Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ...Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ALT flaps have been criticized due to variability in vasculature, which may result in inadequate or non-existent perforators. This retrospective study aims to investigate the utility and validity of positron emission tomography (PET) scan to identify the location and characteristics of perforators to the ALT flap. Methods: We performed a 10-year retrospective review of ALT flaps at our institution to identify patients with preoperative PET scans available for analysis. Three reviewers (attending physician, fellow, and resident) were asked to identify the number, location, and characteristics (myocutaneous versus septocutaneous) of ALT perforators on imaging, and reviewer agreement was assessed. Results were then compared to available operative data. Results: One hundred twenty-one patients were identified who underwent ALT free flap surgery. Thirty-eight preoperative PET scans were identified for review. At least one perforator was identified in 92.1% of scans. Agreement percentages regarding the number of perforators ranged from 53% - 61% whereas agreement regarding the location of a single perforator ranged from 79% - 90%. However, reviewers did not agree regarding the type of perforator, with agreement ranging from 34% - 53%. Poor agreement was observed when compared to intraoperative data, with the number of perforators ranging from 26% - 34% and the type of perforator 11% - 24%. These findings are likely due to insufficient data available in operative reports. Conclusion: Although initial studies suggest that PET scan shows promising evidence to support the capacity to preoperatively identify ALT perforators, future prospective studies are warranted to fully validate these findings.展开更多
Free tissue transfer(FTT)is a cornerstone of head and neck reconstruction.Although rare,complications of FTT surgery can be devastating,including failed flap harvest,wound breakdown,or flap loss ultimately.Thus,modern...Free tissue transfer(FTT)is a cornerstone of head and neck reconstruction.Although rare,complications of FTT surgery can be devastating,including failed flap harvest,wound breakdown,or flap loss ultimately.Thus,modern microvascular surgeons bolster surgical and clinical expertise with a growing number of technological advances to optimize patient care and outcomes.These technologies can be applied in the preoperative,intraoperative,and postoperative period.Various preoperative imaging modalities can assist in selecting the optimal donor site and advanced perforator planning.Intraoperatively,novel technologies can assist with microvascular anastomoses,operative magnification and visualization,and assess free tissue perfusion.Postoperatively,routine clinical assessment can be augmented by a variety of adjunctive monitoring techniques designed to assess tissue health,arterial inflow and venous drainage.The overall ease and success of performing FTT can be improved by employing novel technologies at every phase of the surgical process.This article will expand upon established and upcoming technological advances and the existing literatures to support their use.展开更多
文摘Objectives: The anterolateral thigh (ALT) flap is often considered the workhorse in soft tissue reconstruction of head and neck defects secondary to trauma, infection, or tumor resection. Despite its many advantages, ALT flaps have been criticized due to variability in vasculature, which may result in inadequate or non-existent perforators. This retrospective study aims to investigate the utility and validity of positron emission tomography (PET) scan to identify the location and characteristics of perforators to the ALT flap. Methods: We performed a 10-year retrospective review of ALT flaps at our institution to identify patients with preoperative PET scans available for analysis. Three reviewers (attending physician, fellow, and resident) were asked to identify the number, location, and characteristics (myocutaneous versus septocutaneous) of ALT perforators on imaging, and reviewer agreement was assessed. Results were then compared to available operative data. Results: One hundred twenty-one patients were identified who underwent ALT free flap surgery. Thirty-eight preoperative PET scans were identified for review. At least one perforator was identified in 92.1% of scans. Agreement percentages regarding the number of perforators ranged from 53% - 61% whereas agreement regarding the location of a single perforator ranged from 79% - 90%. However, reviewers did not agree regarding the type of perforator, with agreement ranging from 34% - 53%. Poor agreement was observed when compared to intraoperative data, with the number of perforators ranging from 26% - 34% and the type of perforator 11% - 24%. These findings are likely due to insufficient data available in operative reports. Conclusion: Although initial studies suggest that PET scan shows promising evidence to support the capacity to preoperatively identify ALT perforators, future prospective studies are warranted to fully validate these findings.
文摘Free tissue transfer(FTT)is a cornerstone of head and neck reconstruction.Although rare,complications of FTT surgery can be devastating,including failed flap harvest,wound breakdown,or flap loss ultimately.Thus,modern microvascular surgeons bolster surgical and clinical expertise with a growing number of technological advances to optimize patient care and outcomes.These technologies can be applied in the preoperative,intraoperative,and postoperative period.Various preoperative imaging modalities can assist in selecting the optimal donor site and advanced perforator planning.Intraoperatively,novel technologies can assist with microvascular anastomoses,operative magnification and visualization,and assess free tissue perfusion.Postoperatively,routine clinical assessment can be augmented by a variety of adjunctive monitoring techniques designed to assess tissue health,arterial inflow and venous drainage.The overall ease and success of performing FTT can be improved by employing novel technologies at every phase of the surgical process.This article will expand upon established and upcoming technological advances and the existing literatures to support their use.
