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J Reconstr Microsurg 2022; 38(07): 563-570
DOI: 10.1055/s-0041-1740958
Original Article

Color Doppler Ultrasound versus Computed Tomography Angiography for Preoperative Anterolateral Thigh Flap Perforator Imaging: A Systematic Review and Meta-Analysis

Reece Moore
1   College of Medicine, Medical University of South Carolina, Charleston, South Carolina
,
Donna Mullner
2   Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, South Carolina
,
Georgina Nichols
2   Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, South Carolina
,
Isis Scomacao
1   College of Medicine, Medical University of South Carolina, Charleston, South Carolina
2   Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, South Carolina
,
Fernando Herrera
1   College of Medicine, Medical University of South Carolina, Charleston, South Carolina
2   Division of Plastic and Reconstructive Surgery, Medical University of South Carolina, Charleston, South Carolina
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Abstract

Background The anterolateral thigh (ALT) perforator flap is a commonly used flap with a predictable, though often variable, perforator anatomy. Preoperative imaging with color Doppler ultrasound (CDU) and computed tomography angiography (CTA) of ALT flap perforators can be a useful tool for flap planning. This study provides a complete review and analysis of the relevant preoperative ALT imaging literature.

Methods Studies related to preoperative CDU and CTA imaging were reviewed, and information related to imaging method, sensitivity, false-positive rates, and perforator course identification (musculocutaneous vs. septocutaneous) were analyzed.

Results A total of 23 studies related to preoperative ALT flap CDU and CTA imaging were included for review and analysis. Intraoperative perforator identification was compared with those found preoperatively using CDU (n = 672) and CTA (n = 531). Perforator identification sensitivity for CDU was 95.3% (95% CI: 90.9–97.6%) compared with the CTA sensitivity of 90.4% (95% confidence interval [CI]: 74.4–96.9%). The false-positive rate for CDU was 2.8% (95% CI: 1.1–4.5%) compared with 2.4% (95% CI: 0.7–4.1%) for CTA. Accuracy of perforator course identification was 95.5% (95% CI: 93.6–99.2%) for CDU and 96.9% (95% CI: 92.7–100.1%) for CTA.

Conclusion CDU provides the reconstructive surgeon with greater preoperative perforator imaging sensitivity compared with CTA; however, false-positive rates are marginally higher with preoperative CDU. Preoperative imaging for ALT flap design is an effective tool, and the reconstructive surgeon should consider the data presented here when selecting a flap imaging modality.

Keywords

anterolateral thigh flap - perforator flap - imaging - ultrasound - computed tomography angiography - preoperative


Publication History

Received: 20 June 2021

Accepted: 09 November 2021

Article published online:
27 December 2021

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