Assessment of perfusion of facial microvascular transplants and early detection of ischemia by perfusion-CT scan.
OBJECTIVE
Perfusion-computed tomography (CT) is a promising new technique to assess ischemic lesions caused by ischemic brain stroke. In this study, the use of perfusion-CT scans to predict ischemia in microvascular transplants of the face was examined.


METHODS
Thirty-eight patients with microvascular latissimus dorsi transplants after tumor surgery were assessed by perfusion-CT scan 34 to 72 hours after surgery. In these cases, clinical examination of the transplant and examination by means of O(2)-probes were either unsuccessful or impossible. An electron beam tomography of the region of interest was performed by using an intravenous nonionic iodine-containing contrast medium (Ultravist 300, Nycomed, Germany) that was applied with an injector at a flow rate of 5 mL/min. Twenty scans with a scanning time of 300 ms and an interscanning time of 3 seconds were carried out. Changes in the Houndsfield units within the transplant as well as the region of the contralateral erector spinae muscle were measured.


RESULTS
Central malperfusion resulting in later complete transplant loss was detected in 2 cases. Peripheral malperfusion was found in 6 cases, resulting in localized resection and secondary wound closure. When no malperfusion was registered, the straightforward healing process took place.


CONCLUSIONS
Perfusion-CT scans are of great aid in the assessment of microvascular transplant perfusion in the face, when adequate perfusion is not verifiable clinically or by O(2)-probe because of removal or malfunction.
Gaggl
Alexander
A
Department of Oral and Maxillofacial Surgery, University Hospital Graz, Austria. Alexander.Gaggl@lkh-klu.at
Penka
Bernd
B
Schultes
Günter
G
Kärcher
Hans
H
D016025:Bone Transplantation; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D016009:Chi-Square Distribution; D003287:Contrast Media; D005153:Facial Neoplasms / Q000601:surgery*; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D007511:Ischemia / Q000000981:diagnostic imaging*; D008334:Mandible / Q000601:surgery; D008866:Microsurgery; D009060:Mouth Floor / Q000601:surgery; D009062:Mouth Neoplasms / Q000601:surgery; D018482:Muscle, Skeletal / Q000098:blood supply / Q000637:transplantation*; D009336:Necrosis; D010100:Oxygen; D012039:Regional Blood Flow / Q000502:physiology; D012086:Reoperation; D016038:Skin Transplantation; D013223:Statistics as Topic; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014059:Tongue / Q000601:surgery; D014945:Wound Healing
D003287:Contrast Media; D007472:Iohexol; C038192:iopromide; D010100:Oxygen