Akademik Veri Yönetim Sistemi
Turk Plastik, Rekonstruktif ve Estetik Cerrahi Dergisi, cilt.19, sa.2, ss.53-59, 2011 (Scopus)
Due to variations in location, course between tissue planes and branching of the skin perforators, a preoperative vascular mapping is mandatory during perforator flap surgery. The aim of this article is to emphasize the importance of perforator mapping in preoperative planning of the perforator flaps and discuss each method used. Hand held acoustic doppler sonography, color doppler ultrasonography, multidetector computed tomographic angiogram (MDCT-ANG) and magnetic resonance angiography (MR-ANG) were compared. Hand held acoustic doppler sonography is a cheap and simple method, but it has a high rate of false positivity and most of the time it is inadequate when used alone. Color doppler ultrasonography evaluates the flow rates, vessel diameters and branching. But an experienced radiologist is needed and the examination takes long time. Vascular mapping with MDCT-ANG is one of the most valuable methods in preoperative planning of perforator flaps. It has high sensitivity, can be applied fast and gives detailed three-dimensional anatomical information. But the expensive cost of the machine itself and its application, and unwanted effects of ionizing radiation and radio-opaque are the disadvantages. MR-ANG is a radiation and contrast free imaging technique, however the quality of the images is not as good as MDCT-ANG. In conclusion, the facilities of the center, experiences and personal preferences determine the method chosen for surgical planning of the perforator flaps. MDCT-ANG and MR-ANG are the most advanced and powerful tools for this purpose. MDCT-ANG provides high quality detailed images; MR-ANG gives moderate quality images without the need of radiation. If verification with acoustic doppler sonography and intraoperative visual evaluation is added to the chosen imaging technique during preoperative planning, possibility of errors in correct perforator selection can be minimized.