Imaging in Propeller Flap Surgery

AbstractSince propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.

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Preoperative Use of CT Angiography in Infants With Coarctation of the Aorta

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135116683929 ◽

2017 ◽

Vol 8 (2) ◽

pp. 196-202 ◽

Cited By ~ 8

Author(s):

Kirsten Rose-Felker ◽

Joshua D. Robinson ◽

Carl L. Backer ◽

Cynthia K. Rigsby ◽

Osama M. Eltayeb ◽

...

Keyword(s):

Radiation Dose ◽

Surgical Approach ◽

New Technology ◽

Three Dimensional ◽

Coarctation Of The Aorta ◽

Computed Tomographic Angiography ◽

Great Vessel ◽

Z Score ◽

Computed Tomographic ◽

Tomographic Angiography

Background: Computed tomographic angiography (CTA) and echocardiography (echo) are used preoperatively in coarctation of the aorta to define arch hypoplasia and great vessel branching. We sought to determine differences in quantitative measurements, as well as surgical utility, between modalities. Methods: Infants (less than six months) with both CTA and echo prior to coarctation repair from 2004 to 2013 were included. Measurements were compared and correlated with surgical approach. Three surgeons reviewed de-identified images to predict approach and characterize utility. Computed tomographic angiography radiation dose was calculated. Results: Thirty-three patients were included. No differences existed in arch measurements between echo and CTA ( z-score: −2.59 vs −2.43; P = .47). No differences between modalities were seen for thoracotomy ( z-score: −2.48 [echo] vs −2.31 [CTA]; P = .48) or sternotomy ( z-score: −3.13 [echo] vs −3.08 [CTA]; P = .84). Computed tomographic angiography delineated great vessel branching pattern in two patients with equivocal echo findings ( P = .60). Surgeons rated CTA as far more useful than echo in understanding arch hypoplasia and great vessel branching in cases where CTA was done to resolve anatomical questions that remain after echo evaluation. Two of three surgeons were more likely to choose the surgical approach taken based on CTA (surgeon A, P = .02; surgeon B, P = .01). Radiation dose averaged 2.5 (1.6) mSv and trended down from 2.9 mSv (1.8 mSv; n = 20) to 1.6 mSv (0.5 mSv; n = 7) ( P = .06) with new technology. Conclusion: Although CTA and echo measurements of the aorta do not differ, CTA better delineates branching and surgeons strongly prefer it for three-dimensional arch anatomy. We recommend CTA for patients with anomalous arch branching patterns, diffuse or complex hypoplasia, or unusual arch morphology not fully elucidated by echo.

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