title: The utility of CT angiography in planning perineal flap reconstruction following radical pelvic surgery.
abstract: BACKGROUND
  Closure of the perineum following radical excision of pelvic tumours can prove to be a complex surgical problem. A number of pedicled flaps have been used for perineal reconstruction in order to reduce post-operative complications such as infection and abscess formation. The aim of this case series was to analyse the use of pre-operative computer tomography (CT) angiography to guide flap selection for perineal reconstruction following radical excision of pelvic tumours.
  
  
  METHODS
  We conducted a retrospective review to identify all patients who underwent CT angiography prior to radical excision of pelvic tumours and planned flap reconstruction over an 18 month period. Six patients were identified and are presented in this case series. Patients' medical records, histology reports, pre-operative investigations and CT angiograms, complications and follow-up were reviewed.
  
  
  RESULTS
  The mean patient age was 58.3 years, with a male to female ratio of 1:2. Four out of six patients (66.6%) underwent pre-operative radiotherapy. The deep inferior epigastric arteries (DIEA) were visualised in all six cases (100%) and the pre-operative CT angiography helped guide flap choice in all cases (100%). In one case, narrowing of the DIEA vessels was noted precluding the use of a DIEA-based flap. One patient had a minor superficial wound dehiscence.
  
  
  CONCLUSIONS
  Pre-operative CT angiography allows accurate visualisation of the DIEA system including perforator vessels. CT angiography is a useful tool, providing the surgical team with significant additional information to aid pre-operative planning and optimise reconstructive choice and outcome.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.
authors.forename: A
authors.initials: A
authors.lastname: Rosich-Medina
authors.forename: J
authors.initials: J
authors.lastname: Ariyaratnam
authors.forename: B
authors.initials: B
authors.lastname: Koo
authors.forename: W H
authors.initials: WH
authors.lastname: Turner
authors.forename: N S
authors.initials: NS
authors.lastname: Fearnhead
authors.forename: A
authors.initials: A
authors.lastname: Durrani
authors.forename: R J
authors.initials: RJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019074:Epigastric Arteries / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010386:Pelvic Neoplasms / Q000601:surgery*; D010502:Perineum / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013529:Surgical Wound Dehiscence; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome