty-two of 58 patients had operative findings consistent with CTA, but 4 perforators failed to appear in preoperative CTA and 3 musculocutanenous perforators were initially identified as septocutaneous type but actually had a short intramuscular course.Preoperative mapping using MDCT angiography is fast, simple, and provides fairly accurate information about the location, type, and the course of the perforators. It allows appropriate selection of the sizable perforator with the shortest intramuscular course preoperatively leading to safer and easier operation with optimal outcome.