Using 320-slice computed tomography to preoperatively investigate the leg perforator arterial system and design a perforator flap for patients with a soft-tissue defect in the leg.

Purpose: To investigate the leg perforator arterial system, identify the perforator flap's pedicle artery and its projected cutaneous point using a 320-slice computed tomography (CT 320) scanner.

Methods: A total of 24 patients with leg soft-tissue defects unilaterally underwent 320-slice CT angiography scanning (CTA 320) with 47 legs. The used method enabled investigation of the perforator arteries originating from the tibial, peroneal arteries, perforator flap's pedicle artery and its projected cutaneous point. These data were used to preoperatively design an improved flap. Then, the CT-confirmed location and length of the flap's pedicle artery were compared with intraoperative findings.

Results: Findings of the CTA 320 on 47 legs showed that 217 perforator arteries with diameters of ≥0.5mm were detected; the average number of arteries per leg, their average length and diameter were 4.6±2.1, 30.7±10.4mm and 1.16±0.27mm, respectively. The perforator arteries originating from the anterior tibial artery were mainly distributed in the proximal and middle thirds of the leg. Perforators from the posterior tibial and peroneal arteries were distributed abundantly in the middle and distal thirds of the leg. As identified in the CT, the location and length of the flap's pedicle artery and its projected cutaneous point were consistent with those observed during the surgery.

Conclusions: The CTA 320 is a minimally invasive imaging method that provides high-quality images of the leg perforator arterial system and can identify the exact location and projected cutaneous point of the perforator flap's pedicle artery.