Multidetector-row computed tomography in the planning of abdominal perforator flaps

Masià, Jaume; Clavero, Juan A.; Larrañaga, Jose; Alomar, Xavier; Pons, Gemma; Serret, P.

doi:10.1016/j.bjps.2005.10.024

Cited by 309 publications

(224 citation statements)

References 8 publications

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“…4,[9][10][11] The selected dominant perforator is usually medially located, bares a short intramuscular course and a diameter >1 mm, with an extended vascular distribution within the flap adipose tissue to match the flap and to allow preservation of muscle innervation. 2,12 The pre-operative vascular mapping includes imaging modalities ranging from Color Doppler 13 to sophisticated stereotactic vascular representation systems. 11,14 The ideal imaging technique should have no risk to the patient, attain exceptional quality and highly informative images, and be fast and comfortable to the patient.…”

Section: Background:-mentioning

confidence: 99%

“…11,14 The ideal imaging technique should have no risk to the patient, attain exceptional quality and highly informative images, and be fast and comfortable to the patient. 11,12 Prerequirement for the reliability of each of the imaging techniques is a standardized protocol for accurate identification of DIEA perforators. 13 This review presents current imaging methods integrated in DIEP mapping for breast reconstruction, emphasizing on ultrasonography and computed tomographic angiography.…”

Section: Background:-mentioning

confidence: 99%

“…Expertise is required while there is interobserver variability. 11,12 Subcutaneous vessels that are not perforators may be visualized resulting in false positives, while in overweight patients sensitivity further decreases. Moreover, the duration of the examination is 45-60 minutes, rendering the technique uncomfortable for the patient, who has to remain in the same position during the procedure.…”

Section: Background:-mentioning

confidence: 99%

“…Moreover, the duration of the examination is 45-60 minutes, rendering the technique uncomfortable for the patient, who has to remain in the same position during the procedure. 11,12 It is noteworthy that CDU does not provide information on the anatomic relationship between the deep inferior epigastric system and other structures, such as the superior inferior epigastric (SIE) system. In addition, as CDU is a real-time technique, further post examination analysis of data is not possible.…”

Section: Background:-mentioning

confidence: 99%

“…Moreover, CTA may reveal the structure and competence of the abdominal wall fascial layers. 11,12,23 The rate and timing of the injection and the patient's cardiac output and body habitus determine the degree of enhancement. Careful optimization of single phase CTA prevents low opacification due to early scan as well as venous contamination due to late arterial phase.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Bahhati.¹,

Gravvanis²,

Karakitsos³

et al. 2017

IJAR

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Section: Background:-mentioning

confidence: 99%

Section: Background:-mentioning

confidence: 99%

Section: Background:-mentioning

confidence: 99%

Section: Background:-mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Bahhati.¹,

Gravvanis²,

Karakitsos³

et al. 2017

IJAR

View full text Add to dashboard Cite

Breast reconstruction

Blondeel

and

Tromaropoulos

2015

Plastic and Reconstructive Surgery

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The presence of breasts is a defining feature of adult mammalian gender. It must therefore be considered an essential element of human femininity, and the role it plays in female psychology cannot be understated. 1,2 The requirement for reconstruction of the female breast is almost exclusively consequent on breast surgery for breast cancer.Providers are becoming legally bound to educate and prepare patients who require mastectomy for reconstruction, such that informed choices can be made. They are obliged to offer a mul tidisciplinary setting as part of a care pathway, in particular allowing for cross-specialty engagement to allow for immediate reconstruction. The surgery of reconstruction has become a recognized specialist area, which by virtue of its appreciation of three-dimensional form, and its possible call on microsurgical skills, naturally falls within the domain and skill set of the plastic surgeon.In this chapter the techniques of breast reconstruction and the principles behind them are reviewed, and it is hoped this will offer the practitioner a ready reference for what we trust will be a meticulously if not passionately executed endeavour. reconstructive aimsAny attempt at reconstruction should appreciate the nuances of breast form, volume and its complex three dimensionality. Its position on the chest wall is determined by its footprint, 3-5 a fixed entity that does not change with age, and that is set by the inframammary fold (IMF) at the 6-7th rib inferiorly, the 2nd rib superiorly, 1-2 cm behind the anterior axillary line laterally, and the lateral border of the sternum medially. The footprint sets the basic breast position on the chest, and by complementing the opposite side creates the necessary foundation for symmetry.The breast conus represents the tissue that projects from the chest wall, a complex of skin envelope with its glandular and fatty content that falls inferiorly to a variable extent over the IMF in a manner termed ptosis. Unlike the footprint, the conus is variable with age. Creating, therefore, a symmetrical ptotic conus precisely positioned on the breast footprint embodies the art of breast reconstructive sculpture. The skin envelope aids in determining shape and any damage or removal of skin will influence its final shape. The ultimate goal of breast reconstruc tion is to create symmetrical, natural-looking breasts and not necessarily a specific shape or volume. aesthetic and functional considerationsBreast ideals have changed over time, as depicted in art and reflecting past and existing cultural differences. There is also a potential variation between what the surgeon and the patient perceives as aesthetic. For this reason it is critical to be attentive to the patient's wishes, appreciating that simple breast symmetry rather than an idealized form may well be their preference.However, insofar as it is possible to specify what an ideal breast should be, the following can be stated: 6 • Breast size relates to the size and shape of the torso.• Nipple placement is critical -ideall...

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The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

et al. 2009

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The anterior abdominal wall integument is frequently used in a range of reconstructive flaps. These tissues are supplied by the deep and superficial inferior epigastric arteries (DIEA and SIEAs) and the deep and superficial superior epigastric arteries (DSEA and SSEAs). Previous abdominal wall surgery alters this vascular anatomy and may influence flap design. One hundred and sixty-eight patients underwent abdominal wall computed tomographic angiography (CTA) for preoperative imaging. Fifty-eight of these patients had undergone previous abdominal surgery, and were assessed for scar pattern and relationship to the course and distribution of all major axial vessels and perforators. Two cadaveric abdominal wall specimens with midline abdominal scars underwent contrast injection of the DIEAs and DSEAs, with subsequent CTA. The course and distribution of all cutaneous vessels were assessed. In all clinical and cadaveric cases, the vasculature of the abdominal wall had been altered by previous surgery. In the clinical cases, vascular architecture was universally altered in the region of the scar, often modifying the filling patterns of the abdominal wall and occasionally precluding the use of an abdominal wall flap. In both cadaveric specimens, regions of non-filling were evident upon contrast injection, highlighting the angiosomes not supplied by the DIEA or DSEA. Previous abdominal wall surgery necessarily alters the vascular architecture of the abdominal wall, and may alter the source vessels supplying cutaneous tissues. CTA was useful in identifying and delineating these changes, and may be used as a preoperative tool in this role.

show abstract

Multidetector-row computed tomography in the planning of abdominal perforator flaps

Cited by 309 publications

References 8 publications

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Breast reconstruction

The effect of anterior abdominal wall scars on the vascular anatomy of the abdominal wall: A cadaveric and clinical study with clinical implications

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