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

BACKGROUND

Reconstruction of complex lower leg wounds presents significant challenges due to extensive soft tissue damage, vascular variations, and potential neurovascular injuries. While flap transfer, particularly free flaps, remains the preferred method for reconstruction, the lack of precise preoperative vascular information often complicates surgical planning. This study introduces a Computed Tomographic Angiography (CTA)-guided approach for precision reconstruction to address these challenges.

PURPOSE: This study aims to elucidate the critical role of precise preoperative assessment of recipient-site vasculature using Computed Tomographic Angiography (CTA) in optimizing surgical outcomes for complex lower leg wound reconstruction.

METHODS

From March 2013 to October 2023, 57 patients with complex lower leg defects underwent reconstruction using CTA-guided flap surgery. Patient demographics, injury characteristics, and surgical outcomes were retrospectively analyzed. Preoperative CTA was employed to map donor and recipient vascular anatomy, evaluate perforator vessels, and guide flap selection and design. Flap options included anterolateral thigh perforator (ALTP) and deep inferior epigastric perforator (DIEP) flaps, with selection tailored to wound dimensions, depth, and vascular conditions.

RESULTS

Flap sizes ranged from 5 × 10 cm to 55 × 70 cm, 54 flaps survived completely (94.7%), 1 partial necrosis requiring revision (1.8%), and 2 total flap losses (3.5%). CTA demonstrated 100% concordance with intraoperative vascular findings, enabling precise recipient vessel localization and enhanced surgical efficiency. Postoperative complications included vascular compromise (8.8%), flap bulkiness (19.3%), and minimal wound dehiscence (1.8%). Functional and aesthetic outcomes were rated as excellent in 61.4% of cases.

CONCLUSION

The CTA-guided reconstruction approach enables comprehensive preoperative vascular assessment, optimizing donor flap selection and recipient vessel anastomosis. This evidence-based method significantly improves surgical precision and outcomes, representing an advancement over traditional empirical techniques in managing complex lower leg wounds.