title: The Value of Multidetector Row Computed Tomography Angiography for Preoperative Planning of Freestyle Pedicled Perforator Flaps.
abstract: BACKGROUND
  Because the course and territory of perforators are different in each region, careful preoperative planning to identify the proper perforators can be critical to ensure a successful dissection of a freestyle pedicled perforator flap. In this study, our first experience for preoperative perforator mapping of a freestyle pedicled perforator flap using multidetector row computed tomography (MD-CT) angiography is presented.
  
  
  METHODS
  Twelve patients were planned to undergo various soft-tissue reconstructions with freestyle pedicled perforator flaps. They were evaluated with preoperative MD-CT angiography. The OsiriX for mac software was used to process the data obtained from MD-CT angiography. The available images from MD-CT angiography were analyzed to determine where the proper perforators were located for preoperative planning of a freestyle pedicled perforator flap. Through the MD-CT angiography, the optimal perforators were mapped and a reliable flap design could be made so that the flap was elevated more safely and perfectly to cover an adjacent soft-tissue defect.
  
  
  RESULTS
  In all 12 patients, each flap was elevated successfully based on the perforators mapped preoperatively with MD-CT angiography. A total of 27 perforators (1-3 perforators per flap) were identified by MD-CT angiography in 12 patients and later confirmed during the flap dissection (sensitivity, 100%).
  
  
  CONCLUSIONS
  The MD-CT angiography can be a new but very effective imaging modality for preoperative planning of a freestyle pedicled perforator flap surgery. It allows surgeons to accurately select the most appropriate perforators with the shortest intramuscular or suprafascial course preoperatively leading to safer and easier flap dissection.
authors.affiliation: From the *Department of Plastic and Aesthetic Surgery, Dongguan Kanghua Hospital, Dongguan, Guangdong Province, China; †Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo; ‡Department of Radiology, Dongguan Kanghua Hospital, Dongguan, Guangdong Province, China; and §Division of Plastic Surgery, University of California Davis Medical Center, Sacramento, CA.
authors.forename: Si-Fen
authors.initials: SF
authors.lastname: Yang
authors.forename: Chun-Mei
authors.initials: CM
authors.lastname: Wang
authors.forename: Shimpei
authors.initials: S
authors.lastname: Ono
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Kai-Yuan
authors.initials: KY
authors.lastname: Xu
authors.forename: Lee L Q
authors.initials: LL
authors.lastname: Pu
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D017063:Outcome Assessment, Health Care; D061525:Perforator Flap / Q000098:blood supply*; D011300:Preoperative Care / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D055815:Young Adult