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 ≥ 0.5 mm were detected; the average number of arteries per leg, their average length and diameter were 4.6 ± 2.1, 30.7 ± 10.4 mm and 1.16 ± 0.27 mm, 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.

Immune checkpoint inhibitors (ICIs) have transformed the therapeutic landscape of advanced melanoma, significantly improving long-term survival. Nevertheless, these therapies may induce immune-related cardiovascular adverse events, which are uncommon but potentially life-threatening. Myocarditis is the best-characterized and most severe manifestation, although a broad spectrum of cardiovascular complications—including pericardial disease, arrhythmias, conduction abnormalities, heart failure, Takotsubo syndrome, and vascular events—has increasingly been recognized. Emerging evidence suggests that melanoma itself and dual immune checkpoint blockade may confer a higher risk of cardiotoxicity than other malignancies or single-agent immunotherapy. This narrative review summarizes current evidence regarding the epidemiology, pathophysiological mechanisms, clinical presentation, diagnostic evaluation, cardiovascular surveillance, and management of ICI-associated cardiotoxicity in patients with melanoma. Diagnosis relies on integrating clinical findings with electrocardiography, cardiac biomarkers, echocardiography, cardiac magnetic resonance imaging, and, in selected cases, endomyocardial biopsy. Prompt interruption of ICI therapy, early administration of high-dose corticosteroids, and escalation to additional immunosuppressive therapies in refractory cases remain the cornerstone of treatment. As the use of ICIs continues to expand, improving cardiovascular risk stratification and implementing evidence-based surveillance strategies will become increasingly important. A multidisciplinary cardio-oncology approach is essential to ensure early diagnosis, optimize cardiovascular outcomes, and preserve the anticancer efficacy of immunotherapy.