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MRI and CT Predicts Flap Failure After Head and Neck Reconstructive Cancer Surgery

By MedImaging International staff writers
Posted on 24 Jun 2022

Image: A composite picture from MR perfusion of a free flap demonstrating measurements made within the flap (Photo courtesy of Michigan Medicine)

When a patient with head and neck cancer has surgery to remove it, they often need reconstructive surgery in the form of a “free flap”, which is skin and tissue taken from a different part of the body and connected to the blood vessels of the wound in need of repair. This free flap method, called microvascular reconstruction, carries around a 10-40% risk of wound complications, with 10% of cases requiring another surgery. Currently, most surgeons use ultrasound to assess viability for free flap reconstruction with techniques known as Doppler and skin paddle. Those methods often are unable to evaluate deeper aspects of the flap, or air and blood products cause interference in visualization, which affects how well clinicians can analyze a flap’s viability. Now, a study has found that early postoperative CT scans and MRIs can help predict whether a flap will fail, which could allow surgeons to intervene earlier.

In the study, a team of researchers from the University of Michigan Health (Ann Arbor, MI, USA) analyzed 19 patients who had successful free flap reconstruction, as well as five who had wound failure, between January 2016 to mid-2018. They found that both CT and MRI perfusion techniques showed significant differences between the two patient groups. Researchers were not able to compare the two methods to ultrasound techniques or each other due to the small sample size. They hope to accomplish those comparisons through a larger future trial.

“All patients who have this procedure can be investigated with non-invasive post-operative CT or MRI perfusion, and these two methods show a lot of promise as accurate biomarkers of predicting free flap viability,” said Ashok Srinivasan, M.D., FACR, a neuroradiologist at University of Michigan Health.

“This pilot research shows us that these models work, as all areas of the flap can be assessed using CT and MRI, unlike doppler and skin paddle where some areas may be blind to evaluation,” said Yoshiaki Ota, M.D., a neuroradiology fellow at University of Michigan Health. “We know that using CT and MRI could help shorten a patient’s hospital stay or avoid a prolonged hospitalization, and now we need to look further at which is more effective and cost-effective.”

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70 (254.15420532227): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (252.00843811035): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.100646972656): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (64.13459777832): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (32.186508178711): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (55.789947509766): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (30.994415283203): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (37.908554077148): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (44.822692871094): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

105 (42.915344238281): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

106 (51.021575927734): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294793571 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294793571 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

109 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

110 (46.014785766602): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294793571 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (450.84953308105): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294793571 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (512.12310791016): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (370.02563476562): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

115 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

116 (56.982040405273): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

117 (39.815902709961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

118 (95.844268798828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

119 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

120 (262.97569274902): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 16961.097717285): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

122 (88.930130004883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

123 (130.17654418945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

124 (442.0280456543): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294793571 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294793571 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 414160.01319885): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (83.92333984375): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (399.11270141602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (49.114227294922): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (259.8762512207): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (40.054321289062): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (189.06593322754): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (36.001205444336): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (495.91064453125): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (381.9465637207): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (259.1609954834): SELECT name FROM jos_deeppockets WHERE id=212

136 (38.14697265625): SELECT name FROM jos_deeppockets WHERE id=212

137 (478.02925109863): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (367.87986755371): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

140 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

141 (!!!!! 10560.989379883): TRUNCATE TABLE jos_trademed_module

142 (113.01040649414): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294793571 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (56.028366088867): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294793571 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (771.04568481445): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

147 (44.822692871094): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

148 (!!!!! 1049.9954223633): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

149 (53.167343139648): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

150 (37.908554077148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

151 (50.067901611328): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294793571 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294793571 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (28.848648071289): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

153 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

154 (27.894973754883): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (98.943710327148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

156 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294793571 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294793571 AND published='1' LIMIT 1

157 (110.86463928223): select jos_twitters.link from jos_twitters where cat=10

158 (28.133392333984): select jos_facebook.link from jos_facebook where cat=10

159 (26.941299438477): select jos_google_plus.link from jos_google_plus where cat=10

160 (25.98762512207): select jos_linkedin.link from jos_linkedin where cat=10

161 (294.92378234863): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1074.0756988525): insert into jos_banners_delta values (14615,'2025-04-30 21:55:57','3.133.145.211','view'),(14202,'2025-04-30 21:55:57','3.133.145.211','view'),(14203,'2025-04-30 21:55:57','3.133.145.211','view')

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