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. 2025 May 6.
doi: 10.1007/s00266-025-04861-5. Online ahead of print.

Advancing Preoperative Planning in Perforator Flap Surgery with Photon-Counting Computed Tomography Angiography: Less Challenges with More Precision

Yining Lan #  1   2 , Runzhu Liu #  1 , Luqi Guo  1 , Chao Zhang  3 , Hailin Zhang  1 , Jiuzuo Huang  1 , Nanze Yu  1 , Feng Feng  3 , Fengzhou Du  4 , Wang Yun  5 , Xiao Long  6
Affiliations

Advancing Preoperative Planning in Perforator Flap Surgery with Photon-Counting Computed Tomography Angiography: Less Challenges with More Precision

Yining Lan et al. Aesthetic Plast Surg. .

Abstract

Background: Perforator flaps are crucial in plastic surgery, providing versatility in complex reconstructions. However, anatomical variations pose challenges in flap dissection and anastomosis. Conventional computed tomography angiography (CTA) is standard for preoperative planning but has limitations in evaluating small arteries. A novel technique, photon-counting computed tomography (PCCT), offers enhanced spatial resolution with lower radiation exposure.

Methods: From December 2023 to September 2024, a pilot study was conducted at Peking Union Medical College Hospital in Beijing. Seven patients undergoing perforator flap reconstructions received preoperative PCCT angiography (experimental group). Five patients underwent conventional CTA scans (control group 1), and another five had flap reconstructions guided by traditional imaging methods (control group 2). Three flap types were analyzed: deep inferior epigastric perforator flap, anterolateral thigh perforator flap, and superficial circumflex iliac artery perforator flap. Imaging efficacy, radiation dose, and surgical outcomes were compared.

Results: PCCT identified significantly more perforators (14.5 ± 2.1 vs. 10.2 ± 1.8, p < 0.05) and smaller branch diameters (0.8 ± 0.1 mm vs. 1.2 ± 0.2 mm, p < 0.05) compared to conventional CTA. The radiation dose was lower with PCCT (6.3 ± 1.1 mSv vs. 8.1 ± 0.9 mSv, p < 0.05). The experimental group experienced shorter operation and flap harvesting times, with fewer complications than control group 2.

Conclusion: PCCT angiography enhances preoperative assessment of perforator vessels by detecting more and smaller perforators while reducing radiation exposure, thereby improving surgical planning and outcomes in perforator flap reconstructions.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Computed tomography angiography; Medical imaging; Perforator flap; Photon-counting computed tomography (PCCT); Plastic surgery.

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Conflict of interest statement

Declarations. Conflict of interest: This study is approved by the institutional review board (1-23PJ1863). Informed consent: Informed consent has been obtained from each participant.

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