Three-Dimensional Angiography of the Superior Gluteal Artery and Lumbar Artery Perforator Flap

Background: Three-dimensional angiography was first proposed by Cornelius and advanced by Voigt in 1975. Since then, a variety of improvements have been made. The three-dimensional evaluation of perforator flaps is no longer a clinical curiosity but an absolute necessity. By combining three-dimensional digital imaging and angiography, the authors have developed a new three-dimensional technique for visualizing blood vessels. This method produces a digitized model of the lumbar artery and superior gluteal artery musculocutaneous perforators that enables secure elevation of the lumbar and superior gluteal artery cross-boundary perforator flap. Methods: Two cadavers underwent whole body lead oxide-gelatin injection. Spiral computed tomographic scanning was then performed on the cadavers and three-dimensional reconstructions were performed. Six fresh bodies were used, and underwent latex injection. Specimens were then dissected by layers to document the individual perforators. Results: An average of five superior gluteal artery musculocutaneous perforators with a diameter of 0.6 mm were present in the specimens. The average diameter and area supplied by perforators from the lumbar arteries was 0.7 mm and 30 cm(2), respectively. The three-dimensional reconstructed model of the lumbar region can display the modality, spatial location, and adjacent relationship of the lumbar and superior gluteal arteries. Conclusions: Three-dimensional modeling of lumbar and superior gluteal artery perforator flaps could provide greater insight into perforator anatomy in combination with traditional sectional imaging. Three-dimensional reconstructive modeling is now a clinically available process which, in the future, could provide great value in basic science investigation, clinical training, preoperative design, and virtual surgical procedures. (Plast. Reconstr. Surg. 123: 79, 2009.)