Three-dimensional angiography of the superior gluteal artery and lumbar artery perforator flap.

Abstract

Three-dimensional angiography was first proposed by Cornelius and advanced by Voigt in 1975. Since then, a variety of improvements have been made. The three-dimensional evaluation of perforator flaps is no longer a clinical curiosity but an absolute necessity. By combining three-dimensional digital imaging and angiography, the authors have developed a new three-dimensional technique for visualizing blood vessels. This method produces a digitized model of the lumbar artery and superior gluteal artery musculocutaneous perforators that enables secure elevation of the lumbar and superior gluteal artery cross-boundary perforator flap. Two cadavers underwent whole body lead oxide-gelatin injection. Spiral computed tomographic scanning was then performed on the cadavers and three-dimensional reconstructions were performed. Six fresh bodies were used, and underwent latex injection. Specimens were then dissected by layers to document the individual perforators. An average of five superior gluteal artery musculocutaneous perforators with a diameter of 0.6 mm were present in the specimens. The average diameter and area supplied by perforators from the lumbar arteries was 0.7 mm and 30 cm, respectively. The three-dimensional reconstructed model of the lumbar region can display the modality, spatial location, and adjacent relationship of the lumbar and superior gluteal arteries. Three-dimensional modeling of lumbar and superior gluteal artery perforator flaps could provide greater insight into perforator anatomy in combination with traditional sectional imaging. Three-dimensional reconstructive modeling is now a clinically available process which, in the future, could provide great value in basic science investigation, clinical training, preoperative design, and virtual surgical procedures.