title: Guiding local perforator flaps with preoperative imaging:  revealing perforator anatomy to improve flap design.
abstract: BACKGROUND
  Perforator flap nomenclature continues to evolve, with many classification schemes reported. Each of them focuses on the fascial penetration pattern of perforators, which has no impact on flap perfusion. With the advent of advanced imaging technologies, the subcutaneous course of perforators can be highlighted for the first time, offering new insight into flap design.
  
  
  METHODS
  The current study presents the authors' technique for imaging local perforator flaps with computed tomographic angiography, utilizing a standard technique for perforator imaging with computed tomographic angiogram, regardless of whether the flap is a local or free flap, and regardless of body region. This technique has been used in more than 1000 image-guided perforator flaps, with the current study highlighting three such cases in different body regions.
  
  
  RESULTS
  With the use of preoperative imaging, flap design can be based on the subcutaneous ramification of individual perforators. Several ramification patterns are presented and potential improvements to nomenclature schemes suggested.
  
  
  CONCLUSIONS
  : With the use of preoperative imaging, "image-guided" perforator flaps that are truly axial-pattern in terms of their arterial supply can be designed.
  
  
  METHODS
  Diagnostic: V.
authors: Parkville, Victoria, Australia From the Jack Brockhoff Reconstructive Plastic Surgery Research Unit, Department of Anatomy and Cell Biology, The University of Melbourne.
authors: Warren M
authors: WM
authors: Rozen
authors: Alenka M
authors: AM
authors: Paddle
authors: Daniel
authors: D
authors: Chubb
authors: Jeremy
authors: J
authors: Wilson
authors: Damien
authors: D
authors: Grinsell
authors: Mark W
authors: MW
authors: Ashton
mesh_terms: D003952:Diagnostic Imaging / Q000379:methods*; D004867:Equipment Design; D006801:Humans; D008297:Male; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000295:instrumentation*; D015203:Reproducibility of Results; D013524:Surgical Flaps / Q000098:blood supply*