Perforator mapping in the trunk: a guide for freestyle flap surgery and an introduction to the sustainable anatomical study

Introduction: Freestyle Perforator flaps minimize flap harvest morbidity and can be harvested anywhere in the body if perforators anatomy is well known. A study of trunk perforator vessels has been performed on recycled CT scans avoiding cadaver investigations or unnecessary radiation exposure. Materials and Methods: 200 CT scans, performed for the study of liver or pancreatic disease, were examined. No unnecessary radiation was administered. Previous abdominal surgery was reason of exclusion. The trunk between the xyphoid process and Downloaded by: Biomedische Bibliotheek 193.191.170.2 - 10/8/2014 8:35:28 AM Abstracts Eur Surg Res 2012;49:130–216 215 the umbilicus was studied. On axial scans, the trunk was divided in 4 quadrants: Q1 anterior right, Q2 anterior left, Q3 posterior left, Q4 posterior right,. Scans were examined and the position of any perforator >1mm in caliber was measured. The values were transferred on a MS excel® data sheet and analyzed. Results: The average number of perforators per patient was 25,63 (6,09 Q1, 7,21 Q2, 6,20 Q3, 6,14 Q4). Anteriorly, the majority of perforators were between 0 and 5cm from the midline, while posteriorly between 5 and 10 cm. The perforators are more numerous and symmetric anteriorly (Q1 and Q2). Perforators course within the subcutaneous tissue was vertical or oblique for perforators of the Superior Epigastric Artery, horizontal or oblique for perforators of the lateral intercostal arteries, vertical or oblique for perforators of the posterior intercostal arteries. Conclusions: The region of the trunk between the xyphoid process and the umbilicus has several perforators of more than 1mm in caliber that might potentially be used as pedicle of freestyle flaps. This study provides a map of the location of perforator in the middle trunk to serve as a guide for the surgeon to harvest free style flaps in this area. This study also introduces the concept of recycling existing CT scans for the purposes of anatomical investigation and might encourage others to exploit