Three- and four-dimensional computed tomographic angiography and venography for the investigation of the vascular anatomy and perfusion of perforator flaps.
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.
Saint-Cyr
Michel
M
Dallas, Texas From the Department of Plastic Surgery and Department of Medical Physics, Division of Radiology, University of Texas Southwestern Medical Center.
Schaverien
Mark
M
Arbique
Gary
G
Hatef
Dan
D
Brown
Spencer A
SA
Rohrich
Rod J
RJ
D000328:Adult; D000792:Angiography; D001808:Blood Vessels / Q000033:anatomy & histology*; D002102:Cadaver; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008833:Microcirculation; D010690:Phlebography; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D014057:Tomography, X-Ray Computed