New Imaging Techniques in the Preoperative Planning of Abdominal Perforator Flaps

The key to predict the viability of any muscle perforator flap is an adequate circulation of the chosen perforator. Therefore, a reliable method for the precise identification of the dominant perforator with regard to its position, course, and caliber would be extremely valuable. Recently, multidetector–row spiral computed tomography has been used for non–invasive coronary angiography with excellent results.

Between October 2003 and June 2004, the authors performed 46 DIEPs for breast reconstruction in 43 female patients. The mean age was 46.7 (range 24–69 years). A preoperative multi–dectector row CT was done in all cases, comparing results with preoperative Doppler sonography findings and intraoperative clinical findings.

Comparing the MD CT with the intraoperative findings, no false positive and no false negative results were found; only in one early case was a good perforator missed when interpreting the MD CT.

The authors found that MD CT is a useful tool which provides a reliable method for studying the inferior epigastric artery perforators of the lower abdomen. MD CT allows an anatomic study of the donor area and great ease of interpretation, not only by the radiologist but also by the plastic surgeon. It provides the possibility for doing a virtual anatomy dissection of the patient by the computer because the pictures obtained are three–dimensional anatomy reconstructions. This technique is well–tolerated by patients because it is simple and speedy. Therefore, it helps in reducing operating time and complication rates.