Angio-CT preoperative planning of inferior limb free flaps in plastic surgery

Transcription

1 Angio-CT preoperative planning of inferior limb free flaps in plastic surgery Poster No.: C-3046 Congress: ECR 2010 Type: Educational Exhibit Topic: Vascular Authors: L. Saba, M. Atzeni, D. Ribuffo, G. Mallarini; Cagliari/IT Keywords: MDCTA, Free flap transfer, Plastic surgery DOI: /ecr2010/C-3046 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 6

2 Learning objectives The learning objectives of this exhibit is to provide basic and advanced description of vascular imaging techniques necessary to study patient before inferior limb free flap transplantation. Background The osteocutaneous free fibula flap (OFFF) was initially described by Taylor in 1975 and it has been used as a front-line reconstructive tool for trauma and cancer since Its advantages include the fibula bone being long, straight and strong, and since first described in the role by Hidalgo, it has become the workhorse of free tissue transfer for mandibular reconstruction in head and neck cancer. Despite its routine use, variations in lower leg circulation and in the skin island vascular supply can significantly influence its harvest: septocutaneous perforators can be absent or perforators can arise from others source vessels. The use of preoperative imaging in the past has been for identification of the vascular pedicle itself, with the benefits of such imaging not always apparent, and thus conventional catheter angiography and ultrasound have remained equivocal in their widespread usage. Despite gold-standard accuracy, catheter angiography is also invasive, with potential complications including haematoma and false-aneurisms. More recently, imaging technologies have become available that can visualise cutaneous perforator vessels in addition to the major pedicles, increasing the utility of preoperative imaging. Imaging findings OR Procedure details Twenty two consecutive patients were considered for free flap bone/soft tissue reconstruction with the OFFF or ALTF. After written informed consent was obtained from all patients, a preoperative CT, MR or ECD study was performed for surgical planning. Accurate identification of septocutaneous or muscolocutaneous perforator vessels was achieved and their location, course and anatomical variations were reported and influenced surgery. Advantages, limits and techniques will be discussed. Page 2 of 6

3 Images for this section: Fig. 1 Page 3 of 6

4 Fig. 2 Page 4 of 6

5 Conclusion Imaging allows a complete vascular study of the donor area of the OFFF and ALTF. In particular CT and MR imaging methods may be proposed for every patient undergoing OFFF or ALTF reconstruction Personal Information Luca Saba MD, A.O.U. of Cagliari. Department of Radiology References Fukaya E, Grossman RF, Saloner D et al (2007) Magnetic resonance angiography for free fibula flap transfer. J Reconstr Microsurg. 23(4): Hallock GG (2003) Doppler sonography and color duplex imaging for planning a perforator flap. Clin.Plast.Surg 30:347 Harrison DH (1986) The osteocutaneous free fibular graft. J Bone Joint Surg Br. 68(5): Bretzman PA, Manaster BJ, Davis WL et al (1994) MR angiography for preoperative evaluation of vascularized fibular grafts. J Vasc Interv Radiol. 5(4): Chow LC, Napoli A, Klein MB et al (2005) Vascular mapping of the leg with multi-detector row CT angiography prior to free-flap transplantation. Radiology 237(1): Cordeiro PG, Disa JJ, Hidalgo DA et al (1999) Reconstruction of the mandible with osseous free flaps: a 10-year experience with 150 consecutive patients. Plast Reconstr Surg. 104(5): Dublin BA, Karp NS, Kasabian AK et al (1997) Selective use of preoperative lower extremity arteriography in free flap reconstruction. Ann Plast Surg. 38(4): Page 5 of 6

6 Cambria RP, Kaufman JA, L'Italien GJ et al (1997) Magnetic resonance angiography in the management of lower extremity arterial occlusive disease: a prospective study. J Vasc Surg. 25(2): Chen ZW, Yan W. (1983) The study and clinical application of the osteocutaneous flap of fibula. Microsurgery.4(1):11-6. Cho BC, Kim SY, Park JW et al (2001) Blood supply to osteocutaneous free fibula flap and peroneus longus muscle: prospective anatomic study and clinical applications. Plast Reconstr Surg. 108(7): Hidalgo DA (1989) Fibula free flap: a new method of mandible reconstruction. Plast Reconstr Surg. 84(1):71-9. Futran ND, Stack BC Jr, Payne LP (1997). Use of color Doppler flow imaging for preoperative assessment in fibular osteoseptocutaneous free tissue transfer. Otolaryngol Head Neck Surg.117(6): Futran ND, Stack BC Jr, Zaccardi MJ (1998) Preoperative color flow Doppler imaging for fibula free tissue transfers. Ann Vasc Surg. 12(5): Giunta RE, Geisweid A, Feller AM (2000) The value of preoperative Doppler sonography for planning free perforator flaps. Plast Reconstr Surg. 105(7): Bardsley JL, Staple TW (1970) Variations in branching of the popliteal artery. Radiology. 94(3): Beppu M, Hanel DP, Johnston GH et al (1992) The osteocutaneous fibula flap: an anatomic study. J Reconstr Microsurg. 8(3): Blondeel PN, Beyens G, Verghaege R (1998) Doppler flowmetry in the planning of perforators flaps Br. J Plast Surg; Page 6 of 6