MRA (Magnetic Resonance Angiography) and DIEP Flaps
Recent technological advances in MRA has made it possible to image blood vessels as small as 1 mm and locate the blood vessel in relation to the overlying skin. The advantage of using this new technology is that the surgeon can visualize the blood vessels nourishing skin and fat on the body. The surgeon can identify the best blood vessel to use and can locate the best blood vessel on the patient. This allows the surgeon to plan the surgery in advance, which can result in decreased operating time and general anesthesia for the patient.
In addition, the surgeon can adjust the position of the flap of skin and fat that will be removed, based on the location of the best blood vessel. Ideally, the tissue that will be removed should be centered around the best blood vessel. Using MRA in our practice, has resulted in adjusting the design of the abdominal tissue to be removed with a DIEP (deep inferior epigastric artery perforator ) flap upward or downward 70% of the time. The position of the flap can be adjusted upward to center the flap around blood vessels located around the umbilicus (belly button) or downward when the best vessel is located lower in the abdomen or when a SIEA (superficial inferior epigastric artery ) appears to be the dominant vessel.
Many patients have had previous abdominal surgeries (cesarian sections, tubal ligation, appendectomy, gall bladder removal, gastric bypass, etc) and are not sure that they are a candidate for using their abdominal tissue. The MRA can visualize the blood vessel and the course of the blood vessel through the abdominal tissue to help the surgeon make this decision. In addition, if the abdomen cannot be used, MRA can be used to look at blood vessels on other parts of the body, such as the buttock, thigh, and lateral chest.
The goal of the practice is to perform perforator flap microsurgical breast reconstruction as safely and efficiently as possible. Dr. Vasile's research on using MRA (magnetic resonance angiography) with perforator flaps is one of several ways the practice continuously works to achieve this goal. The advantage of MRA over other imaging modalities is that there is no radiation exposure. In addition, the contrast material used is gadolinium based. In comparison to the iodinated contrast material used with CTA (computed tomography angiography), the chance of allergic reaction is two orders of magnitude lower with MRA (0.07%). There have been some reports of a rare condition called nephrogenic fibrosing dermopathy (NSF) associated with gadolinium contrast agents. This condition has developed only in patients with impaired kidney function and only about 200 cases have been reported worldwide. Generally, our patients are healthy and are not at risk for developing NSF. However, a creatinine blood test is performed if patients have risk factors for impaired kidney function before a MRA is scheduled. Furthermore, iodinated CT contrast material can cause kidney impairment in patients with normal kidney function. In comparison, gadolinium contrast agents do not cause kidney impairment in patients with normal kidney function.