Impact of Perforator Mapping Using Multidetector-Row Computed Tomographic Angiography on Free Thoracodorsal Artery Perforator Flap Transfer

Abstract

The preoperative localization of thoracodorsal artery perforators has been a challenge because of their topographic variation. From November of 2005 to January of 2007, 25 patients underwent free thoracodorsal artery perforator flap transfer for reconstruction of the lower extremities (22 flaps) and the head and neck (three flaps). All of the patients underwent multidetector-row computed tomographic angiography for preoperative perforator mapping. The computed tomographic findings were compared with the acoustic Doppler flowmetric and intraoperative findings. Surgical outcomes were compared with those of a historical group of patients treated before the adoption of computed tomography-based perforator mapping. The flap sizes ranged from 3 x 5 cm to 27 x 13 cm. One to four perforators (mean, 2.2) were marked on the three-dimensional computed tomographic image for each patient and the locations correlated with the handheld Doppler examination. Intraoperatively, all perforators marked were confirmed, and three additional perforators that had not been identified on the computed tomographic images were observed. All of the flaps survived, with the exception of two cases with marginal necrosis. Concrete planning based on knowledge of the precise location of the perforators allowed a shorter harvest time, minimized the incision for flap harvest, particularly with small flaps, and enabled the planned use of multiple perforators for better perfusion or complex designs. Perforator mapping with preoperative multidetector-row computed tomographic angiography is valuable for both planning and executing thoracodorsal artery perforator flap transfer. The targeted perforator flap harvesting allows a safe and straightforward harvest and an elegant reconstruction, with less donor-site morbidity.