Three-dimensional multislice spiral computed tomographic angiography (3D-MSCTA) is a minimally invasive method of vascular mapping. The aim of this study was to evaluate the clinical usefulness of this imaging technique in delineating the recipient vessels for safer free tissue transfer to complicated regions. 3D-MSCTA was performed preoperatively in 26 patients scheduled for free tissue transfer, in whom the availability of the recipient vessels were considered to be uncertain, and 23 of these were operated on. Radiographic and operative findings regarding the availability of the recipient vessels for anastomosis were correlated in 21 of these 23 patients. 3D-MSCTA yielded two false-positive results; anastomosis was not possible because of widespread atherosclerotic plaques and poor flow observed in the recipient arteries despite the good caliber observed in 3D-MSCTA images. 3D-MSCTA provides a noninvasive means of preoperatively assessing recipient site vessels for anatomic variations and suitability before free tissue transfer and enables the surgeon to establish an appropriate treatment plan. But it is not 100% reliable yet and the possibility of false-positive results should be kept in mind, especially inthe patients with peripheral vascular disease. 3D-MSCTA has the potential to replace digital subtraction angiography for planning of microvascular reconstructions and newer devices with higher resolutions will probably increase the reliability of this technique. (c) 2009 Wiley-Liss, Inc. Microsurgery, 2009.