Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

Du, Eugenie; Patel, Sagar; Huang, Benjamin; Patel, Samip

doi:10.1002/hed.25775

Cited by 13 publications

(7 citation statements)

References 38 publications

(89 reference statements)

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“…They recommend patients to be positioned similar to the intraoperative position at the time of imaging to allow for more accurate marking of perforators at the time of surgery. Kim and Lee [11] recommend requesting 1 mm cuts when obtaining imaging to better visualize small perforators. They also recommend utilizing both the coronal and axial cuts to identify perforators off the transverse and descending thoracodorsal artery [11] .…”

Section: Computer Tomography Angiographymentioning

confidence: 99%

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Technological advancements in head and neck free tissue transfer reconstruction

Ali¹,

Tamaki²,

Thuener³

et al. 2021

PAR

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Free tissue transfer (FTT) is a cornerstone of head and neck reconstruction. Although rare, complications of FTT surgery can be devastating, including failed flap harvest, wound breakdown, or flap loss ultimately. Thus, modern microvascular surgeons bolster surgical and clinical expertise with a growing number of technological advances to optimize patient care and outcomes. These technologies can be applied in the preoperative, intraoperative, and postoperative period. Various preoperative imaging modalities can assist in selecting the optimal donor site and advanced perforator planning. Intraoperatively, novel technologies can assist with microvascular anastomoses, operative magnification and visualization, and assess free tissue perfusion. Postoperatively, routine clinical assessment can be augmented by a variety of adjunctive monitoring techniques designed to assess tissue health, arterial inflow and venous drainage. The overall ease and success of performing FTT can be improved by employing novel technologies at every phase of the surgical process. This article will expand upon established and upcoming technological advances and the existing literatures to support their use.

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Section: Computer Tomography Angiographymentioning

confidence: 99%

“…Kim and Lee [11] recommend requesting 1 mm cuts when obtaining imaging to better visualize small perforators. They also recommend utilizing both the coronal and axial cuts to identify perforators off the transverse and descending thoracodorsal artery [11] .…”

Section: Computer Tomography Angiographymentioning

confidence: 99%

Technological advancements in head and neck free tissue transfer reconstruction

Ali¹,

Tamaki²,

Thuener³

et al. 2021

PAR

View full text Add to dashboard Cite

show abstract

“…Imaging in the form of a computed tomography (CT) or magnetic resonance imaging (MRI) with contrast can provide useful to confirm vessel patency and to provide anatomic positioning after prior neck manipulation. A dual phase CT angiogram is ideal for highlighting arterial and venous vasculature, often times the most important planning step (9). Single phase CT and MRI angiography are good alternatives that demonstrate arterial flow but omit high quality venous vasculature views.…”

Section: Preoperative Planningmentioning

confidence: 99%

Head and neck reconstruction in the vessel depleted neck

Prince¹,

Broderick²,

Neal³

et al. 2020

Front Oral Maxillofac Med

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Microvascular free tissue transfer has revolutionized reconstruction and subsequently functional outcomes in the head and neck, but requires suitable recipient vessels for successful results. Recipient vessels can be significantly compromised by prior surgery, radiation therapy, or existing and/or underlying vascular disease in the neck. When further microvascular reconstruction is required in the vessel-depleted neck, identification of appropriate vessels for anastomosis can be difficult and can present complex decisions for the surgeon as well as the patient. In this article, we review the available literature on the vessel depleted neck (VDN) and the possible vessel options. We present critical strategies for preoperative treatment planning and vessel selection in these patients. We also discuss the benefits and limitations of arterial and venous options while commenting on our unique institution's experiences. The external carotid branches as well as the available subclavian artery branches are presented in detail. The venous anatomy is also described, with particular focus on the accompanying veins and cephalic vein. We provide guidance on the selection and modification of free flaps to achieve the greatest function and cosmetic outcomes in the VDN. Our collection of advanced management techniques will provide surgeons with more options to manage the complexity of the VDN, and to further help patients understand the risk and benefits of these selections.

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“…However, the identification of a suitable recipient vein is typically the rate limiting-step in free flap surgery and is not adequately assessed with this modality. 7 Dual-phase angiography, on the other hand, provides a more comprehensive assessment by adding a delayed venous phase. This has been shown to aid in successful targeting of candidate vessels and decreasing operative times.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

“…This has been shown to aid in successful targeting of candidate vessels and decreasing operative times. 7,8 Ultimately, the decision to obtain additional imaging should be made on an individual basis with consideration of the quality of existing imaging, availability of preferred imaging modalities, extent of previous interventions, and complexity of the planned reconstruction. The use of inoffice pencil Doppler and color-flow ultrasound are additional techniques that can readily be performed to supplement the information provided by physical examination and formal imaging.…”

Section: Preoperative Assessmentmentioning

confidence: 99%

Surgical Techniques for Head and Neck Reconstruction in the Vessel-Depleted Neck

et al. 2020

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The vessel-depleted neck presents a unique and challenging scenario for reconstructive surgery of the head and neck. Prior surgery and radiation often result in significant scarring and damage to the neck vasculature, making identification of suitable recipient vessels for microvascular free tissue transfer exceedingly difficult. Therefore, alternative reconstructive techniques and/or vessel options must be considered to obtain a successful reconstructive outcome for a patient. In this article, we discuss our experience and approach to the management of the vessel-depleted neck, emphasizing the importance of preoperative planning and having multiple backup options prior to surgery. The various preoperative imaging modalities and available options for recipient arteries and veins are presented in detail. Additionally, we discuss modifications of select free flaps to maximize their utility in successful reconstruction. Together with thoughtful preoperative planning, these techniques can help aid the reconstructive surgeon in addressing the complex decisions associated with the vessel-depleted neck.

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Dual‐phase CT angiography for presurgical planning in patients with vessel‐depleted neck

Cited by 13 publications

References 38 publications

Technological advancements in head and neck free tissue transfer reconstruction

Technological advancements in head and neck free tissue transfer reconstruction

Head and neck reconstruction in the vessel depleted neck

Surgical Techniques for Head and Neck Reconstruction in the Vessel-Depleted Neck

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