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Preoperative Perforator Mapping in SGAP Flap: Does Magnetic Resonance Imaging Make the Difference?
Giovanni Zoccali1, Maleeha Mughal1, Paul Roblin1
1From the Department of Plastic and Reconstructive Surgery, Guy's and St. Thomas' Hospital; and the School of Medicine, University of Basel.
Plastic and Reconstructive Surgery
|October 1, 2019
Summary
Preoperative vascular mapping using magnetic resonance imaging (MRI) for superior gluteal artery perforator (SGAP) flaps did not reduce operative time compared to Doppler ultrasonography. Donor site outcomes were also unaffected by the imaging modality used for preoperative perforator mapping.
Area of Science:
- Plastic Surgery
- Radiology
- Surgical Outcomes
Background:
- Preoperative vascular mapping aids perforator flap surgery by optimizing operative time and perforator selection.
- Superior Gluteal Artery Perforator (SGAP) flaps are utilized in breast reconstruction.
- Identifying the ideal perforator is crucial for successful flap surgery.
Purpose of the Study:
- To evaluate the impact of preoperative magnetic resonance imaging (MRI) vascular mapping on operative time for SGAP flap breast reconstruction.
- To compare the efficacy of MRI with Doppler ultrasonography in localizing perforators for SGAP flaps.
- To assess whether flap design based on MRI localization versus tissue availability influences donor site outcomes.
Main Methods:
- A prospective randomized study involving patients undergoing SGAP flap breast reconstruction.
- Group 1: Preoperative MRI for perforator localization and flap planning.
- Group 2: Flap planning based on tissue availability, followed by Doppler ultrasonography for perforator identification.
Main Results:
- Mean flap elevation times were 252 minutes for MRI group (n=35) and 228 minutes for Doppler ultrasonography group (n=27).
- No significant differences were found in flap elevation times between the two groups.
- Cosmetic outcomes of the donor sites were also comparable between the groups.
Conclusions:
- Preoperative vascular mapping with MRI for SGAP flap planning does not significantly reduce operative time.
- The choice of imaging modality (MRI vs. Doppler ultrasonography) for preoperative perforator mapping does not impact donor site outcomes.
- Both MRI and Doppler ultrasonography are viable options for preoperative vascular mapping in SGAP flap surgery.
