Three-dimensional computed tomography angiography fusion imaging for posterior interosseous artery perforator location of forearm flap: a retrospective study of 23 patients

Background Flap surgery, integral to various reconstructive procedures, necessitates accurate identification of perforator locations for optimal outcomes. While Color Doppler Sonography (CDS) has been a staple in preoperative planning, its limitations in providing a comprehensive overview of perforator relationships prompted exploration of alternative imaging modalities. This study introduces the application of a novel technique, three-dimensional computed tomography angiography fusion imaging (3D-CTA-FI), for precise dorsal interosseous artery perforator localization in forearm flap surgery. Method A retrospective investigation including 23 patients undergoing forearm flap surgery of posterior interosseous artery perforator was conducted, employing a two-phase computed tomography angiography (CTA) protocol. Utilizing Mimics software, 3D models of vascular structures were meticulously reconstructed. Surgical procedures were guided by the 3D-CTA-FI, and accuracy of CDS and 3D-CTA-FI was evaluated by comparing indicated and actual perforator positions. Results All flaps exhibited viability, with 3D-CTA-FI consistently portraying accurate depictions of vascular pedicles and perforators. The mean discrepancy between indicated and actual perforator positions was 2.9 ± 1.7 mm (Group 1) and 2.4 ± 1.7 mm (Group 2), accompanied by excellent accordance rates of 47.8% and 60.9%, respectively. Conclusions Three-dimensional computed tomography angiography fusion imaging (3D-CTA-FI) emerges as a valuable tool for forearm flap surgery. Its ability to provide detailed, accurate images of perforators enhances preoperative planning and intraoperative precision, making it a feasible and beneficial addition to clinical practice.