Preoperative planning for DIEP breast reconstruction: early experience of the use of computerised tomography angiography with VoNavix 3D software for perforator navigation

The Supraclavicular Artery Perforator Flap: A Comparative Study of Imaging Techniques Used in Preoperative Mapping

“…31,32 It has been used to identify the pedicle and design flaps in different parts of the body. 6,17,21,23,29,[32][33][34][35][36][37] The limitations are inability to define the perforator perfusion zones, the radiation exposure, and the vasospastic properties of the iodinated dye, which can make the accurate assessment of small caliber vessels difficult, as reported by Masia et al, Ogawa et al, and Rozen et al 21,29,38 With MRA, the transverse cervical artery and the larger branches could be seen clearly in supraclavicular region, while the distal course of the supraclavicular artery and perforators was difficult to be reliably identified and accurately mapped. MRA was not as sensitive as CTA for depiction and mapping of smaller vessels reported by Alonso-Burgos et al, Mathes and Neligan, Chernyak et al, and Rozen et al 29,32,39,40 However, the value of MRA as mentioned by Smit et al, Fukaya et al, Kelly et al, and Lohan et al could be used as a guide for flap design and dissection in a patient with a contraindication to radiation exposure.…”

ACR Appropriateness Criteria® Imaging of Deep Inferior Epigastric Arteries for Surgical Planning (Breast Reconstruction Surgery)

“…Additional information that can be obtained by CTA includes venous communication between the right and left abdomen, cutaneous perforators, as well as other parameters that can be used to calculate flap viability and flap weights, all of which can help preoperative planning by surgical teams [3,25,26]. Recent research has shown that 3-D postprocessing of CTA data may also improve accuracy in identifying perforators [6,[27][28][29]. CTA has been accepted as the gold standard in preoperative planning for DIEP flaps with sensitivity of 96% for all perforators and sensitivity of 100% for perforators > 1 mm [30].…”

Image-guided technologies to facilitate the dissection of microsurgical autologous tissue-free flaps

“…In particular, CT angiography has become the primary method of such preoperative imaging, with many reconstructive surgeons insisting that their patients undergo such imaging prior to their surgery. Although its accuracy is unknown, preoperative imaging does allow for generalities to be made, such as identifying the course of the deep inferior epigastric vessels and associated perforators, and allowing the reconstructive plastic surgeon to expect an easy or difficult intramuscular dissection [9][10][11].…”

“…As noted above, it is a common practice in DIEP flap planning to obtain preoperative CT angiogram imaging of the abdominal vessels in order to allow the reconstructive plastic surgeon to confirm that the necessary vessels are present and of adequate size, as well as to determine the general location of these vessels in relation to landmarks, such as the umbilicus or a portion of the rectus muscle, before ever making a skin incision on the abdominal wall [9,11]. However, by allowing for co-registration of preoperative CT angiogram imaging with a properly designed intraoperative navigation system during DIEP flap breast reconstruction, one can create a highly useful tool for optimizing successful intraoperative identification and isolation of specific microvasculature from the patient's abdominal anatomy.…”