MRI Appearance of Myocutaneous Flaps Commonly Used in Orthopedic Reconstructive Surgery
Michael G. Fox1,
Laura W. Bancroft2,
Jeffrey J. Peterson2,
Mark J. Kransdorf2,3,
Sarvam P. TerKonda4 and
Mary I. O'Connor5
1 Department of Radiology, University of Virginia, Charlottesville, VA
22908.
2 Radiology Department, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL
32224.
3 Department of Radiologic Pathology, Armed Forces Institute of Pathology,
Washington, DC 20306-6000.
4 Department of Plastic and Reconstructive Surgery, Mayo Clinic, Jacksonville,
FL 23224.
5 Department of Orthopedic Surgery, Mayo Clinic, Jacksonville, FL 23224.
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Fig. 1A —41-year-old woman with rotational medial gastrocnemius flap
used for coverage after debridement for osteomyelitis. Axial proton-density
(TR/TE, 4,000/15; echo-train length, 8) image obtained 35 months after surgery
shows preserved vascular pedicle (arrows) and flap signal
characteristics similar to background muscles.
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Fig. 1B —41-year-old woman with rotational medial gastrocnemius flap
used for coverage after debridement for osteomyelitis. Diagram of rotational
gastrocnemius flap.
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Fig. 2A —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Coronal T1-weighted
(TR/TE, 683/17) spin-echo MR image at 4 months after placement of free flap
(asterisk).
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Fig. 2B —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Diagram of free flap.
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Fig. 2C —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Progressive fatty atrophy
of rectus abdominus free flap to ankle is seen. Patient did not receive
radiation therapy. Coronal T1-weighted image obtained at 5 months (C),
at 15 months (D), at 28 months (E), and at 41 months
(F).
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Fig. 2D —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Progressive fatty atrophy
of rectus abdominus free flap to ankle is seen. Patient did not receive
radiation therapy. Coronal T1-weighted image obtained at 5 months (C),
at 15 months (D), at 28 months (E), and at 41 months
(F).
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Fig. 2E —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Progressive fatty atrophy
of rectus abdominus free flap to ankle is seen. Patient did not receive
radiation therapy. Coronal T1-weighted image obtained at 5 months (C),
at 15 months (D), at 28 months (E), and at 41 months
(F).
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Fig. 2F —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Progressive fatty atrophy
of rectus abdominus free flap to ankle is seen. Patient did not receive
radiation therapy. Coronal T1-weighted image obtained at 5 months (C),
at 15 months (D), at 28 months (E), and at 41 months
(F).
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Fig. 2G —39-year-old woman with rectus abdominus free flap to ankle
after resection of dermatofibrosarcoma protuberans. Coronal fast spin-echo
T2-weighted (TR/TE, 3,000/95) image shows markedly increased T2-weighted
signal at 4 months after flap placement.
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Fig. 3A —42-year-old man with rectus abdominus rotational flap.
Resolution of hyperintense T2-weighted flap signal for high-grade malignant
fibrous histiocytoma is seen. Axial conventional T2-weighted (TR/TE 2,930/80)
spin-echo MR image obtained 2 months postoperatively displays hyperintense
signal in flap (large asterisk) relative to background musculature.
Patient had received postoperative radiation, and increased signal is also
seen in native muscle of anterior compartment (small asterisk).
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Fig. 3B —42-year-old man with rectus abdominus rotational flap.
Resolution of hyperintense T2-weighted flap signal for high-grade malignant
fibrous histiocytoma is seen. Axial conventional T2-weighted (TR/TE, 2,250/80)
spin-echo MR image obtained during follow-up at 27 months shows marked atrophy
of flap (large asterisk) with near reversion of flap signal to that
of adjacent muscles. Slight increased signal is seen within flap because of
fatty infiltration. Note slight residual increased signal in radiated muscle
(small asterisk).
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Fig. 4A —72-year-old woman with rectus abdominus flap. Resolution of
flap enhancement is seen after resection of well-differentiated liposarcoma.
Patient received postoperative radiation. Axial T1-weighted image (A)
and enhanced fat-suppressed image (B) obtained 6 months after flap
placement shows diffuse enhancement of this rotational flap. Margins of flap
are well delineated (arrows) in A.
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Fig. 4B —72-year-old woman with rectus abdominus flap. Resolution of
flap enhancement is seen after resection of well-differentiated liposarcoma.
Patient received postoperative radiation. Axial T1-weighted image (A)
and enhanced fat-suppressed image (B) obtained 6 months after flap
placement shows diffuse enhancement of this rotational flap. Margins of flap
are well delineated (arrows) in A.
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Fig. 4C —72-year-old woman with rectus abdominus flap. Resolution of
flap enhancement is seen after resection of well-differentiated liposarcoma.
Patient received postoperative radiation. Axial T1-weighted image (C)
and enhanced fat-suppressed image (D) obtained at 19 months. Signal
intensity of flap now equals that of background muscle. Margins of flap are
well delineated (arrows) in C.
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Fig. 4D —72-year-old woman with rectus abdominus flap. Resolution of
flap enhancement is seen after resection of well-differentiated liposarcoma.
Patient received postoperative radiation. Axial T1-weighted image (C)
and enhanced fat-suppressed image (D) obtained at 19 months. Signal
intensity of flap now equals that of background muscle. Margins of flap are
well delineated (arrows) in C.
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Copyright © 2006 by the American Roentgen Ray Society.
