Computed Tomographic Angiography (CTA)-guided precision reconstruction in complex lower leg wounds.

Area of Science:

• Plastic Surgery
• Vascular Surgery
• Radiology

Background:

• Complex lower leg wounds pose significant reconstruction challenges due to extensive tissue damage and vascular complexities.
• Free flap transfer is preferred, but lacks precise preoperative vascular data, complicating surgical planning.
• A Computed Tomographic Angiography (CTA)-guided approach is introduced to enhance precision in reconstruction.

Purpose of the Study:

• To evaluate the role of preoperative Computed Tomographic Angiography (CTA) in assessing recipient-site vasculature.
• To optimize surgical outcomes for complex lower leg wound reconstruction through precise vascular mapping.
• To demonstrate the benefits of CTA in guiding flap selection and anastomosis.

Main Methods:

• Retrospective analysis of 57 patients undergoing CTA-guided flap surgery for lower leg defects (March 2013-October 2023).
• Preoperative CTA used to map vascular anatomy, identify perforators, and guide flap design (ALTP, DIEP flaps).
• Flap selection was based on wound characteristics and vascular conditions.

Main Results:

• High flap survival rate (94.7% complete survival), with low rates of partial necrosis (1.8%) and total flap loss (3.5%).
• CTA showed 100% concordance with intraoperative findings, enabling precise vessel localization and improved surgical efficiency.
• Postoperative complications included vascular compromise (8.8%) and flap bulkiness (19.3%); 61.4% had excellent functional and aesthetic outcomes.

Conclusions:

• CTA-guided reconstruction facilitates comprehensive preoperative vascular assessment, optimizing flap choice and anastomosis.
• This evidence-based method significantly enhances surgical precision and patient outcomes for complex lower leg wounds.
• CTA represents an advancement over traditional methods for managing challenging lower leg reconstructions.