Septocutaneous Tensor Fasciae Latae (sc-TFL) perforator flap for breast reconstruction: Radiological considerations and clinical series Radiology Contrast-enhanced magnetic resonance angiography (CE-MRA) images were acquired on a 1.5T MRI system (Ingenia or Intera, Philips Healthcare, Best, NL) with a SENSE body coil (Philips Healthcare, Best, NL). Contrast agent used was 15 mL Gadovist (Bayer Schering Pharma) administered intravenously, followed by 25 mL of normal saline using an electronic injector at 2 mL/s. A 3D fat suppressed ultra fast gradient echo sequence was used: with the following parameters: TE: 4 msec; TR: 8.4 msec; SF: 2 (feet-head); FOV: 380 x 304; Matrix: 400 x 320. Retrospective analysis was performed with IMPAX 6 software (AGFA Healthcare) on the original and reconstructed images (T.B.) The following parameters were systematically analyzed (1) number of septocutaneous branches of the ascending branch of the lateral circumflex artery, (2) origin from the lateral circumflex femoral artery, (3) the distance from septocutaneous branches entering the subcuta- neous fat to the anterior superior iliac spine (ASIS): y axis (4) maximal pedicle length defined as the distance from the origin of the ascending branch of the lateral circumflex femoral artery to the location where the septocutaneous branch enters the subcutaneous fat. Clinical cases Five consecutive sc-TFL flaps were performed in 4 patients for breast recon- struction between September 2012 and February 2013 at the Maastricht University Medical Centre in The Netherlands. Patients’ demographics, medical history, smoking status, perforator characteristics, pedicle length and vessel size, operative technique and time, length of hospital stay and outcomes were registered. Preoperative landmarks All patients underwent preoperative imaging using MRA and color Doppler before surgery. Only patients with a suitable septocutaneous perforator (with a good caliber and a pedicle length of 6 cm or more) were considered for using the sc-TFL flap (Fig 8.1). The projection of the septocutaneous perforator entering the subcutaneous tissue on the surface of the patient was identified On the MRA the distance on the y-axis between antero-superior iliac spine (ASIS) and the position of the perforator emerging from the fascia in the subcutaneous tissue on the same axis was measured as schematically shown on fig 8.2. Because the skin contour in the gluteal-thigh region is convex (not flat as for example in the abdominal region) the distance of the perforator from the midline calculated on the MRA in our hands is not always reproducible. 134
5. lay-out phd DEFINITIEF_digitaal2
To see the actual publication please follow the link above