Articles from Plastic & Reconstructive Surgery

Link to journal online
Saint-Cyr, Michel M.D.; Schaverien, Mark M.R.C.S.; Arbique, Gary Ph.D.; Hatef, Dan et al
Three- and Four-Dimensional Computed Tomographic Angiography and Venography for the Investigation of the Vascular Anatomy and Perfusion of Perforator Flaps
Plastic & 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.
(C)2008American Society of Plastic Surgeons

Domeshek, Leahthan F. B.S.E.; Mukundan, Srinivasan Jr M.D., Ph.D.; Yoshizumi, Terry Ph.D.; Marcus, Jeffrey R.
Increasing Concern Regarding Computed Tomography Irradiation in Craniofacial Surgery
Plastic & Reconstructive Surgery. 123(4):1313-1320, April 2009.
Abstract
Summary: The safety of medical radiation, particularly computed tomography, has recently received much attention in both the medical literature and the popular press. As knowledge regarding side effects of radiation exposure has increased, so have attempts to limit doses to patients through more selective use of scans and transitions to lower-dose protocols to conform to the As Low As Reasonably Achievable (ALARA) principle. This trend has been apparent across many fields within medicine, including craniofacial surgery. Craniofacial surgeons should be familiar with these issues to participate in the determination of practice standards and to address patient concerns. A number of authors have questioned the value and necessity of obtaining computed tomography scans for the management of single-suture craniosynostosis in light of known radiation risks. Although unnecessary exposure to radiation from computed tomography scans should be avoided, imaging provides useful--often vital--information to the treatment of craniosynostosis. Use of low-dose protocols, which have been shown to provide images of satisfactory quality for the evaluation of both suture patency and associated intracranial abnormalities, may be a favorable alternative. The authors discuss the issue of medical radiation and its risks. In the context of risks and benefits, the authors reviewed the current practice of imaging in craniofacial surgery with the intent to encourage dialogue between surgeons and radiologists to develop thoughtful practice standards.(C)2009American Society of Plastic Surgeons

Casey, William J. III M.D.; Chew, Roderick T. M.D.; Rebecca, Alanna M. et al
Advantages of Preoperative Computed Tomography in Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction
Plastic & Reconstructive Surgery. 123(4):1148-1155, April 2009.
Abstract
Background: Preoperative computed tomography has been used to facilitate deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction. This study identifies the improvements in outcome that this may provide.Methods: A retrospective review of a consecutive series of DIEAP and superficial inferior epigastric artery (SIEA) flap breast reconstructions was performed over 5 years. All patients underwent hand-held Doppler interrogation of the abdomen. Patient demographics, operative times, and postoperative outcomes were compared before and after the routine use of computed tomographic imaging.Results: Two hundred eighty-seven flaps were performed on 213 patients. There were 139 unilateral and 74 bilateral reconstructions, with 168 flaps performed immediately after mastectomy and 119 flaps performed in a delayed setting. One hundred one flaps were performed with computed tomographic imaging, whereas 186 flaps followed hand-held Doppler interrogation alone. Mean follow-up was 24 months. The use of computed tomography had a beneficial impact on operative times (unilateral, 370 versus 459 minutes; bilateral, 515 versus 657 minutes...