Abstract
Through their experience with 144 patients, the authors evaluate the use of the free open-source DICOM viewer OsiriX for Mac in the preoperative planning of perforator flaps with three objectives: 1) increase the present knowledge related with the preoperative planning of perforator flaps with computed tomography angiography (CTA), 2) evaluate the application in the image post-processing of perforator flaps, and 3) evaluate the performance of the image post-processing when performed by a surgeon. The experience demonstrated that the use of OsiriX allowed an adequate evaluation of different structures and parameters of great preoperative interest in perforator flap surgery: 1) source artery, 2) diameter of artery and vein/s at the hypothetical site of microsurgical anastomoses, 3) course and branching pattern of the flap pedicle, 4) perforator course in the subcutaneous fat (theoretical flap axis), 5) measurement of the skin and fat where the perforator pierced the deep fascia (theoretical flap thickness), 6) measurement of the distance between the point of entrance of the perforator in the subcutaneous fat to the source artery (theoretical maximal pedicle length), and 7) measurement of the perforator diameter where it pierced the deep fascia. For the home user, OsiriX is an efficient alternative, comparable to the more professional applications only available in Radiology services and dedicated professional PACS workstations.
Highlights
Whether or not CTA is justified in the preoperative planning of perforator flaps is still under debate but there is a growing evidence of the associated benefits [1] and, despite the lack of randomized multicentric studies, a substantial and growing amount of bibliography supports the use and security of CTA [1,2]
Only magnetic resonance angiography can rival CTA [17,18], some reports have found that the technique is still far from it because of a lesser resolution, higher cost and limited availability [19,20,21]
A retrospective review was made of the authors' experience in the preoperative evaluation of perforators with CTA with three objectives: 1) widen the present knowledge of the use of CTA in preoperative planning of perforator flaps, 2) evaluate the OsiriX application in the DICOM image post-processing of perforator flaps and 3) analyze the performance of the postprocessing when done by a surgeon
Summary
Whether or not CTA is justified in the preoperative planning of perforator flaps is still under debate but there is a growing evidence of the associated benefits [1] and, despite the lack of randomized multicentric studies, a substantial and growing amount of bibliography supports the use and security of CTA [1,2]. Very popular in breast reconstruction with abdominal flaps, its use has rapidly expanded to other body regions because the technique is readily available, extremely fast and shows a low interobserver variability [9,10,11]. Computed tomography has drawn experts' attention because of its relatively high radiation dose per study [12,13,14]. In this scenario, different measures are imperative: 1) a correct indication of CT studies, 2) the improvement of technology and 3) the optimization of the acquisition parameters to minimize the radiation dose following the ALARA (As Low As Reasonably Available) principle [4, 15,16].
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