IN-VIVO ANATOMIC STUDY OF CUTANEOUS PERFORATORS IN FREE FLAPS USING MAGNETIC-RESONANCE-IMAGING

Adequate knowledge of perforator location preoperatively will enable t he surgeon to achieve optimal flap design and flap survival. Most prev ious attempts have relied on the use of Doppler ultrasound and earlier anatomic knowledge. With ultrasound, there may at times be signals fr om overlapping blood vessels. Magnetic resonance imaging (MRI) is sens itive to flowing blood and, on an MRI scan, dark-flow void characteriz ation is used to identify perforators. This study was undertaken to ev aluate the anatomic location and the number of perforators in the flap zone, based on inherent blood flow, and to determine information abou t the dominant perforators for free-flap design, using MRI. The CSMEMP technique allowed the characterization of flow void signals, which ap peared in the image as dark spots. This technique also enabled differe ntiation of the surrounding tissue, with a high degree of accuracy. Th e relationship of the perforators aided in an ''ideal'' flap design. N o necrosis was noted in any of these cases. It appears from this study that MRI can be a useful imaging modality, to assess the location and number of perforators in musculocutaneous flaps.