CT‐angiography prior to diep flap breast reconstruction: A systematic review and meta‐analysis

Teunis, Teun; Voss, Marise R. Heerma van; Kon, Moshe; Maurik, Joanne F.M. Macaré van

doi:10.1002/micr.22119

Cited by 109 publications

(79 citation statements)

References 21 publications

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“…24 A meta-analysis of lowquality studies demonstrated that computed tomographic angiography may reduce flap loss and partial necrosis. 25 However, experts cite limitations and indicate that significant clinical judgment remains necessary for preoperative interpretation and intraoperative correlation of computed tomographic angiography. 24 Computed tomographic angiography may be a useful adjunct for the SIEA flap, given the inherent variability of the SIEA anatomy, caliber, and angiosome.…”

Section: Discussionmentioning

confidence: 99%

SIEA versus DIEP Arterial Complications

Coroneos

Heller

Voineskos

et al. 2015

Plastic and Reconstructive Surgery

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Section: Discussionmentioning

confidence: 99%

SIEA versus DIEP Arterial Complications

Coroneos

Heller

Voineskos

et al. 2015

Plastic and Reconstructive Surgery

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“…The most serious drawback of CTA is that it uses ionizing radiation with the potential increased risk of radiation‐induced carcinogenesis. Other imaging techniques are represented by doppler ultrasound and color duplex ultrasound, which have been used in planning free perforator flaps (Teunis, Heerma van Voss, Kon, & van Maurik, ), and magnetic resonance angiography (Kurlander, Brown, Iglesias, Gulani, & Soltanian, ), or combined techniques (Onoda, Azumi, Hasegawa, & Kimata, ). In particular the intraoperatory Doppler ultrasound could be useful, but it does not allow a preoperative assessment of the individual vascular anatomy.…”

Section: Discussionmentioning

confidence: 99%

Radiological anatomy of the perforators of the gluteal region: The “radiosome” based anatomy

Vigato

Tiengo

et al. 2017

Microsurgery

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Background The superior (SGA) and the inferior gluteal artery (IGA) perforator flaps are widely used in pressure‐sore repair and in breast reconstruction. The aim was to exhaustively depict the topographical anatomy of the whole system of perforators in the buttock. Methods Eighty lower‐extremity computed tomographic angiography (CTA) of patients (20 males/20 females, mean age 61‐years old, range 38‐81) were considered. The source artery, location, type, and caliber of gluteal perforators were analyzed. The location of perforators was reproduced using a standardized two‐dimensional grid on the coronal plane, centered onto defined bone landmarks. We defined “radiosome” the cutaneous vascular territory of a source artery inferred through the representation of its whole perforator system at the exit point through the deep fascia. Results A mean number of 25.6 ± 5.7 perforators in the gluteal region was observed, distributed as follows: 11.6 ± 4.8(45.2%) from SGA; 7.9 ± 4.5(30.8%) from IGA; 1.5 ± 0.8(5.8%) from fifth lumbar artery; 1.2 ± 0.8(4.7%) from internal pudendal artery; 1.2 ± 1(4.8%) from lateral circumflex femoral artery; 0.3 ± 0.7(1.2%) from circumflex iliac superficial artery. At least one large (internal diameter > 1 mm) SGA septocutaneous perforator was present in 77.5% of patients. Conclusions The gluteal region is vascularized by perforators of multiple source arteries. Septocutaneous perforators of SGA and IGA were planned along a curve drawn from the posterior‐superior border of the iliac crest to the greater trochanter. The lumbar artery perforators are clustered over the apex of the iliac crest; the internal pudendal artery perforators are clustered medially to the ischiatic tuberosity. Contributions can also come from the sacral and superficial circumflex iliac arteries.

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“…However, until a recent study by Tuinder et al who used magnetic resonance imaging (MRI) to delineate the characteristics of the intercostal spaces and IMVs, the intercostal space characteristics had been neglected. The DIEP flap in particular has a steep learning curve: additional information gained from imaging the flap/donor vasculature has demonstrated improvements in complication rates and operative time . Information about the characteristics of the recipient site may contribute further improvements and be of especial relevance to a surgeon considering performing total rib‐sparing vessel exposure.…”

Section: Discussionmentioning

confidence: 99%

The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure

et al. 2014

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Being able to predict patients with a small ICD in whom microsurgery may be more challenging can influence surgical planning. The anatomy of the intercostal spaces is variable and was not predictable in relation to height, BMI, or age. Height was not a reliable proxy for ICD and where there is a concern about the available ICD it is suggested that it is measured directly through preoperative imaging. This study found no increase in the complication rate and flap ischemia time using the rib-sparing IMV exposure technique.

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CT‐angiography prior to diep flap breast reconstruction: A systematic review and meta‐analysis

Cited by 109 publications

References 21 publications

SIEA versus DIEP Arterial Complications

SIEA versus DIEP Arterial Complications

Radiological anatomy of the perforators of the gluteal region: The “radiosome” based anatomy

The relationship between the intercostal distance, patient height and outcome in microsurgical breast reconstruction using the second interspace rib-sparing internal mammary vessel exposure

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