Computed Tomography Angiography Allows the Classification of the First Dorsal Metatarsal Arteries
Lin Xu1, Keqin Yang1, Pingou Wei1
1Department of Hand & Foot Microsurgery, Guigang City People's Hospital, Guigang, Guangxi, China.
Insights
Computed tomography angiography (CTA) effectively maps foot arteries for reconstructive surgery, guiding donor site selection. This minimally invasive imaging ensures successful finger and thumb reconstructions with good functional outcomes.
Area of Science:
- Vascular Surgery
- Plastic Surgery
- Medical Imaging
Background:
- Conventional angiography is invasive.
- Submillimeter computed tomography angiography (CTA) offers an effective alternative for peripheral artery imaging.
- CTA aids in assessing peripheral artery branches for reconstructive procedures.
Purpose of the Study:
- To evaluate the utility of CTA in guiding the selection and design of foot donor areas for finger or thumb reconstruction.
- To compare preoperative CTA findings with intraoperative observations at the donor site.
Main Methods:
- Retrospective study of 79 patients undergoing finger/thumb reconstruction (Jan 2011-Mar 2014).
- Preoperative CTA performed to visualize foot arterial supply (DPA, FDMA, TWA).
- Comparison of CTA imaging with intraoperative findings.
Main Results:
- CTA evaluated 474 artery segments across 158 feet, with high satisfaction for DPA (100%) and FDMA (89.2%).
- Arterial patterns classified using Gilbert types: 57.0% Type I, 32.9% Type II, 8.2% Type III.
- CTA-intraoperative findings for FDMA were consistent; all reconstructions survived, with good functional recovery at 6-18 months follow-up.
Conclusions:
- CTA provides valuable 3D imaging of extremity arteries.
- Preoperative CTA enables accurate assessment of blood supply for donor site planning.
- CTA is a reliable tool for guiding successful digital and thumb reconstruction.
Abstract:
Background Conventional angiography is an invasive technique. Submillimeter computed tomography angiography (CTA) has been shown to be an effective alternative for peripheral artery branches. This study aimed to assess the use of CTA to guide the choice and design of foot donor area for finger or thumb reconstruction. Methods This was a retrospective study of 79 patients who underwent finger or thumb reconstruction between January, 2011 and March, 2014. All these patients underwent preoperative CTA to determine the exact blood supply at the donor site. Preoperative imaging and intraoperative findings at the donor site were compared. Results Among the 79 patients (158 feet), 474 artery segments (dorsalis pedis artery [DPA], first dorsal metatarsal artery [FDMA], and toe web artery [TWA]) were evaluated using CTA. Image satisfaction rates of the vessels were 100.0 ± 0.0%, 89.2 ± 3.2%, and 60.1 ± 5.0% for DPA, FDMA, and TWA, respectively. Among the 158 feet, 90 were Gilbert type I (57.0%), 52 were Gilbert type II (32.9%), 13 were Gilbert type III (8.2%), and 3 were with poor visibility and could not be classified (1.9%). In all 79 patients, the CTA image of the FDMA was consistent with the intraoperative observations. All reconstructed fingers survived. Follow-up was available for 69 patients. After a 6- to 18-month follow-up, the reconstructed fingers and donor area recovered well, and the reconstructed fingers had strong holding power, without pain. Conclusion CTA can produce three-dimensional images for extremity arteries, allowing the preoperative assessment of blood supply and planning of donor site.
More Related Videos
Related Concept Videos
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:28Imaging Studies for Cardiovascular System V: CT
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:11Pulse Assessment Sites
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:20Arteries of Lower Limbs