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Perforator flap imaging

Maximilian V Muntean, Patriciu A Achimas-Cadariu
No abstract text is available yet for this article.
July 20, 2018: Plastic and Reconstructive Surgery
Nicolás Pereira
No abstract text is available yet for this article.
July 21, 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...
June 25, 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 Wd Ramsey, Jennifer E Rusby
INTRODUCTION: The aim of this study was to investigate aesthetic outcome and patient satisfaction in women who have undergone DIEP reconstruction in the setting of PMRT. Patients who underwent DIEP reconstruction without PMRT were the control group. METHODS: Participants who had undergone DIEP between 9/1/2009-9/1/2014 were recruited, answered the BREAST-Q and underwent 3D surface-imaging. A panel assessed the aesthetic outcome by reviewing these images. RESULTS: 167 women participated...
June 12, 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...
May 18, 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
Bilal Mujtaba, Gaurav K Synghal, Patrick B Garvey, Behrang Amini, Tamara Miner Haygood, John E Madewell, Colleen M Costelloe
OBJECTIVE: The objective of this video article is to provide an introduction to the use of fibular free flaps. Normal and variant vascular anatomy of the fibular free flap is discussed, as are imaging acquisition and CT angiography interpretation, computer-assisted design and manufacturing, and the limitations of the fibular free flap. CONCLUSION: The fibular free flap is commonly used for head and neck reconstructive surgery. Variation exists between individuals regarding the origin of the peroneal artery and the perforating arteries...
June 2018: AJR. American Journal of Roentgenology
Sun-June Park, Kyeong-Tae Lee, Byung-Joon Jeon, Kyong-Je Woo
Pedicled perforator flaps (PPFs) have been widely used to treat pressure sores in the gluteal region. Selection of a reliable perforator is crucial for successful surgical treatment of pressure sores using PPFs. In this study, we evaluate the role of magnetic resonance imaging (MRI) in planning PPF reconstruction of pressure sores in the gluteal region. A retrospective chart review was performed in patients who had undergone these PPF reconstructions and who had received preoperative MRI. Preoperatively, the extent of infection and necrotic tissue was evaluated using MRI, and a reliable perforator was identified, considering the perforator location in relation to the defect, perforator size, and perforator courses...
June 2018: International Journal of Lower Extremity Wounds
Itaru Tsuge, Susumu Saito, Hiroyuki Sekiguchi, Aya Yoshikawa, Yoshiaki Matsumoto, Masakazu Toi, Shigehiko Suzuki
The distal branching pattern of perforators is associated with thin anterolateral thigh flap failure. The purpose of this study was to investigate the feasibility of using photoacoustic tomography as a diagnostic imaging modality to identify anterolateral thigh perforators and their branching patterns in the subcutaneous layer. Ten thighs in five healthy men were studied. The anterolateral aspect of the midthigh was examined using photoacoustic tomography. The correlation between photoacoustic tomography and ultrasound findings was evaluated...
May 2018: Plastic and Reconstructive Surgery
Leonard Walle, Hisham Fansa, Onno Frerichs
BACKGROUND: Thermography permits non-invasive examination and presentation of cutaneous temperature differences. When planning microvascular flaps, thermography may illustrate these differences and may portray patterns of blood circulation near to perforators. As an additional tool, thermography may enhance quality and diversity in free flaps. PATIENTS AND METHODS: In this prospective study, we examined 10 patients with 13 free DIEP-flaps for breast reconstruction...
April 2018: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
Jeremy M Powers, Mariana Martinez, Shuhao Zhang, Santosh S Kale
BACKGROUND: The perforator anatomy of the tensor fascia lata (TFL) flap has been studied using cadaver dissection; however, exact descriptions of location, size, and origin of perforator vessels using preoperative imaging modalities remain limited. The aims of this study are to describe TFL perforator anatomy using high-resolution computed tomography angiography (CTA) and to correlate these findings with landmarks for the anterolateral thigh flap to facilitate flap planning. METHODS: We identified 33 patients who previously underwent bilateral lower extremity CTAs for preoperative planning of free-flap reconstruction...
June 2018: Annals of Plastic Surgery
John P Miller, Martin J Carney, Soobin Lim, John T Lindsey
BACKGROUND: Color Doppler ultrasound (CDUS) has not been routinely used in plastic and reconstructive surgery. Barriers to use have included large, cumbersome equipment, low-definition images, cost, and availability. In addition, programs in plastic surgery have not included training with ultrasound (US); thus, many current-day practitioners are unfamiliar with and reluctant to use this technology. Nevertheless, recent studies have demonstrated the utility of US in surgical planning. With the miniaturization, clearer imaging, and decreased costs of the latest US technology, previous barriers to use have largely been eliminated...
June 2018: Annals of Plastic Surgery
Amanda R Sergesketter, Bryan J Pyfer, Brett T Phillips, Ruya Zhao, Scott T Hollenbeck
BACKGROUND:  Perforator mapping with computed tomography angiography (CTA) prior to autologous breast reconstruction reduces donor-site morbidity and operative time, but is costly. The aim of this study was to evaluate whether pre-existing CT scans could be used for dominant perforator identification before autologous reconstruction. METHODS:  We identified all female patients who underwent mastectomy with immediate or delayed breast reconstruction with abdominal free flaps at a single institution between 2006 and 2016...
April 1, 2018: Journal of Reconstructive Microsurgery
Edinson Najera, Carl H Snyderman, Juan C Fernandez-Miranda
In this video, we describe the technical nuances of an endoscopic endonasal approach (EEA) for a complex macroadenoma with suprasellar and retrochiasmatic extension. The patient is a 51-year-old male with several years' history of progressive visual loss. Neuro-ophthalmology assessment revealed a profound visual loss with homonymous hemianopsia and left optic nerve atrophy. His pituitary hormonal profile was normal. The options for surgical approach included transcranial, endoscopic endonasal, or a combination of both...
April 2018: Journal of Neurological Surgery. Part B, Skull Base
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