A trial to visualize perforators images from CTA with a tablet device: experience of operating on minipigs

A reliable method for precise perforator mapping can be extremely valuable in perforator flap surgery. In this study, we attempted to map perforator location using 3-dimensional computed tomography angiography (CTA), a newly developed application, and a tablet device. Preliminary examinations to test the device were conducted in mini-pigs. We used 5 female mini-pigs. Preoperative imaging of the vasculature was undertaken with CTA in the prone position, following Iopamidol (200 ml) injection via the internal jugular vein. Prior to the examination, we placed round markers on the backs of the mini-pigs. To assess accuracy, we compared the perforator positions acquired with an optical position measurement device with the perforator positions acquired with the tablet device. Furthermore, we compared the perforator positions with the tablet navigation device, which we measured directly. We measured 12 perforators with the optical position measurement device. The mean difference was 10 mm (minimum, 2 mm; maximum, 20 mm). We measured these perforators with the tablet navigation device. The mean difference was 5.4 mm (minimum, 0 mm; maximum, 20 mm). The perforator flaps were elevated safely. The perforator flaps could be elevated safely using our device, as the mean difference was only 10 mm, which is acceptable for navigating perforator flap operations. Pig backs are triangular in shape; therefore, we were unable to place markers on the contralateral side. Thus, for clinical applications of the device, we should determine the ideal marker locations.