Predicting Free Flap Failure Using CT and MRI Scan

Can CT and MRI Predict Free Flap Failure?

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Can CT and MRI Predict Free Flap Failure?

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CT (computerized tomography) and MRI (magnetic resonance imaging) scans have revolutionized the medical industry. Both can provide valuable images to the medical team regarding diseases and human anatomy.

Today, CT and MRI have plenty of uses, from diagnosing muscle disorders and detecting brain and spinal cord anomalies. But there is another area that experts are looking into where CT and MRI scans can help.

And that area is the free flap procedure.

In this blog, we’ll examine CT and MRI and whether or not both can predict the free flap method’s success rate. But before that, let’s define free flap and its uses.

What is a free flap procedure?

A free flap procedure is where a piece of tissue is disconnected from its original area and reconnected to a distant part to cover a wound. Then, the blood vessel of the said flap is sewn to another blood vessel to reestablish the connection.

That procedure is done with the use of microvascular surgery. Here, the two blood vessels are sewn back together under a microscope.

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A free flap procedure has a 95% success rate. However, failure isn’t uncommon either. If worse comes to worst, the process will result in the total loss of the flap. In this case, experts may carry out a new procedure, which still has an 89% success rate, although it’s technically demanding.

Thus, monitoring the flap to assess if the procedure will hold is better. If not, early detection is crucial to salvaging the flap.

Here’s where CT and MRI come in.

Can CT and MRI foresee free flap failure?

According to a Michigan University study, CT and MRI scans are promising avenues to explore when trying to predict if a flap will fail. It will allow surgeons to intervene early and conduct appropriate corrections if proven true.

Using CT scans and MRI scans, experts can examine patients who underwent the procedure to determine if the free flap is a success, says Ashok Srinivasan, M.D., FACR, senior author of the paper and neuroradiologist at the University of Michigan Health.

Srinivasan added that the areas they’re evaluating are the blood flow going in and out of the tissue. Depending on the findings, the patient may be discharged early or if further surgical intervention is required.

If it’s the former, it will significantly lower the cost of the patient’s hospitalization. People undergoing a free flap procedure are estimated to stay in the hospital for a week. If discharged early, it will save them a substantial sum.

It’s still too early to conclude

Despite the promising findings, however, it’s still too early to say whether or not CT scans and MRI scans can indeed predict free flap viability. The researchers still need to analyze more cases before a conclusion is drawn.

As it stands, only 19 successful cases have been evaluated by the researchers. An additional five more cases were also analyzed, which exhibited wound failure.

The researchers couldn’t compare the two methods against each other due to the small sample size. Nor were they able to contrast CT and MRI perfusion techniques to ultrasound techniques for the same reason.

Surgeons often use Doppler and skin paddle techniques to evaluate the viability of free flap reconstruction. Unfortunately, both methods aren’t able to examine deeper flap aspects. Air and blood products also obstruct evaluation, which considerably lessens its accuracy.

Hence, a more robust evaluation method like CT and MRI scans is needed. The next step is to determine which of the two is more effective and cost-efficient.

Key Takeaway

From the preceding discussion, it becomes obvious CT and MRI are valuable diagnostic tools to predict free flap failure. Particularly in critical-size defects, they can be helpful in judging the quality of microsurgical skills and avoiding maloperation.

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