An overview of methods for vascular mapping in the planning of free flaps

Abstract

Introduction: The aim of this overview is to describe the various methods for vascular mapping of flaps together with their advantages and drawbacks.

Materials and methods: The PubMed database was used. Relevant search terms included 'flap' in combination with 'hand-held Doppler' (HHD), 'colour duplex sonography' (CDS), 'digital subtraction angiography' (DSA), 'computed tomography angiography' (CTA) and 'magnetic resonance angiography' (MRA). All studies found between January 2000 and January 2010 was evaluated.

Results: A total of 72 articles were found. Of these, 62 were usable for this overview. Recommendations could not be found for all types of flaps. Therefore, no uniform guidelines can be provided; some findings are, however, unequivocal. In general, HHD is cheap and easy to use, but relatively unreliable in determining the exact site of emergence at fascia level of perforators. CTA and MRA provide the best three-dimensional images. CTA offers more detailed images, MRA has the advantage however of not using radiation. CDS can be of value to offer information about the amount of flow in vessels or in cases in which CTA or MRA are contraindicated. DSA appears to be fading out slowly.

Conclusion: CTA and MRA are currently the best methods available to map the vasculature of donor sites of perforator flaps with variable anatomy such as anterolateral thigh (ALT) and deep inferior epigastric perforator (DIEP). In flaps with standard anatomy and superficial vasculature, HHD or no mapping at all remains the method of choice.