Three Dimensional-CTA versus Doppler Ultrasound for Anterolateral Thigh Flap Reconstruction in Limb Defects: A Retrospective Study

Background: Soft tissue limb defects often require anterolateral thigh (ALT) flap reconstruction, but anatomical variability of perforator vessels poses a challenge. The comparative efficacy of 3-dimensional computed tomographic angiography (3D-CTA) and color Doppler ultrasonography (CDUS) for preoperative planning remains unclear. Methods: This retrospective study analyzed 95 patients who underwent ALT flap limb reconstruction between March 2017 and May 2023, comparing a 3D-CTA–guided group (n=45) with a CDUS-guided group (n=50). Key outcomes included perforator mapping accuracy, surgical efficiency, postoperative complications, functional and aesthetic results, and cost-effectiveness. Results: Use of 3D-CTA demonstrated superior perforator detection sensitivity (98.4% versus 85.8%, P < 0.001) and positional accuracy (deviation: 0.3 versus 1.8 cm, P < 0.001). The 3D-CTA group had significantly shorter flap harvest times (38.5 versus 51.4 min, P < 0.001), fewer vascular complications (4.4% versus 20.0%, P = 0.0489), and higher flap survival (100% versus 92.0%, P = 0.047). The 3D-CTA cohort also achieved better sensory recovery and donor-site outcomes (Vancouver Scar Scale: 2.1 versus 4.3, P < 0.01). Despite higher initial imaging costs, 3D-CTA proved more cost-effective overall. Conclusions: For ALT flap reconstruction in limb defects, 3D-CTA provides superior perforator mapping, enhances surgical efficiency, improves clinical outcomes, and offers greater cost-effectiveness compared with CDUS. These findings support prioritizing 3D-CTA in preoperative planning for complex limb salvage.