As the field of surgery progresses with innovative techniques and materials, there becomes a subsequent need for radiologists to add onto their knowledge, in order to distinguish between true pathology and post surgical changes. This presentation will focus on surgical flaps, non-native surgical materials, and soft tissue changes after surgical procedures.
Educational Goals / Teaching Points
To elucidate the imaging features of post-surgical changes and materials, which may mimic pathology
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Myocutaneous flaps are commonly utilized for structural support after extensive surgical procedures. Recognizing the normal anatomy of the flap is essential to allow for identification of complications. Complications include infection, ischemia, hemorrhage, or recurrent tumors. Tumor recurrence within the flap must be evaluated as it requires more extensive surgical resection. A common flap used in the groin and perineum is the gracilis flap.
Surgically implanted devices, if not recognized, can be commonly mistaken for a disease process. Hemostatic agents are materials that function by promoting the intrinsic pathway of clotting cascade. These materials are normally absorbed within 4 to 8 weeks. Oxidized regenerated cellulose, in particular, can mimic the appearance of abscess or tumor recurrence. It presents itself as a gas and debris collection with a rim enhancing wall. It is therefore crucial to correlate with operative history to allow for accurate characterization.
Soft tissue changes are common after surgical procedures. Especially in the setting of known malignancy, it becomes crucial to differentiate soft tissue masses or thickening from post-surgical changes. These findings require knowledge of prior surgical procedures, distinction through stability in size, MRI characteristics, and further evaluation of PET/CT if indicated.
It is necessary for radiologists to be aware of advances in medicine and surgical techniques. This allows for accurate and timely diagnosis, which optimizes patient treatment planning.