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Three- and Four-Dimensional Computed Tomographic Angiography and Venography for the Investigation of the Vascular Anatomy and Perfusion of Perforator Flaps

Saint-Cyr, Michel M.D.; Schaverien, Mark M.R.C.S.; Arbique, Gary Ph.D.; Hatef, Dan M.D.; Brown, Spencer A. Ph.D.; Rohrich, Rod J. M.D.

Plastic and Reconstructive Surgery: March 2008 - Volume 121 - Issue 3 - p 772-780
doi: 10.1097/01.prs.0000299338.97612.90
Experimental: Original Articles

Background: Two-dimensional contrast radiography is the current standard for investigating the vascular anatomy of surgical flaps. The microvascular anatomy of the perforator flap, however, is limited conceptually by representation in two dimensions. Static three-dimensional computed tomographic angiography enables vascular anatomy to be evaluated in the coronal, axial, and sagittal planes, and dynamic four-dimensional computed tomographic angiography allows the vascular filling of a perforator flap to be visualized over short time intervals in three dimensions.

Methods: An anatomical study was performed using 11 fresh adult cadavers acquired through the Willed Body Program at the University of Texas Southwestern Medical Center, in Dallas, Texas. Four male and seven female cadavers were included in the study. Perforator flaps harvested included the following: anterolateral thigh, deep inferior epigastric perforator, superior gluteal artery perforator, inferior gluteal artery perforator, thoracodorsal artery perforator, anteromedial thigh, and dorsal intercostal artery perforator.

Conclusions: Novel techniques for acquiring both static and dynamic three-dimensional images of macrovascular and microvascular perforator flap anatomy using computed tomographic angiography have been described. This methodology has also allowed the sequential investigation of adjacent vascular territories. This can provide a better understanding of how perforator flaps and the skin are perfused and may aid in the future design of new flaps.


Dallas, Texas

From the Department of Plastic Surgery and Department of Medical Physics, Division of Radiology, University of Texas Southwestern Medical Center.

Received for publication February 26, 2007; accepted May 29, 2007.

Disclosure: None of the authors has any financial relationships, interest, or commercial association with the products, drugs, or devices mentioned in this article.

Michel Saint-Cyr, M.D., Department of Plastic Surgery, University of Texas Southwestern Medical Center, 1801 Inwood Road, Dallas, Texas 75390-9132,

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©2008American Society of Plastic Surgeons