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The Value of Multidetector Row Computed Tomography Angiography for Preoperative Planning of Freestyle Pedicled
Si-Fen Yang1, Chun-Mei Wang, Shimpei Ono
1From the *Department of Plastic and Aesthetic Surgery, Dongguan Kanghua Hospital, Dongguan, Guangdong Province, China; †Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo; ‡Department of Radiology, Dongguan Kanghua Hospital, Dongguan, Guangdong Province, China; and §Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA.
Background:
Because the course and territory of perforators are different in each region, careful preoperative planning to identify the proper perforators can be critical to ensure a successful dissection of a freestyle pedicled perforator flap. In this study, our first experience for preoperative perforator mapping of a freestyle pedicled perforator flap using multidetector row computed tomography (MD-CT) angiography is presented.
Methods:
Twelve patients were planned to undergo various soft-tissue reconstructions with freestyle pedicled perforator flaps. They were evaluated with preoperative MD-CT angiography. The OsiriX for mac software was used to process the data obtained from MD-CT angiography. The available images from MD-CT angiography were analyzed to determine where the proper perforators were located for preoperative planning of a freestyle pedicled perforator flap. Through the MD-CT angiography, the optimal perforators were mapped and a reliable flap design could be made so that the flap was elevated more safely and perfectly to cover an adjacent soft-tissue defect.
Results:
In all 12 patients, each flap was elevated successfully based on the perforators mapped preoperatively with MD-CT angiography. A total of 27 perforators (1-3 perforators per flap) were identified by MD-CT angiography in 12 patients and later confirmed during the flap dissection (sensitivity, 100%).
Conclusions:
The MD-CT angiography can be a new but very effective imaging modality for preoperative planning of a freestyle pedicled perforator flap surgery. It allows surgeons to accurately select the most appropriate perforators with the shortest intramuscular or suprafascial course preoperatively leading to safer and easier flap dissection.
