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Imaging modalities in perforator flap reconstruction.

This issue represents the first in a line of Special Topic issues for the Journal of Reconstructive Microsurgery. We have gathered an experienced group of contributors with a wide and varied experience in perforator flap reconstruction. The use of preoperative imaging in surgery is not new. Advances in the field of cardiac and vascular surgery have been able to localize pathology indispensably. Surgical advances have been mirrored by progress in radiology and cardiology providing more specific three-dimensional detail. It would be hard to imagine undergoing any cardiac or vascular surgery currently without preoperative planning and imaging of the vessels involved. The use of imaging in perforator flap reconstruction and its advantages are starting to emerge. Whereas pioneers of perforator flaps relied on clinical examination of vessels and perfusion, complications arising from the variability of the vessels were often confused with lack of experience and the learning curve. Improvements in imaging technology have provided microsurgeons with the ability to visualize vessels with higher resolution and clarity allowing for accurate preoperative planning. In this issue, we start with a discussion by Drs. Mathes and Neligan of the current techniques for imaging available. Next, Drs. Hijjawi and Blondeel describe their experience and transition from duplex ultrasound to computed tomography (CT) angiography. Further experience with CT angiography is provided by Drs. Masia et al who describe a tremendous 5-year series with over 350 patients. The evolution to MR imaging is also described by Drs. Masia et al, and Drs. Greenspun et al for abdominal perforator flaps, and Drs. Vasile et al for gluteal perforator flaps. A new modality for intraoperative imaging with near-infrared angiography, described by Drs. Lee et al, holds potential future promise. Finally, the counterpoint by Drs. Lin et al describes a large experience with anterolateral thigh flaps with no imaging. I hope that this collection of papers will be beneficial in your reconstructive practice and may lead you to consider preoperative imaging because the early experience is convincing. However, further research demonstrating cost effectiveness and improvements in complications are necessary. Finally, do all patients need imaging? Are there indications where imaging can be particularly beneficial? This special issue should provide the impetus to explore further avenues of research regarding imaging in perforator flap reconstruction.