• Shao-Cheng Liu, Wen-Kuan Chiu, Shih-Yi Chen, Tzu-Peng Lee, Hsing-Won Wang, and Shyi-Gen Chen.
• Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, ROC.
• J Craniomaxillofac Surg. 2011 Dec 1; 39 (8): 633-8.

ObjectivesAnterolateral thigh flap (ALT) is an useful flap for head and neck reconstruction, but the variable perforators may limit its applications. Our goal was to clarify the benefits of preoperative CT angiography (CTA) in mapping of free ALT perforators for reconstruction of cheek through-and-through defects.MethodWe retrospectively reviewed 32 patients undergoing reconstruction of through-and-through cheek defects with a free ALT flap between February 2005 and July 2009. These patients were divided into two groups. Group I (N=17): the ALT flap was designed based on the traditional handheld Doppler probe. Group II (N=15): preoperative imaging with CTA was used to map the perforator's number, size and variations. Surgical results were evaluated for both major and minor complications, as with the operation time, length of hospital stay and donor-site morbidity.ResultsOverall flap survival was 96.88% (31 of 32 flaps). The use of preoperative CTA was associated with a significant reduction in major surgical complications, length of surgery and the need for a secondary debulking procedure (p<0.05). There was no difference in minor complication and donor-site morbidity.ConclusionsThe use of CTA for preoperative navigation of ALT flap for cheek reconstruction is associated with improved operative outcomes. Detailed data from images allow the surgeon to interpret any anatomical variations, choosing the exact suitable thigh, facilitate flap design, and greatly reduce major postoperative complications.Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

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