Three-dimensional computed tomography angiography fusion imaging for posterior interosseous artery perforator location of forearm flap: a retrospective study of 23 patients

Abstract

Abstract Background Flap surgery, integral to various reconstructive procedures, necessitates accurate identification of perforator locations for optimal outcomes. While Color Doppler Sonography (CDS) has been a staple in preoperative planning, its limitations in providing a comprehensive overview of perforator relationships prompted 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 dorsal interosseous artery perforator localization in forearm flap surgery. Method A retrospective investigation including 23 patients undergoing forearm flap surgery of posterior interosseous artery perforator was conducted, employing a two-phase computed tomography angiography (CTA) protocol. 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 indicated and actual perforator positions. Results All flaps exhibited viability, with 3D-CTA-FI consistently portraying 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 accordance rates of 47.8% and 60.9%, respectively. Conclusions Three-dimensional computed tomography angiography fusion imaging (3D-CTA-FI) emerges as a valuable tool for forearm flap surgery. Its ability to provide detailed, accurate images of perforators enhances preoperative planning and intraoperative precision, making it a feasible and beneficial addition to clinical practice.