Introduction: This study evaluates the role of ct angiography in preoperative vascular mapping for free flap reconstruction in contemporary surgical practice, assessing its impact on clinical outcomes, procedural accuracy, and patient safety in a prospective comparative analysis. Materials and Methods: A prospective comparative study was conducted on 280 patients from June 2017 to March 2024 at a tertiary care center. Patients were divided into CTA-planned (n=140) and Doppler-planned (n=140) groups. Primary outcomes included procedural success rate, complication rates, and clinical efficacy measures. Results: The CTA-planned group demonstrated significantly improved primary outcomes compared to Doppler-planned (p<0.05). Complication rates were lower in the study group, and procedural efficiency was maintained or improved. Multivariate analysis confirmed the imaging modality as an independent predictor of favorable outcomes. Conclusion: The findings support the integration of advanced imaging guidance in surgical practice, demonstrating measurable improvements in accuracy, safety, and clinical outcomes that justify the investment in imaging technology.