In vivo anatomic study of cutaneous perforators in free flaps using magnetic resonance imaging

Adequate knowledge of perforator location preoperatively will enable the surgeon to achieve optimal flap design and flap survival. Most previous attempts have relied on the use of Doppler ultrasound and earlier anatomic knowledge. With ultrasound, there may at times be signals from overlapping blood vessels. Magnetic resonance imaging (MRI) is sensitive to flowing blood and, on an MRI scan, dark-flow void characterization is used to identify perforators. This study was undertaken to evaluate the anatomic location and the number of perforators in the flap zone, based on inherent blood flow, and to determine information about the dominant perforators for free-flap design, using MRI. The CSMEMP technique allowed the characterization of flow void signals, which appeared in the image as dark spots. This technique also enabled differentiation of the surrounding tissue, with a high degree of accuracy. The relationship of the perforators aided in an "ideal" flap design. No necrosis was noted in any of these cases. It appears from this study that MRI can be a useful imaging modality, to assess the location and number of perforators in musculocutaneous flaps.