Advancing Preoperative Planning in Perforator Flap Surgery with Photon-Counting Computed Tomography Angiography: Less...

Area of Science:

• Plastic Surgery
• Radiology
• Medical Imaging

Background:

• Perforator flaps are vital for complex plastic surgery reconstructions.
• Anatomical variations in perforator vessels challenge traditional imaging and surgical dissection.
• Conventional computed tomography angiography (CTA) has limitations in visualizing small perforator arteries.

Purpose of the Study:

• To evaluate the efficacy of photon-counting computed tomography (PCCT) angiography for preoperative assessment in perforator flap surgery.
• To compare PCCT angiography with conventional CTA and traditional methods in terms of imaging detail, radiation dose, and surgical outcomes.

Main Methods:

• A pilot study compared PCCT angiography (7 patients) with conventional CTA (5 patients) and traditional imaging (5 patients) for perforator flap reconstructions.
• Deep inferior epigastric artery perforator, anterolateral thigh, and superficial circumflex iliac artery perforator flaps were analyzed.
• Key metrics included imaging efficacy, radiation dose, and surgical outcomes.

Main Results:

• PCCT identified significantly more perforators (14.5 vs. 10.2) and smaller vessel diameters (0.8 mm vs. 1.2 mm) compared to CTA (p < 0.05).
• PCCT utilized a lower radiation dose (6.3 mSv vs. 8.1 mSv) than conventional CTA (p < 0.05).
• The PCCT group showed shorter operation/harvesting times and fewer complications.

Conclusions:

• PCCT angiography offers superior preoperative assessment of perforator vessels for flap reconstructions.
• The technique detects more and smaller perforators with reduced radiation exposure.
• Enhanced imaging improves surgical planning and leads to better outcomes in perforator flap surgery.