PhD ceremony mr. S. Klein: The significance of preoperative vascular mapping of donor- and acceptor vessels in free flap surgery

PhD ceremony: mr. S. Klein, 12.45 uur, Academiegebouw, Broerstraat 5, Groningen

Dissertation: The significance of preoperative vascular mapping of donor- and acceptor vessels in free flap surgery

Promotor(s): prof. P.M.N. Werker

Faculty: Medical Sciences

Parallel to the elucidation of the vascular anatomy of the tegument of the human body, composite tissue (free) flaps are increasingly being developed for application by plastic surgeons in the reconstruction of congenital defects or wounds resulting from trauma or tumor ablation. The biggest advancement of the past 25 years is that surgeons can now isolate composite tissue flaps on a small side branch of the source vessels thereby limiting damage at the donor-site. It is therefore conceivable that the preoperative identification of the supplying (perforator) vessels is of paramount importance for successful flap transfer with limited morbidity. This thesis deals with various aspects of the identification process of the donor and recipient sites of flaps, including a discussion about the pro’s and con’s of methods for preoperative vascular mapping. These include Hand-held Doppler, colour duplex, digital subtraction angiography (DSA), computed tomographic angiography (CTA) and magnetic resonance angiography (MRA). Furthermore, various aspects of the applicability of the Ankle-Arm Index (AAI) as a tool for assessment of the vascular supply of the lower limb are assessed.

Each method was found to have its specific indication. DSA proved more reliable for preoperative vascular mapping of the free fibula than AAI. CTA and MRA are in this respect a good alternative for DSA and are the preferred methods for perforator flaps. Atherosclerotic or irradiation damage to vessels cannot always be detected pre-operatively by angiography, and not even by direct intra-operative examination.