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Perforator flap imaging

Zhongjie Wang, Xiaoping Yi, Jiqiang He, Liming Qing, Zhengbing Zhou, Youming Zhang, Zhiming Zhu, Chunhui Zhou, Hui Xie, Xuejun Li, Chishing Zee, Bihong T Chen
BACKGROUND:  During reconstructive surgery, anterolateral thigh (ALT) flap harvest is challenging due to variation and uncertainty in perforator distribution. We performed a pilot study to identify the predictive value of catheter-based computed tomography angiography (C-CTA) and traditional CTA (T-CTA) in ALT perforator mapping for patients whose ALT perforators were difficult to identify. METHODS:  Thirty-four consecutive T-CTA/C-CTA-mapped ALT flaps were evaluated for extremity reconstruction...
October 2, 2018: Journal of Reconstructive Microsurgery
M Barone, A Cogliandro, E Tsangaris, R Salzillo, M Morelli Coppola, S Ciarrocchi, B Brunetti, S Tenna, V Tambone, P Persichetti
INTRODUCTION: The objectives of this study are: (1) comparison of long-term outcomes after correction of severe gynecomastia using different techniques; (2) apply the Italian version of the BODY-Q; (3) present the role of intercostal perforator flap (ICAP) after massive weight loss for correction of severe gynecomastia. MATERIALS AND METHODS: Between January 2008 and March 2016, we performed surgical correction of bilateral severe gynecomastia in 80 men (160 breasts) following massive weight loss...
September 26, 2018: Aesthetic Plastic Surgery
Li-Ying Liao, Tzong-Shiun Li, Hung Chi Chen
In the past decades, numerous surgical techniques and conservative treatments for pilonidal sinus disease (PSD) had been discussed and published. There is still no consensus yet of the best techniques because of high recurrence rates and prolonged wound healing. In the case of complicated discharging sinus or recurrent PSD resistant to treatment with antibiotics, we recommend radical excision followed by a regional flap, which can obliterate the dead space with well-vascularised tissue. In this article, we presented the technique of snug suture fixation between the dermis and periosteum using a superior gluteal artery perforator (SGAP) flap...
September 21, 2018: International Wound Journal
Eric I Chang, Carrie K Chu, Edward I Chang
The use of preoperative imaging has become routine for many reconstructive microsurgeons to help localize perforators for planning of microvascular free flaps. However, with advancements in imaging technology, perforator mapping represents only one potential benefit as virtual planning and medical modeling, and flap tissue perfusion are also rapidly becoming commonplace and the standard of care for many surgeons who perform high-volume free flap reconstruction for the breast, head and neck, torso, and the extremities...
October 2018: Journal of Surgical Oncology
Christopher R Davis, Lyn Jones, Rachel L Tillett, Helen Richards, Sherif M Wilson
BACKGROUND: Venous congestion is the principle cause of flap failure after microsurgical breast reconstruction. We aim to correlate preoperative computed tomography angiography (CTA) findings with postoperative venous congestion to predict patients at risk of congestion. METHODS: All patients undergoing deep inferior epigastric perforator (DIEP) breast reconstruction between August 2009 and August 2013 underwent preoperative CTA and prospectively entered the study...
September 5, 2018: Microsurgery
Mitsunaga Narushima, Tatsuya Yamasoba, Takuya Iida, Yu Matsumoto, Takumi Yamamoto, Hidehiko Yoshimatsu, Shim Timothy, Georgios Pafitanis, Shuji Yamashita, Isao Koshima
BACKGROUND: Recently, a superthin "pure skin perforator" flap without any subcutaneous tissue was proposed, but the vascularity is still unclear. The authors therefore investigated the vascularity of the proposed superficial circumflex iliac artery-pure skin perforator along with its clinical applications and findings on indocyanine green imaging. METHODS: The locations and dimension of 70 pure skin perforators on 40 flaps were investigated and classified into central-peripheral and mediolateral parts...
September 2018: Plastic and Reconstructive Surgery
Julia V M Huiskes, Mariël E Keemers-Gels, Jan Fabré, Luc J A Strobbe
Local recurrence after an autologous breast reconstruction is uncommon. We describe 2 patients with local recurrence 3 and 9 years, respectively, after mastectomy with DIEAP (deep inferior epigastric artery perforator) flap breast reconstruction. Patients generally present with a palpable mass, pain, or other visible abnormalities. Various imaging techniques are helpful, always completed by biopsy to characterize the tumour. A repeated sentinel node procedure can be useful in staging. The treatment of the local recurrence needs to be determined in a multidisciplinary team consultation...
May 2018: Case Reports in Oncology
Akhil K Seth, Pieter G L Koolen, Steven M Sultan, Bernard T Lee, Heather A Erhard, David T Greenspun
BACKGROUND:  The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint...
August 15, 2018: Journal of Reconstructive Microsurgery
Maximilian V Muntean, Patriciu A Achimas-Cadariu
No abstract text is available yet for this article.
October 2018: Plastic and Reconstructive Surgery
Nicolás Pereira
No abstract text is available yet for this article.
October 2018: Plastic and Reconstructive Surgery
Francesco Pisana, Holger Haubenreisser, Thomas Henzler, Stefan Schönberg, Marc Kachelrieß
Dynamic CT angiography provides much more information compared to static 3D CT angiography, in several clinical applications. The prolonged exposure, on the other hand, results in higher radiation dose for to the patient. Care should be taken when designing noise reduction algorithms so that temporal profiles and spatial resolution is not significantly compromised. In particular, in deep inferior epigastric perforators (DIEP) flap studies, the temporal enhancement of small abdominal subcutaneous and intramuscular vessels needs to be evaluated from the surgeons to plan breast reconstruction...
August 10, 2018: Physics in Medicine and Biology
Hyun Ho Han, Min Kyu Kang, Sin Young Song, Hyung Chul Lee, Eun Key Kim, Jin Sup Eom
Deep inferior epigastric perforator (DIEP) flap is associated with less donor site morbidity than transverse rectus abdominis myocutaneous flap. However, abdominal muscle atrophy and donor site complications caused by denervation during pedicle dissection cannot be avoided. This retrospective study investigated the change in the rectus abdominis muscle volume after DIEP flap harvest. Of 395 patients who underwent unilateral DIEP flap breast reconstruction between August 2007 and July 2017, 25 patients with >2-year postoperative abdominal computed tomography data were evaluated...
September 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Rachel L O'Connell, Rosa Di Micco, Komel Khabra, Anna M Kirby, Paul A Harris, Stuart E James, Kieran Power, Kelvin W D Ramsey, Jennifer E Rusby
BACKGROUND: The authors investigated aesthetic outcome and patient satisfaction in women who have undergone deep inferior epigastric artery perforator (DIEP) flap reconstruction in the setting of postmastectomy radiotherapy. Patients who underwent DIEP flap reconstruction without postmastectomy radiotherapy were the control group. METHODS: Participants who had undergone DIEP flap reconstruction between September 1, 2009, and September 1, 2014, were recruited, answered the BREAST-Q, and underwent three-dimensional surface-imaging...
September 2018: Plastic and Reconstructive Surgery
Yujin Myung, Bomi Choi, Sang Jun Yim, Bo La Yun, Heeyeon Kwon, Chang Sik Pak, Chanyeong Heo, Jae Hoon Jeong
PURPOSE: Studies focusing on the originating patterns of the deep inferior epigastric artery (DIEA) have not been conducted. Here, we analyzed the vascular anatomy of the DIEA with computed tomographic angiography (CTA) to provide assistance during proximal pedicle dissection of a DIEA-based flap. METHODS: We conducted a retrospective study on patients who had undergone breast reconstruction with the transverse rectus abdominis musculocutaneous flap and the deep inferior epigastric perforator flap from March 2006 to October 2016...
June 20, 2018: Surgical and Radiologic Anatomy: SRA
X L Shao, S C Ma, D L Xia, L Chen
Objective: Using digital technique to design the preoperative flap of oral and maxillofacial soft tissue defect, to instruct the operation and to provide the basis for making the individual femoral flap. Method: We chosed 7 patients with oral and maxillofacial malignancies to undergo thin-line CT scans of lower extremities and analyzed the data of CTA examination to measure the diameter, shape and length of vascular pedicle. Then selected the appropriate perforation as the source of blood supply for flap. The location of perforation was marked on the skin to simulate flap removal range...
December 20, 2017: Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery
Ignacio Javier Cifuentes, Bruno Leonardo Dagnino, María Carolina Salisbury, María Eliana Perez, Claudia Ortega, Daniela Maldonado
Dynamic infrared thermography (DIRT) has been used for the preoperative mapping of cutaneous perforators. This technique has shown a positive correlation with intraoperative findings. Our aim was to evaluate the accuracy of perforator mapping with DIRT and augmented reality using a portable projector. For this purpose, three volunteers had both of their anterolateral thighs assessed for the presence and location of cutaneous perforators using DIRT. The obtained image of these "hotspots" was projected back onto the thigh and the presence of Doppler signals within a 10-cm diameter from the midpoint between the lateral patella and the anterior superior iliac spine was assessed using a handheld Doppler device...
May 2018: Archives of Plastic Surgery
Hemin Oathman Sheriff, Kawa Abdullah Mahmood, Nzar Hamawandi, Aram Jamal Mirza, Jawad Hawas, Esther Granell Moreno, Juan Antonio Clavero, Christopher Hankins, Jaume Masia
BACKGROUND:  The supraclavicular artery flap is an excellent flap for head and neck reconstruction. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap. METHODS:  Six imaging techniques were used for supraclavicular artery mapping in 65 cases; handheld Doppler, triplex ultrasound, computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, and indocyanine green angiography...
September 2018: Journal of Reconstructive Microsurgery
John Dortch, Antonio J Forte, Candice Bolan, Pujan Kandel, Galen Perdikis
BACKGROUND: Venous congestion after deep inferior epigastric artery perforator (DIEP) flap breast reconstruction is a complication that may be partially attributable to variations in venous abdominal wall anatomy. In previous work, we have shown that ferumoxytol may be used as a bloodpool contrast agent to perform high-resolution venous imaging. Our current aim was to use this technology to perform a detailed analysis of the venous anatomy among patients undergoing DIEP flap breast reconstruction...
May 14, 2018: Annals of Plastic Surgery
Anna K Steve, Colin P White, Ali Alkhawaji, Thomas E J Hayakawa, Edward W Buchel, Steven F Morris
BACKGROUND: The purpose of this study was to evaluate the territory supplied by the lateral circumflex femoral artery for the consistency of a proximal perforator that could be used as an alternative pedicle for the anterolateral thigh flap if a tedious intramuscular course is encountered during elevation of the perforator used to develop the initial surgical plan. It is hypothesized that a consistent "bail-out" perforator supplying the proximal thigh would facilitate a simpler anterolateral thigh flap harvest, with minimal modification to flap design...
July 2018: Annals of Plastic Surgery
Philip Pratt, Matthew Ives, Graham Lawton, Jonathan Simmons, Nasko Radev, Liana Spyropoulou, Dimitri Amiras
Precision and planning are key to reconstructive surgery. Augmented reality (AR) can bring the information within preoperative computed tomography angiography (CTA) imaging to life, allowing the surgeon to 'see through' the patient's skin and appreciate the underlying anatomy without making a single incision. This work has demonstrated that AR can assist the accurate identification, dissection and execution of vascular pedunculated flaps during reconstructive surgery. Separate volumes of osseous, vascular, skin, soft tissue structures and relevant vascular perforators were delineated from preoperative CTA scans to generate three-dimensional images using two complementary segmentation software packages...
2018: European radiology experimental
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