A Preoperative Marking Template for Deep Inferior Epigastric Artery Perforator Flap Perforators in Breast Reconstruction

Abstract

Preoperative perforator marking for deep inferior epigastric artery perforator flaps is vital to the success of the procedure in breast reconstruction. Advances in imaging have facilitated accurate identification and preselection of potentially useful perforators. However, the reported imaging accuracy may be lost when preoperatively marking the patient, due to 'mapping errors', as this relies on the use of 2 reported vectors from a landmark such as the umbilicus. Observation errors have been encountered where inaccurate perforator vector measurements have been reported in relation to the umbilicus. Transcription errors have been noted where confusing and wordy reports have been typed or where incorrect units have been given (millimetres vs. centimetres). Interpretation errors have also occurred when using the report for preoperative marking. Furthermore, the marking process may be unnecessarily time-consuming. We describe a bespoke template, created using an individual computed tomography angiography image, that increases the efficiency and accuracy of preoperative marking. The template is created to scale, is individually tailored to the patient, and is particularly useful in cases where multiple potential suitable perforators exist.

3D-printed, patient-specific DIEP flap templates for preoperative planning in breast reconstruction: a prospective case series

“…This is marked out on the patient by the surgeon preoperatively and confirmed using a handheld Doppler probe. Unsurprisingly, during observation, transcription and interpretation of the report, errors can be introduced and compromise efficiency (36). Thus, Miranda et al have proposed, in their proof-of-concept study, a method of creating patient-specific 2D DIEP templates using transparent acetate sheets, punch biopsy holes, and coronal images from the CTA (36).…”

“…Unsurprisingly, during observation, transcription and interpretation of the report, errors can be introduced and compromise efficiency (36). Thus, Miranda et al have proposed, in their proof-of-concept study, a method of creating patient-specific 2D DIEP templates using transparent acetate sheets, punch biopsy holes, and coronal images from the CTA (36). However, this technique is rather cumbersome and is significantly susceptible to observation and transcription errors.…”

Contemporary Microsurgical Breast Reconstruction: Abdominally Based Flaps

“…Some surgeons will use a printed grid template that can be laid on the patient’s abdomen while lying supine to allow for accurate markings. 59 Other surgeons will measure and mark out the perforator points in reference to the umbilicus, based on preoperative imaging. In cases where preoperative imaging has not been obtained, the flap outline is delineated, and the perforator location is determined intraoperatively while raising the flap.…”

Alternative imaging technologies for perforator mapping in free flap breast reconstructive surgery – A comprehensive overview of the current literature

“…The grid with the representation of the abdominal wall is preoperatively centered on the umbilicus with the midline as reference points and perforators are marked. 62 Chae et al compared the preoperative made grid with the intraoperative perforator location and found a statistically significant difference of 7 mm. Most discrepancies arose in the lateral row perforators.…”