ABSTRACT
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.
KEYWORDS
Gluteal artery perforator flap - superior gluteal artery perforator flap - inferior
gluteal artery perforator flap - magnetic resonance imaging angiography - preoperative
imaging
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Julie VasileM.D.
Center for Microsurgical Breast Reconstruction
1776 Broadway, Suite 1200, New York, NY 10019
eMail: jvasile1@msn.com