Summary SUMMARY In this thesis we describe the topographical anatomy of different perforator flaps and recipient vessels and, as a result, the clinical applications and im- plications. We started with anatomic dissection studies and our findings were supported by imaging studies. This led to our conclusion that imaging is help- ful in planning perforator surgery. In chapter 2 we investigated the perforator variability of the anterolateral thigh flap: particularly the presence and the prevalence of septocutaneous and musculocutaneous perforators was analysed. For every thigh an average of 2 perforators was found in the flap with a prevalence of the musculo- cutaneous ones. A strong variability concerning the vascular pattern of the branches (ascending, descending and transverse) of the lateral circumflex femoral artery (LCFA) was identified (e.g. in nearly half of the thighs the descending branch of the LCFA divided into a medial and a lateral branch). In chapter 3 musculocutaneous perforators in the calf region were studied: they are the pedicle of the medial sural artery perforator flap. Two different intramuscular courses were described. In chapter 4 we performed a preliminary anatomical study on septocutaneous perforators of the superior gluteal artery. A dissection study was correlated to a color Doppler study. Only septocutaneous perforators running between gluteus maximus and gluteus medius muscle were identified or dissected. In every corps and every volunteer at least one septocutaneous perforator was found. We concluded that to include these perforator in the flap the drawing of the S-GAP had to be more cranial than conventional. In chapter 5 we presented a series of patients undergoing an sc-GAP flap (septocutaneous gluteal artery perforator flap) for breast reconstruction. The presence of septocutaneous perforators was preoperatively investigated with MRA or CTA. The dissection of a septocutaneous perforator was clearly easier than that of a musculocutaneous one. In addition in the gluteal region the veins were more fragile. Moreover the sc-GAP had, in most of the cases, longer pedicles than the standard S-GAP. The skin island of the sc-GAP was more cranial and more lateral than in a conventional S-GAP, minimizing the contour changes in the buttock. In chapter 6 we presented our experience with the sc-GAP flap. Tips and trics of the technique are presented. In chapter 7 we analysed the accuracy of equilibrium-phase high spatial resolution (EP) contrast-enhanced magnetic resonance angiography (CE- MRA) at 1.5T for the preoperative evaluation of perforators of the deep 172
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