Current state of the art in perforator flap imaging with computed tomographic angiography

Abstract

Computed tomographic angiography (CTA) has become increasingly adopted for preoperative imaging in perforator flap surgery, as it has been shown to improve operative outcomes and decrease operating times prior to deep inferior epigastric artery perforator (DIEP) flap and anterolateral thigh perforator flap surgery. Current technologies are readily available for the preoperative imaging of all perforator flaps, however only sporadic reports of the use of CTA for the imaging of other perforators have been described. We describe our experience with 325 CTAs performed for the preoperative imaging of perforators prior to 370 perforator flaps throughout several body regions. The scanning techniques, software reconstructions and technical issues are explored. In all cases, CTA was scored by the radiologist as at least "sufficient", and described as "optimal" in the majority of cases. Similarly, the surgeon described the correlation of imaging to operative findings as at least "good", and described the correlation as "optimal" in the majority of cases. As such, a standardized protocol for the use of CTA prior to perforator flap surgery is provided, which has been shown to be successful prior to a range of perforator flap operations.

Free deep circumflex iliac artery vascularised bone flap for reconstruction of the distal radius: Planning with CT angiography

“…The efficacy and accuracy of CTA for mapping vasculature in other body regions has also been established. [6][7][8][9] An additional feature of the use of CTA in this case was the ability to clearly demonstrate not only vascular anatomy but also vascular communications with the soft-tissue structure being supplied. The iliac bone to be harvest was able to be mapped in three dimensions (Fig.…”

“…The use of CTA to evaluate the DCIA has only recently been described, 9,10 and such descriptions were limited to its cutaneous perforating branches, with the location and course of these perforators described for application in the DCIA osteo-cutaneous or osteo-musculo-cutaneous flap. In these studies, the size, path, and branches of the DCIA were demonstrated with a highdegree of accuracy able to visualize perforators as small as 0.3 mm in diameter.…”

“…Although these descriptions of the use of CTA to map DCIA perforators have only recently been described, 9,10 and its unique role in the planning of a vascularized DCIA bone flap has not been explored. This case demonstrates the role of preoperative planning of this flap with CTA, highlighting the means to potentiating reliable flap harvest and overall surgical success.…”

“…Computed tomographic angiography (CTA) has been increasingly used as a tool for preoperative planning in reconstructive surgery, [6][7][8][9] and with this technology, imaging of the DCIA and the soft tissue structures it supplies has become achievable, 9,10 and it may potentiate safe and easy harvest of vascularized iliac crest, overlying anterior abdominal wall musculature or overlying skin or both. Although these descriptions of the use of CTA to map DCIA perforators have only recently been described, 9,10 and its unique role in the planning of a vascularized DCIA bone flap has not been explored.…”

Der anterolaterale Oberschenkellappen

“…Aus diesem Grund hat beispielsweise die Gruppe um Yu [28] dieses Verfahren wieder verlassen und wendet stattdessen eine präoperative Markierung basierend auf Erkenntnissen aus anatomischen und klinischen Studien, genannt das ABC-System, an. Die CT-Angiographie bietet zwar eine detaillierte Darstellung der anatomischen Verhältnisse [17,19], ist jedoch unserer Meinung nach aufgrund der nicht unerheblichen Strahlenbelastung als kritisch zu werten. Die Farbduplexsonographie hingegen ist ein zuverlässiges Verfahren zur Perforatordarstellung beim ALT, deren Vorzüge von verschiedenen Autoren propagiert wurden [3,9,22].…”