Predicting the Feasibility of Utilizing SIEA Flap for Breast Reconstruction with Preoperative BMI and Computed Tomography Angiography (CTA) Data

Zhang, Xiaoyu; Mu, Dali; Yang, Yan; Li, Wandi; Yang, Lin; Li, Haoran; Luan, Jie

doi:10.1007/s00266-019-01605-0

Cited by 15 publications

(19 citation statements)

References 19 publications

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“…Similarly, during the Navarra meeting, they found consensus that the venous system plays an immense role [ 32 ]. This was also mentioned by Zhang et al without dealing in detail with the SIEV communicating with the perforators [ 43 ]. Between the right and left hemiabdomen, we did not find any statistically significant difference, thus it can be considered as symmetrically distributed.…”

Section: Discussionmentioning

confidence: 73%

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Improving the Safety of DIEP Flap Transplantation: Detailed Perforator Anatomy Study Using Preoperative CTA

Frank

Ströbel

Ludolph

et al. 2022

JPM

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Background: Deep inferior epigastric perforator and muscle sparing transverse rectus abdominis muscle flaps are commonly used flaps for autologous breast reconstruction. CT-angiography allows to analyse the perforator course preoperatively. Our aim was to compare the different aspects of perforator anatomy in the most detailed study. Methods: CT-angiographies of 300 female patients with autologous breast reconstruction of 10 years were analysed regarding the anatomy of the deep inferior epigastric artery and every perforator. Results: Overall, 2260 perforators were included. We identified correlations regarding the DIEA branching point and number of perforators and their intramuscular course. The largest perforator emerged more often from the medial branch of the DIEA than the smaller perforators (70% (416/595) vs. 54% (878/1634), p < 0.001) and more often had a direct connection to the SIEV (large 67% (401/595) vs. small 39% (634/1634), p < 0.01). Medial row perforators were larger than the laterals (lateral 1.44 mm ± 0.43 (n = 941) vs. medial 1.58 mm ± 0.52 (n = 1304) (p < 0.001)). The larger and more medial the perforator, the more likely it was connected to the SIEV: perforators with direct connection to the SIEV had a diameter of 1.65 mm ± 0.53 (n = 1050), perforators with indirect connection had a diameter of 1.43 ± 0.43 (n = 1028), perforators without connection had a diameter of 1.31 mm ± 0.37 (n = 169) (p < 0.001). Medial perforators were more often directly connected to the SIEV than lateral perforators (medial 56% (723/1302) vs. lateral 35% (327/941), p < 0.001). A lateral perforator more often had a short intramuscular course than medial perforators (69% (554/800) vs. 45% (474/1055), p < 0.001), which was also more often observed in the case of a small perforator and a caudal exit of the rectus sheath. Conclusion: The largest perforator emerges more often from the medial branch of the DIEA and frequently has a direct connection to the SIEV, making medial row perforators ideal for DIEP flap transplantation.

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Section: Discussionmentioning

confidence: 73%

“…This matches the observations seen in other studies. Zang et al had a smaller mean BMI of 23.6 kg/m 2 probably resulting from the fact that only Asian women were included [ 43 ]. Furthermore, the higher the BMI, the more likely a perforator emerges more lateral through the rectus sheath.…”

Section: Discussionmentioning

confidence: 99%

Improving the Safety of DIEP Flap Transplantation: Detailed Perforator Anatomy Study Using Preoperative CTA

Frank

Ströbel

Ludolph

et al. 2022

JPM

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“…While conventional angiography remains relevant primarily for the evaluation of recipient vessels in lower extremity reconstruction, 93 recent trends have favored less-invasive imaging modalities. Both CTA and MRA can provide detailed 3D images of vascular structures and their surrounding anatomy, and their use has been described in preoperative planning for breast, 3,20,31,64,94,95 head and neck, and extremity reconstructions. 96,97 Although CTA has been shown to accurately detect the location and intramuscular course of perforators less than 1 mm in diameter, 98 a typical CTA of the abdomen requires an average of 6.0 to 9.9 mSv of ionizing radiation which has been shown to be associated with a low but still existent risk of fatal radiation-induced cancer along the order of 1 in 4,270 per 6 mSv.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Various Modalities Utilized for Preoperative Planning in Microsurgical Reconstructive Surgery

Nassar

Maselli

Manstein

et al. 2021

J Reconstr Microsurg

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Background The benefits of preoperative perforator imaging for microsurgical reconstruction have been well established in the literature. Methods An extensive literature review was performed to determine the most commonly used modalities, and their applicability, advantages and disadvantages. Results The review demonstrated varioius findings including decreases in operative time and cost with the use of CT angiography to identification of perforators for inclusion in flap design with hand-held Doppler ultrasound. Modalities like MR angiography offer alternatives for patients with contrast allergies or renal dysfunction while maintaining a high level of clarity and fidelity. Although the use of conventional angiography has decreased due to the availability of less invasive alternatives, it continues to serve a role in the preoperative evaluation of patients for lower extremity reconstruction. Duplex ultrasonography has been of great interest recently as an inexpensive, risk free, and extraordinarily accurate diagnostic tool. Emerging technologies such as indocyanine green fluorescence angiography and dynamic infrared thermography provide real-time information about tissue vascularity and perfusion without requiring radiation exposure. Conclusion This article presents an in-depth review of the various imaging modalities available to reconstructive surgeons and includes hand held Doppler ultrasound, CT angiography, MR angiography, conventional angiography, duplex ultrasonography, Indocyanine Green Fluorescence Angiography and Dynamic Infrared Thermography.

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“…Besides, the patient can have an aesthetic overview of what the breast will look like after reconstruction. Also, Zhang et al [17] reported an analysis of CTA data of patients who received postoperative treatment for breast cancer to determine the need to use superficial epigastric artery (SIEA) flaps. They concluded that the SIEA is recommended when one of the two criteria are matched, patients with a Body Mass Index (BMI) ≥ 25 kg/m 2 or an SIEA diameter ≥ 2.0 mm.…”

Section: Introductionmentioning

confidence: 99%

Characterization of the volume and thickness of DIEP flap by CTA image processing

Cerón

Duque

Verdoy

et al. 2021

2021 XXIII Symposium on Image, Signal Processing and Artificial Vision (STSIVA)

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Breast cancer is the most commonly diagnosed cancer worldwide and is the leading cause of cancer-related death in more than 100 countries. Breast cancer surgery, especially when it involves a mastectomy, is associated with unaesthetic results that can be traumatic. Therefore, breast reconstruction is crucial for the patient to return to normal life, avoiding the psychological consequences. Based on free tissue transfer with microsurgery, autologous breast reconstruction is the gold standard for breast reconstruction, especially in irradiated patients. To plan the reconstruction surgery and locate the cutaneous perforating vessels supplying blood to the flap, preoperative Computed Tomography Angiography (CTA) is usually performed. However, only approximate and qualitative measurements are obtained and the location of the umbilical perforators reported by the radiologist. This paper advances a quantitative method to assess autologous Deep Inferior Epigastric Perforator (DIEP) flap volume and thickness from CTA images. This method is validated by measuring flap volume intraoperatively in the operating room of the Hospital Universitari de Bellvitge. These measurements could improve preoperative planning by reconstructive surgeons as they would know beforehand whether the amount of adipose tissue that can be harvested is sufficient to reconstruct the breast completely. This information could be crucial in thin and largebreasted women or if bilateral breast reconstruction is planned.

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Predicting the Feasibility of Utilizing SIEA Flap for Breast Reconstruction with Preoperative BMI and Computed Tomography Angiography (CTA) Data

Cited by 15 publications

References 19 publications

Improving the Safety of DIEP Flap Transplantation: Detailed Perforator Anatomy Study Using Preoperative CTA

Improving the Safety of DIEP Flap Transplantation: Detailed Perforator Anatomy Study Using Preoperative CTA

Comparison of Various Modalities Utilized for Preoperative Planning in Microsurgical Reconstructive Surgery

Characterization of the volume and thickness of DIEP flap by CTA image processing

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