Dual-energy CT angiography-Guided vascularised free thoracodorsal artery lateral branch chimeric flaps for complex maxillofacial defect repair: An anatomical and clinical study.

A modified thoracodorsal artery lateral branch (TDAL) chimeric flap was developed using dual-energy computed tomography (CT) angiography data of perforators to explore the anatomical characteristics and postoperative outcomes of TDAL flaps in complex maxillofacial defect repair. TDAL flaps were harvested from patients with locally advanced oral cancer. Preoperative perforator detection was performed with dual-energy CT angiography. Anatomical data were collected, and patients' perioperative recovery details and complications were recorded. Upper extremity function and quality of life (QoL) data were compared to control data from a paired anterolateral thigh (ALT) flap group. Seventy-six patients survived without major complications. The length of the vascular pedicle was 8.97 ± 1.34 cm, and the diameter of the supplying artery was 1.60 ± 0.48 mm. In the first 3 months postoperatively, the TDAL group showed improved QoL. However, upper extremity function and QoL did not differ significantly between the TDAL and ALT groups at 6, 9, and 12 months postoperatively. A two-dimensional map of the perforation distribution was drawn based on the statistical distribution of perforations. TDAL can be designed as a long spindle-shaped or multi-leaf chimeric flap based on the perforator distribution map. This flap can be used as an alternative to repair large oral and maxillofacial defects.