fig2

Figure 2. Preoperative perforator mapping by magnetic resonance angiography (MRA). As illustrated, the calculated distance from the anatomical landmark (in this case, the symphysis) to the perforator on MRA (green arrow) is shorter than the distance based on preoperative assessment by the plastic surgeon on the outside (yellow arrow), due to the curvature of the thigh. In between red dotted lines = septocutaneous perforator; red triangle = tensor fascia latae (TFL) muscle. Preoperative imaging and perforator mapping are important for the selection of a suitable perforator and are strongly advisable. CTA and MRA are the most commonly used methods^[8,10]. In our clinic, we prefer MRA imaging as it provides high-quality imaging with no exposure of ionizing radiation to the patient. We use the scanning protocol introduced by Vasile and Levine^[13]. Based on MRA imaging, the distance between an anatomical landmark, such as the pubic bone, umbilicus, or ASIS, is marked, and the position of the perforator emerging from the fascia in the subcutaneous tissue is measured and identified on the patient’s skin. Due to the convex shape of the gluteal-thigh region, the distance of the perforator from the midline that is calculated on the MRA is not always reproducible [Figure 2]. However, the perforator always runs through either the dorsal (between the rectus femoris/vastus lateralis muscle and TFL muscle) or the ventral septum (between the TFL muscle and gluteus medius muscle). The septa can be identified using color Doppler, and thus, the perforators can be identified^[8].