A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers

Background: Perforator flaps have become popular worldwide, in part because of their ability to reliably support a large skin territory on a single perforator. Although the lead oxide injection technique provides excellent images for anatomical study, it is not possible to show the location, course, and direction of the source artery. Materialise's Interactive Medical Image Control System allows microvascular anatomy to be evaluated in three-dimensions to design perforator flaps. Methods: Two fresh cadavers were injected using the lead oxide-gelatin injection technique. The cadavers were imaged using a spiral computed tomography scanner. The computed tomographic data were transferred to Digital Imaging and Communications in Medicine format and imported to a personal computer. Three-dimensional reconstructions of various parts of the body were then performed using Materialise's Interactive Medical Image Control System software. Results: Three-dimensional visualization of various parts of the body was obtained. This technique clearly shows the bone, soft tissue, skin, and vascular structures in a layer-by-layer transparent process. The detailed views of the microvasculature provide extensive information regarding the course of vessels in all layers of tissue. Conclusions: The intricate vascular details captured by this technique clearly demonstrate the three-dimensional anatomy of the integument, bone, and soft tissue in a layer-by-layer transparent process. It is a powerful, quick, easy method with which to demonstrate cadaver vascular anatomy that may be useful in the design of surgical flaps.