Case Report: Digital CTA-assisted anterolateral thigh perforator pedicled flap for repairing postoperative defects in...

Vulvar Paget's disease (VPD) often requires extensive resection that may result in perineal tissue defects. The anterolateral thigh (ALT) flap is a commonly used reconstructive option; however, anatomical variations in its perforator vessels can pose surgical challenges. This study aims to evaluate the role of preoperative digital computed tomographic angiography (CTA) in ALT flap planning and to report our experience with vulvar reconstruction following Vulvar Paget's disease excision.

Clinical data from a patient with Vulvar Paget's disease were retrospectively analyzed. Following wide local excision, vulvar reconstruction using an ALT flap was planned. Preoperative CTA combined with three-dimensional (3D) digital reconstruction technology was performed to localize and assess the perforator vessels of the anterolateral thigh, guiding the design of a customized flap. The flap was harvested and transferred according to the preoperative plan to reconstruct the vulvar defect.

Digital CTA successfully delineated the origin, course, and caliber of the perforator vessels, facilitating safe and precise flap harvest. Postoperatively, the flap demonstrated good perfusion, with satisfactory vulvar morphology and functional recovery. The donor site healed uneventfully.

Preoperative CTA effectively assesses the perforator anatomy of the ALT flap, enhancing surgical predictability and safety. It serves as a valuable adjunct in vulvar reconstruction following Vulvar Paget's disease excision.