Anatomic imaging of gluteal perforator flaps without ionizing radiation: seeing is believing with magnetic resonance angiography.
Preoperative imaging is essential for abdominal perforator flap breast reconstruction because it allows for preoperative perforator selection, resulting in improved operative efficiency and flap design. The benefits of visualizing the vasculature preoperatively also extend to gluteal artery perforator flaps. Initially, our practice used computed tomography angiography (CTA) to image the gluteal vessels. However, with advances in magnetic resonance imaging angiography (MRA), perforating vessels of 1-mm diameter can reliably be visualized without exposing patients to ionizing radiation or iodinated intravenous contrast. In our original MRA protocol to image abdominal flaps, we found the accuracy of MRA compared favorably with CTA. With our increased experience with MRA, we decided to use MRA to image gluteal flaps. Technical changes were made to the MRA protocol to improve image quality and extend the field of view. Using our new MRA protocol, we can image the vasculature of the buttock, abdomen, and upper thigh in one study. We have found that the spatial resolution of MRA is sufficient to accurately map gluteal perforating vessels, as well as provide information on vessel caliber and course. This article details our experience with preoperative imaging for gluteal perforator flap breast reconstruction.
Vasile
Julie V
JV
Center for Microsurgical Breast Reconstruction, New York, New York 10019, USA. jvasile1@msn.com
Newman
Tiffany
T
Rusch
David G
DG
Greenspun
David T
DT
Allen
Robert J
RJ
Prince
Martin
M
Levine
Joshua L
JL
D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D002081:Buttocks / Q000098:blood supply* / Q000601:surgery; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D016462:Mammaplasty; D008875:Middle Aged; D011300:Preoperative Care; D012086:Reoperation; D013524:Surgical Flaps / Q000098:blood supply*