Preoperative identification of perforator vessels by combining MDCT, doppler flowmetry, and ICG fluorescent angiography

Background: The position of perforator vessels varies between individuals. In this report, we present our experience on the use of combining multidetector-row computed tomography (MDCT), Doppler flowmetry, and indocyanine green (ICG) fluorescent angiography to identify perforator vessels of flaps for reconstruction. We evaluated the advantages, disadvantages, and chose the necessary examination, depending on characteristics of the flap. Methods: The combination of MDCT, Doppler flowmetry, and ICG fluorescent angiography examinations to identify perforators was performed in 50 patients before reconstructive surgery. The patients first underwent MDCT of the prospective flap donor region. Perforators were then marked for this site by using Doppler flowmetry in the neighborhood of the points identified by MDCT. After placing the patient in the intraoperative posture, ICG fluorescent angiography was performed to confirm the intensity and position of the perforators. Results: In all 50 patients examined by using this approach, perforators were intraoperatively identified near the preoperatively determined sites. Flap harvesting was possible in all patients with the identified perforators as the vascular pedicle. But it was difficult to identify the perforators on the MDCT in the patients who had a flap thickness of less than 8 mm and the identification of the perforators was difficult on ICG fluorescent angiography in the patients with a flap thickness greater than 20 mm. The transferred free flaps survived in all patients without complications. Conclusion: On the basis of the results, selection of the most suitable mode of examination depending on the characteristics of flap is recommended.