The perforator territories of the body: an anatomical and clinical study with the use of in-vivo angiography
Rozen, Warren Matthew (2011) The perforator territories of the body: an anatomical and clinical study with the use of in-vivo angiography. Professional Doctorate (Research) thesis, James Cook University.
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Abstract
Background: The cutaneous tissues of the body form the basis for a wide variety of flaps used in tissue transplantation for defects in after cancer resection or traumatic loss. These flaps require an intricate knowledge and fine dissection of the macrovascular and microvascular anatomy, and until recently, individual anatomy was only identifiable intraoperatively. Five years ago, advanced imaging technologies were introduced that enabled high resolution demonstration of this vascular anatomy preoperatively, enabling surgeons to effectively plan such surgery, and has since been shown to reduce a broad range of operative complications and facilitate faster and safer surgery. This imaging was first described for the abdominal wall vasculature, and the current researcher (WMR) was amoung the first to describe the imaging advances in this role. In over 100 peer-reviewed publications and fifty national and international presentations, the current researcher described the use of high resolution ultrasound, computed tomographic angiography (CTA), magnetic resonance angiography (MRA) and image-guided stereotaxy for imaging of the abdominal wall vasculature. With a view to achieving the same operative benefits for a much larger cohort of patients and a broader range of flaps, the current compilation of works investigates the use of advanced imaging technologies in a broad range of body regions.
Methods: A clinical study of advanced imaging technologies was undertaken, imaging a range of cutaneous body regions in a cohort of over 500 patients. In all cases, the current researcher described all modifications to imaging protocols and undertook all software reconstructions for generation of three-dimensional reconstructions for use operatively. The reconstructive surgery and imaging was performed across five institutions. Results: The current study was able to accurately identify macrovascular and microvascular anatomy in all patients with a range of advanced imaging modalities. This was achievable using a range of hardware and software imaging modifications, and in particular, high resolution CTA was shown to be optimal in demonstrating such anatomy, and was able to be used throughout the body and in a broad range of patient ages and body habitus types. In addition to demonstrating that the use of such preoperative imaging techniques can result in reduced operative times, reduced donor site morbidity and reduced flap related complications, the imaging was also able to be used to design new flaps in reconstructive surgery.
Conclusions: As finer details of the vascular anatomy of the integument of the body wall have become clinically relevant with refinements in surgical technique, individual differences have become increasingly apparent. This study has been able to develop new imaging modalities, CTA and MRA, for use in preoperative imaging, and has enabled the visualization of microvascular anatomy not previously able to be demonstrated in-vivo. Such imaging has since been shown to improve patient outcomes in reconstructive surgery.
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