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CTA-guided preoperative perforator selection for knee soft tissue reconstruction.
Xuebiao Yang1,2, Te Cai2,3, Xingcheng Dai1,2
1Kunming Medical University, Kunming, 650500, China.
BMC Surgery
|June 19, 2026
Summary
Computed tomography angiography (CTA) aids in selecting the best perforator for knee soft tissue reconstruction, improving surgical planning. This method demonstrated high accuracy in identifying target perforators, leading to successful flap survival.
Area of Science:
- Plastic Surgery
- Radiology
- Orthopedic Surgery
Background:
- Perforator flaps are versatile for knee soft tissue defect reconstruction.
- Variability in perforator anatomy complicates flap selection and increases surgical uncertainty.
- Preoperative planning is crucial for successful knee reconstruction outcomes.
Purpose of the Study:
- To evaluate computed tomography angiography (CTA) for guiding perforator selection in knee soft tissue reconstruction.
- To assess the role of CTA in supporting individualized preoperative planning.
- To determine the feasibility of a CTA-guided workflow for perforator flap surgery.
Main Methods:
- Retrospective evaluation of 16 patients undergoing 17 flap procedures.
- Preoperative CTA used to assess perforator location, course, and length.
- Selection of the most suitable perforator based on comparative preoperative assessment.
Main Results:
- 16 CTA-selected perforator-based flaps and 1 random-pattern flap were harvested.
- All 16 target perforators were identified intraoperatively as predicted (0/16 discrepancy).
- Complete skin-paddle survival was achieved in 15/16 CTA-selected flaps and 16/17 flaps overall.
Conclusions:
- CTA offers a practical decision-support tool for preoperative assessment of knee perforator anatomy.
- The CTA-guided workflow is feasible and concordant with intraoperative findings.
- This approach supports individualized flap planning based on defect and perforator anatomy.