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Pre- and Intraoperative Identification of Perforator Vessels Using MRA/MDCTA, Doppler Sonography, and ICG Fluorescence Angiography

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ICG Fluorescence Imaging and Navigation Surgery

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Abstract

Here, we introduce our method of combined use of magnetic resonance angiography/multidetector-row computed tomography (MRA/MDCTA), Doppler sonography, and indocyanine green (ICG) fluorescence angiography to identify the locations of the perforator vessels of the flaps. This method can be used to accurately confirm perforator vessel location on pre- or intraoperative images. If a detectable perforator is obtained using preoperative MRA/MDCTA and Doppler sonography, we use the term “freestyle perforator-based flap” for propeller or V-Y advancement flaps. In some cases, aggressive perforator dissection is necessary to free these flaps from adhesions and evenly distribute the torsion, and the intraoperative identification of perforator vessels detected by Doppler sonography and ICG fluorescence angiography makes it possible to select perforators of larger caliber and stronger pulsatility without fear of anatomic inconsistencies; furthermore, such identification facilitates the surgical mechanics and shortens the operation time.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, University of Okayama, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Toshiyuki Watanabe, Keita Kawai & Yoshihiro Kimata

Authors
  1. Toshiyuki Watanabe
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  2. Keita Kawai
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  3. Yoshihiro Kimata
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Correspondence to Yoshihiro Kimata .

Editor information

Editors and Affiliations

  1. Department of Surgery, Seiwa Memorial Hospital, Sapporo, Hokkaido, Japan

    Mitsuo Kusano

  2. Hepato-Biliary-Pancreatic Surgery Divisi, University of Tokyo, TOKYO 113-8655, Tokyo, Japan

    Norihiro Kokudo

  3. Department of Breast Surgery Graduate Sc, Kyoto University, Kyoto, Kyoto, Japan

    Masakazu Toi

  4. Department of Surgery, Hirakata Hospital, Kansai Medical University, Hirakata, Osaka, Japan

    Masaki Kaibori

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Watanabe, T., Kawai, K., Kimata, Y. (2016). Pre- and Intraoperative Identification of Perforator Vessels Using MRA/MDCTA, Doppler Sonography, and ICG Fluorescence Angiography. In: Kusano, M., Kokudo, N., Toi, M., Kaibori, M. (eds) ICG Fluorescence Imaging and Navigation Surgery. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55528-5_22

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  • DOI: https://doi.org/10.1007/978-4-431-55528-5_22

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  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-55527-8

  • Online ISBN: 978-4-431-55528-5

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