A pre-expanded perforator flap inherits the characteristic of both perforator flap and expanded flap; it is larger, thinner, more pliable, and less invasive to the donor site, making it a highly versatile option in reconstructive surgery. Recently, plastic surgeons have begun to utilize pre-expanded perforator flaps to reconstruct defects for almost the entire body, including the cervicofacial region, axilla, trunk and extremities Select a donor site with similar color and texture to the recipient site can be an important process since locating an appropriate perforator to supply the flap by MDCT angiograph and perfusion scan can be performed.

The main feature of MDCT angiograph has “4Rs”. Rapid-Obtain Large data in a short time; Reproducible; Reliable-Highly accuracy information; Regional-show all the perforators in a large territory. The advantage lies in Less invasive; Assess the detailed anatomy of the perforator; Possibly provide information on the perfusion of the perforator flap.
We have used the valid software (e.g. the OsiriX for mac) to analysis the DICOM data obtained from MDCT angiography. Preoperative 3D images of perforators are useful information for surgeons; It showed the dominant perforator for the flap accurately and visually. 4D images and the dynamic images can also be performed.
We have measured BF value of each skin flaps in the head or face for 576 patients with 320-Detector row CT system. There are significant differences between the flaps in different region, among which BF value of the buccal flap was the lowest.
The MD-CT angiography allows an appropriate selection of a sizable perforator with the shortest intramuscular or supra-fascial course preoperatively. It can be used for pre-operative planning of various perforator flaps especially for pre-expanded perforator flaps. It may also potentially assess the perfusion zone of a perforator flap that leads to a safe flap dissection.

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