Articles from Plastic & Reconstructive Surgery

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Masia, Jaume , Ph.D.; Clavero, Juan Angel; Larranaga, Jose ; Vives, Lorena M.D.; Pons, Gemma Preoperative Planning of the Abdominal Perforator Flap with Multidetector Row Computed Tomography: 3 Years of Experience.[Editorial]
122(2):80e-81e, August 2008

Rozen, Warren M.; Ashton, Mark W.; Stella, Damien
The Accuracy of Computed Tomographic Angiography for Mapping the Perforators of the DIEA: A Cadaveric Study.
122(2):80e-81e, August 2008
Abstract
Background: The deep inferior epigastric artery (DIEA) perforator flap is increasingly used for breast reconstruction, with preoperative imaging sought as a means of improving operative outcome. Computed tomographic angiography has been recently described as the preferred imaging modality; however, formal evaluation of computed tomographic angiography has not been described. A cadaveric study was undertaken to evaluate the accuracy of computed tomographic angiography for perforator mapping.Methods: Ten cadaveric hemiabdominal walls from five fresh cadavers underwent contrast injection of each DIEA and subsequent computed tomographic scanning, with each DIEA and all perforating branches documented. Dissection was then performed, with the recording of the course of the DIEA and the course of all perforators in each specimen. The concordance of computed tomographic angiography with dissection findings was evaluated.Results: Cadaveric computed tomographic angiography identified 154 perforators in 10 hemiabdominal walls. Computed tomographic angiography was highly accurate, with eight false-positives and six false-negatives on cadaveric computed tomographic angiography, establishing an overall sensitivity of 96 percent and a positive predictive value of 95 percent for mapping perforators. For perforators greater than 1 mm in diameter, the sensitivity was 100 percent and the positive predictive value was 100 percent.Conclusions: Computed tomographic angiography is a highly accurate tool for identifying the perforators of the DIEA before DIEA perforator flaps for breast reconstruction. Preoperative identification of these vessels can aid planning for the preferred hemiabdomen for dissection, and may save operative time, angst, and potentially complications.

Saint-Cyr, Michel; Schaverien, Mark ; Arbique, Gary ; Hatef, Dan
Three- and Four-Dimensional Computed Tomographic Angiography and Venography for the Investigation of the Vascular Anatomy and Perfusion of Perforator FlapsPlastic & Reconstructive Surgery.
121(3):772-780, March 2008.
Abstract Background: Two-dimensional contrast radiography is the current standard for investigating the vascular anatomy of surgical flaps. The microvascular anatomy of the perforator flap, however, is limited conceptually by representation in two dimensions. Static three-dimensional computed tomographic angiography enables vascular anatomy to be evaluated in the coronal, axial, and sagittal planes, and dynamic four-dimensional computed tomographic angiography allows the vascular filling of a perforator flap to be visualized over short time intervals in three dimensions.Methods: An anatomical study was performed using 11 fresh adult cadavers acquired through the Willed Body Program at the University of Texas Southwestern Medical Center, in Dallas, Texas. Four male and seven female cadavers were included in the study. Perforator flaps harvested included the following: anterolateral thigh, deep inferior epigastric perforator, superior gluteal artery perforator, inferior gluteal artery perforator, thoracodorsal artery perforator, anteromedial thigh, and dorsal intercostal artery perforator.Conclusions: Novel techniques for acquiring both static and dynamic three-dimensional images of macrovascular and microvascular perforator flap anatomy using computed tomographic angiography have been described. This methodology has also allowed the sequential investigation of adjacent vascular territories. This can provide a better understanding of how perforator flaps and the skin are perfused and may aid in the future design of new flaps.