I thank Rozen et al. for providing readers with an insight into their experience with the use of computed tomography angiography for cadaveric anatomic research. As was correctly pointed out, my article (Plast. Reconstr. Surg. 120: 442, 2007) did not seek to formally evaluate the use of computed tomography angiography in this setting. My group did, however, undertake extensive preliminary work with this modality to establish some of its limitations and to determine the accuracy of software measurement tools that can be used for perforator mapping in this setting.1 With our particular configuration of equipment and settings, my coauthors and I established that computed tomography angiography does not consistently demonstrate vessels less than 0.4 mm in diameter on processed images. It would be interesting to know whether the false-negative results encountered by Rozen et al. were similarly the result of difficulties in trying to image these very small perforators. Despite this minor limitation, I would agree with Rozen et al. that concordance between computed tomography angiography and dissection findings is extremely high.
The use of computed tomography angiography in a clinical setting for preoperative deep inferior epigastric perforator flap planning has previously been described and is clearly of great potential.2,3 My only reservation concerns the significant radiation dose incurred by the patient when an abdominal computed tomography scan is performed. This is an issue that needs more robust discussion in the future, and I look forward to the forthcoming articles by Rozen et al., which I hope take the opportunity to do so.4–6
Ashley Tregaskiss, M.R.C.S.
Department of Plastic and Reconstructive Surgery
Plymouth, England PL6 8UH
1. Tregaskiss, A. P., Goodwin, A. N., Bright, L. D., et al. Three-dimensional CT angiography: A new technique for imaging microvascular anatomy. Clin. Anat.
20: 116, 2007.
2. Alonso-Burgos, A., Garcia-Tutor, E., Bastarrika, G., et al. Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: Imaging findings and initial experience. J. Plast. Reconstr. Aesthet. Surg.
59: 585, 2006.
3. Masia, J., Clavero, J. A., Larranaga, J. R., et al. Multidetector-row computed tomography in the planning of abdominal perforator flaps. J. Plast. Reconstr. Aesthet. Surg.
59: 594, 2006.
4. Rozen, W. M., Palmer, K. P., Suami, H., et al. The DIEA branching pattern and its relationship to perforators: The importance of preoperative computed tomography angiography for DIEA perforator flaps. Plast. Reconstr. Surg.
5. Rozen, W. M., Phillips, T. J., Ashton, M. W., et al. Preoperative imaging for DIEA perforator flaps: A comparison of computed tomography angiography and Doppler ultrasound. Plast. Reconstr. Surg.
6. Rozen, W. M., Phillips, T. J., Ashton, M. W., et al. A new imaging modality for free flaps in breast reconstruction: Computed tomography angiography. Plast. Reconstr. Surg.
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