Guiding local perforator flaps with preoperative imaging: revealing perforator anatomy to improve flap design.

Abstract

Perforator flap nomenclature continues to evolve, with many classification schemes reported. Each of them focuses on the fascial penetration pattern of perforators, which has no impact on flap perfusion. With the advent of advanced imaging technologies, the subcutaneous course of perforators can be highlighted for the first time, offering new insight into flap design. The current study presents the authors' technique for imaging local perforator flaps with computed tomographic angiography, utilizing a standard technique for perforator imaging with computed tomographic angiogram, regardless of whether the flap is a local or free flap, and regardless of body region. This technique has been used in more than 1000 image-guided perforator flaps, with the current study highlighting three such cases in different body regions. With the use of preoperative imaging, flap design can be based on the subcutaneous ramification of individual perforators. Several ramification patterns are presented and potential improvements to nomenclature schemes suggested. : With the use of preoperative imaging, "image-guided" perforator flaps that are truly axial-pattern in terms of their arterial supply can be designed. Diagnostic: V.