Comparative Study of Three Preoperative Imaging Modalities for the Evaluation and Design of Superficial Circumflex Iliac Artery Perforator Flap: Color Doppler Ultrasound, Computed Tomography Angiography and Magnetic Resonance Angiography

Abstract

Background: Superficial circumflex iliac artery perforator (SCIP) flap is a promising reconstructive candidate for head and neck, trunk and extremity reconstruction. In order to reduce intraoperative errors, preoperative planning is essential for evaluation of the possible variations in vascular anatomy of the groin region. However, the use of these modalities has not been compared. Objectives: The three commonly used imaging modalities [color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA)] were therefore compared in this study for the relative accuracy in the SCIP flap planning. Patients and Methods: This study was conducted on eight patients who underwent CDUS, CTA and MRA [3-dimensional time-of-flight magnetic resonance angiography, (3D TOF-MRA)] and received reconstructions with the SCIP flaps for head and neck defects. The perforators’ locations, courses and calibers were measured or marked for each flap. These imaging preoperative measurements were later compared with intraoperative findings. Results: CDUS, CTA and 3D TOF-MRA were able to effectively identify the courses of the perforators. 3D TOF-MRA was more accurate at measuring the pedicle calibers of SCIP flaps in comparison with CTA and CDUS. Conclusion: Three D-TOF-MRA may be a more valuable imaging modality for the preoperative assessment of the vascular anatomy of SCIP flaps.