Chapter 6 The projection of the umbilicus on the patient’s dorsal midline is identifi ed as a landmark to determine the craniocaudal position of the perforator itself (y axis) (fi g 6.8, A,B,C). Figure 6.8 An example of how to assess the anteroposterior length. Firstly, the location of umbilicus is determined (A, arrow). Secondly, the location of the exit of the perforator be- tween the gluteal muscles into the subcuta- neous fat is determined (B, arrow). Finally, the position of the umbilicus, determined on the sagittal reconstructed images (C, asterisk), and the site of the perforator exit of B are marked by the crosshair (C, arrow). In this way, the craniocaudal length from the umbilicus to the site of the perforator exit can be determined. It was 10.1 cm in this example. Step 3: To determine the position of the perforator as accurately as possible, a number of lines is drawn on the patient’s skin. The patient’s position should be the same as in surgery (see pitfalls). The midline is indicated with line A and the cranial end of the crena analis with a horizontal line B. With a color doppler (Esaote MyLab 25 Color Doppler with a LA523, 4-13 MHz probe) the cranial margin of the gluteus maximus muscle, where it originates from the thick gluteus medius fascia, is also identifi ed, position- ing the probe approximately parallel to this margin (fi g 6.9A). It is marked on the skin as line C. Finally the iliac crest is identifi ed and marked on the skin as a curved line D. The probe then is rotated 90° (fi g 6.9B) and every 99
5. lay-out phd DEFINITIEF_digitaal2
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