Preoperative perforator mapping using multidetector row computed tomography and color doppler ultrasonography for planning perforator flaps

Three-dimensional computed tomography angiography (3DCTA) structured from multidetector row computed tomography (MDCT) data can depict the cutaneous perforators together with their source vessels and accompanying cutaneous veins. Preoperative perforator mapping is possible using 3DCTA in patients who are candidates for perforator flap surgery. Based on the vascular anatomy of the abdomen, the orientation of the dominant cutaneous deep inferior epigastric artery (DIEA) perforators near the umbilicus, the main course of the DIEA in or on the deep side of the rectus abdominis, and the direction and distribution of the perforators approaching the subdermal vascular network can be identified using 3DCTA. 3DCTA can also show the lateral intercostal artery perforators in the flank. In areas with less thick subcutaneous fat tissue, such as the thigh, color Doppler ultrasonography may be more useful than MDCT. Color Doppler ultrasonography can depict the colored perforator with blood flow and the intra-or intermuscular course of the perforator below the fascia lata. However, the clarity and precision of 3DCTA or color Doppler images depend largely on the skill and effort of the radiologist, and these techniques can be time-consuming. Cooperation between plastic surgeons and radiological staff is important.