The vascular anatomy of perforators varies between individuals; thus, accurate preoperative assessment of perforators is essential for safely planning perforator flaps. Perforator computed tomographic angiography (P-CTA) with multidetector-row computed tomography (MDCT) is one of the best available methods to precisely reveal the 3-dimensional anatomic details of perforators. The aim of this report is to describe the authors’ experience using P-CTA with MDCT for detecting the perforating vessel preoperatively and a step-by-step approach to harvest perforator flaps based on this technique. This report also provides a comprehensive review of literature on other preoperative assessment tools of perforators.
Key points
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For safely planning perforator flaps, accurate preoperative assessment of perforators is recommended because their vascular anatomy varies between individuals.
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To assist in preoperative perforator assessment, perforator computed tomographic angiography (P-CTA) with multidetector-row computed tomography is currently one of the best available methods.
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The location of reliable perforators and their subcutaneous course between the deep fascia and skin, known as suprafascial perforator directionality, can be accurately determined preoperatively using P-CTA.
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Using P-CTA, surgeons can share 3-dimensional information of the perforator’s location, diameter, and course, in relation to other anatomic structures preoperatively in a short time, which can shorten operative time and improve operative outcomes.
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