Mapping the vascular anatomy of free transplanted soft tissue flaps with computed tomographic angiography

Abstract

The current study has demonstrated that CTA may be of value in identifying vascular anatomy within transferred tissue, as a guide to evaluate flap perfusion and planning further surgery involving the flap.

Identification of perioperative risk factor by laser-doppler spectroscopy after free flap perfusion in the head and neck: A prospective clinical study

“…With time, perfusion improves and the whole flap, especially the superficial aspect (the last part to be fully perfused), becomes more and more important for the vitality of the flap …”

Anatomical features associated with venous congestion in DIEP flap using CT angiography with three-dimensional reconstruction

“…The diversion of flow through different pathways or vasodilatation are among them. [15] Therefore, the pressure gradient between arterial perfusion and venous drainage is modified, resulting in an imbalance that may lead to venous congestion.…”

“…[7] The routine use of preoperative imaging to assess the microvascular anatomy of the anterior abdominal wall helps to achieve optimal outcomes. [15] Preoperative planning of DIEP flaps with computed tomographic angiography (CTA) followed by three-dimensional (3D) reconstruction has proved to be an effective technique to map the abdominal vascular anatomy, allowing a better tracking of the perforators, including their size, location and course, so as to shorten the operative time and number of complications. [16,17] On the other hand, little is known about the anatomical features related with the postoperative diffuse venous congestion and how new imaging technologies are able to identify aspects that can threaten the perfusion of the DIEP flap.…”

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

“…[19][20][21][22][23] CTA has a sensitivity of 96%, a positive predictive value of 95% and may identify perforators as small as 0.3 mm. Moreover, CTA may reveal the structure and competence of the abdominal wall fascial layers.…”

“…Moreover, CTA may reveal the structure and competence of the abdominal wall fascial layers. 11,12,23 The rate and timing of the injection and the patient's cardiac output and body habitus determine the degree of enhancement. Careful optimization of single phase CTA prevents low opacification due to early scan as well as venous contamination due to late arterial phase.…”