Precise repair of extremity soft tissue defects using anterolateral thigh flaps based on CTA-based 3D reconstruction and digital design: a short-term retrospective clinical study

Traditional anterolateral thigh (ALT) flap harvest relies heavily on surgeon’s empirical judgment, often confronting challenges posed by perforator anatomical variability and imprecise flap design. This study aimed to evaluate the clinical efficacy of a digital workflow integrating computed tomography angiography (CTA)-based 3D reconstruction with virtual surgical planning for extremity defect reconstruction. A retrospective analysis was conducted on 26 patients who underwent ALT flap reconstruction for extremity soft tissue defects between March 2024 and June 2025. Preoperative CTA datasets were imported into Mimics, Geomagic, and SolidWorks software to reconstruct 3D models of the donor site and recipient defect. Virtual perforator mapping, vascular pedicle measurement, and flap templating were performed. Intraoperative navigation was guided by surface projections derived from the virtual plan. Key outcomes included positional deviation, flap harvest time, complication rates, and aesthetic results (Vancouver Scar Scale, VSS). A total of 40 perforators were preoperatively identified, correlating exactly with intraoperative findings. The mean deviation between simulated and actual perforator locations was 0.85 ± 0.34 cm. The mean flap harvest time was 102.5 ± 27.76 min, and the total operative time was 371.15 ± 38.92 min. 25 flaps (96.2%) achieved complete survival, with one flap (3.85%) exhibited partial necrosis. No surgical site infections occurred. The median VSS score at the final follow-up was 3 (3, 5). The integration of CTA-based 3D simulation with digital planning demonstrates the feasibility of enhancing the precision of perforator localization and flap design in ALT flap surgery. This standardized protocol shows potential to mitigate intraoperative uncertainty, augment surgical safety, and yields favorable aesthetic outcomes, offering a promising approach for the standardization of digital reconstructive surgery.