Computed tomography angiography and microsurgical flaps for traumatic wounds: What is the added value?

Autor:	Lucas Sousa Macedo, Raquel Bernardelli Iamaguchi, Alvaro Baik Cho, Gustavo Bersani Silva, Teng Hsiang Wei, Renato Polese Rusig
Rok vydání:	2021
Předmět:	medicine.medical_specialty Microsurgery Physiology Computed Tomography Angiography medicine.medical_treatment Free flap 030230 surgery Anastomosis Free Tissue Flaps 03 medical and health sciences 0302 clinical medicine Physiology (medical) Medicine Humans cardiovascular diseases Computed tomography angiography Retrospective Studies medicine.diagnostic_test business.industry musculoskeletal neural and ocular physiology Angiography Retrospective cohort study Hematology Plastic Surgery Procedures Surgery medicine.anatomical_structure Treatment Outcome Amputation 030220 oncology & carcinogenesis Upper limb Cardiology and Cardiovascular Medicine business Trauma surgery psychological phenomena and processes Artery
Zdroj:	Clinical hemorheology and microcirculation. 78(3)
ISSN:	1875-8622
Popis:	BACKGROUND: Microsurgical flaps are widely used to treat complex traumatic wounds of upper and lower limbs. Few studies have evaluated whether the vascular changes in preoperative computed tomography angiography (CTA) influence the selection of recipient vessel and type of anastomosis and the microsurgical flaps outcomes including complications. OBJECTIVE: The aim of this study was to evaluate if preoperative CTA reduces the occurrence of major complications (revision of the anastomosis, partial or total flap failure, and amputation) of the flaps in upper and lower limb trauma, and to describe and analyze the vascular lesions of the group with CTA and its relationship with complications. METHODS: A retrospective cohort study was undertaken with all 121 consecutive patients submitted to microsurgical flaps for traumatic lower and upper limb, from 2014 to 2020. Patients were divided into two groups: patients with preoperative CTA (CTA+) and patients not submitted to CTA (CTA–). The presence of postoperative complications was assessed and, within CTA+, we also analyzed the number of patent arteries on CTA and described the arterial lesions. RESULTS: Of the 121 flaps evaluated (84 in the lower limb and 37 in the upper limb), 64 patients underwent preoperative CTA. In the CTA+ group, 56% of patients with free flaps for lower limb had complete occlusion of one artery. CTA+ patients had a higher rate of complications (p = 0.031), which may represent a selection bias as the most complex limb injuries and may have CTA indicated more frequently. The highest rate of complications was observed in chronic cases (p = 0.034). There was no statistically significant difference in complications in patients with preoperative vascular injury or the number of patent arteries. CONCLUSIONS: CTA should not be performed routinely, however, CTA may help in surgical planning, especially in complex cases of high-energy and chronic cases, since it provides information on the best recipient artery and the adequate level to perform the microanastomosis, outside the lesion area.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::f80a099f470a1de8641c5e4ba7f5dd02 https://pubmed.ncbi.nlm.nih.gov/33646143 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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