J Reconstr Microsurg 2010; 26(1): 037-044
DOI: 10.1055/s-0029-1220862
© Thieme Medical Publishers

Anatomic Imaging of Abdominal Perforator Flaps without Ionizing Radiation: Seeing Is Believing with Magnetic Resonance Imaging Angiography

David Greenspun1 , 2 , Julie Vasile2 , Joshua L. Levine2 , Heather Erhard4 , Rebecca Studinger6 , Victoria Chernyak5 , Tiffany Newman3 , Martin Prince3 , Robert J. Allen2
  • 1Greenwich Hospital, Greenwich, Connecticut
  • 2Center for the Advancement of Breast Reconstructive Surgery at New York Eye and Ear Infirmary, New York, New York
  • 3Weill Cornell Imaging at New York Presbyterian, New York, New York
  • 4Einstein-Weiler Hospital, Bronx, New York
  • 5Montefiore Medical Center, Bronx, New York
  • 6Providence Hospital, Southfield, Michigan
Further Information

Publication History

Publication Date:
18 May 2009 (online)

ABSTRACT

The tremendous variability of the inferior epigastric arterial system makes accurate imaging of the vasculature of the anterior abdominal wall an essential component of optimal perforator selection. Preoperative imaging of the abdominal vasculature allows for preoperative perforator selection, resulting in improved operative efficiency and flap design. Abdominal wall perforators of 1-mm diameter can be reliably visualized without exposing patients to ionizing radiation or iodinated intravenous contrast through advances in magnetic resonance imaging angiography (MRA). In this study, MRA imaging was performed on 31 patients who underwent 50 abdominal flaps. For each flap, the location, relative to the umbilicus, of the three largest perforators on both the left and right sides of the abdomen was determined with MRA. Vessel diameter and anatomic course were also evaluated. Postoperatively, a survey was completed by the surgeon to assess the accuracy of the MRA with respect to the intraoperative findings. All perforators visualized on MRA were found at surgery (0% false-positive). In 2 of 50 flaps, the surgeon transferred a flap based upon a vessel not visualized on the MRA (4% false-negative). This article details our experience with MRA as a reliable preoperative imaging technique for abdominal perforator flap breast reconstruction.

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Julie VasileM.D. 

Center for the Advancement of Breast Reconstructive Surgery at New York Eye and Ear Infirmary

310 E. 14th St. New York, NY 10003

Email: jvasile1@msn.com