Preoperative vascular mapping with multislice CT of deep inferior epigastric artery perforators in planning breast reconstruction after mastectomy

Pellegrin, Andrea; Stocca, Tiziano; Belgrano, Manuel; Bertolotto, Michele; Mucelli, Fabio Pozzi; Arnež, Zoran Marij; Cova, Maria Assunta

doi:10.1007/s11547-012-0887-5

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…Rozen and Ashton (2012) believe that limitations in CTA imaging are probably due to how challenging it is to obtain optimal timing for image‐acquisition (Pellegrin et al, 2013). It is beyond any shadow of doubt that the CTA introduces a bias linked to the radiologist's expertise, which may not always be consistent.…”

Section: Discussionmentioning

confidence: 99%

Free‐style technique versus computed tomographic angiography‐guided perforator selection in deep inferior epigastric perforator flap harvest: A prospective clinical study

et al. 2023

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BackgroundComputed tomographic angiography (CTA) is the preferred diagnostic tool in preoperative deep inferior epigastric perforator (DIEP) flap assessment, though some surgeons prefer approaching perforator selection with intraoperative findings alone.MethodsThis prospective observational study conducted between 2015 and 2020 assessed our intraoperative decision‐making “free‐style” technique for DIEP flap harvest. Any patient with indication for immediate or delayed breast reconstruction using abdominally based flaps and who received preoperative CTA was enrolled. Only unilateral cases performed by the same surgeon were considered. Allergy to iodine‐based contrast media, renal impairment and claustrophobia were other exclusion criteria. Primary endpoint consisted in comparing operative times and complication rates between free‐style technique and CTA‐guided approach. Secondary endpoints included evaluation of agreement rate between intraoperative findings and CTA, and identification of variables affecting operative time and complication rate. Demographics, surgical information, agreement versus non‐agreement and complications were collected.ResultsStarting from 206 patients, 100 were enrolled. Fifty were assigned to Group A, receiving DIEP flap with free‐style technique. The other 50 were assigned to Group B, receiving DIEP flap with CTA‐guided perforators selection. Study groups' demographics were homogenous. Operative time was statistically lower (p = .036) in free‐style group (252.4 ± 44.77 min vs. 265.6 ± 31.67 min). Complication rates were higher in CTA‐guided group (10% vs. 2%) though this was not significant (p = .092). Overall agreement rate in dominant perforator selection between intraoperatively and CTA‐based assessment was 81%. Multiple regression analysis showed no variable increased complication rate, though CTA‐guided approach, BMI > 30 and harvesting more than one perforator were respectively associated with B‐coefficient of 17.391 (2.430–32.351, 95% CI) [p = .023], 3.50 (0.640–6.379, 95% CI) [p = .017] and 18.887 (6.232–31.542, 95% CI) [p = .004], predicting increased operative time.ConclusionsThe free‐style technique proved to be a useful tool for guiding DIEP flap harvest with good sensibility in detecting the dominant perforator suggested by CTA without statistically increasing surgery duration and complications.

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Section: Discussionmentioning

confidence: 99%

Free‐style technique versus computed tomographic angiography‐guided perforator selection in deep inferior epigastric perforator flap harvest: A prospective clinical study

et al. 2023

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“…Using the modified Moon and Taylor classification for grading the DIEA in a coronal view, we found a type II branching in 49%. The Moon and Taylor study showed 57% type II DIEAs, whereas Pellegrin only noticed a type II in 28% and mainly type I (65%) [ 39 ]. Masia et al also included over 300 patients, but they analysed the perforators for only some patients in greater detail [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Having four perforators on each side, the mean diameter for the largest perforator was 1.9 mm on the left and 2 mm on the right side [ 35 ]. Pellegrin et al found fewer perforators [ 39 ] and differences between the left and the right side: three perforating branches on the right and two on the left side. This might be due to different inclusion criteria since in our study every single perforator that was found was analysed.…”

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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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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“…Meanwhile, several studies showed that intraoperative findings were highly concordant with the preoperative CTA. [27][28][29] The high sensitivity and specificity of CTA make it as a useful tool in surgical planning by identifying the anatomy of vasculature, especially in scarred abdomen. Many plastic surgeons considered that CTA showed the potential to reduce intraoperative error, optimize perforator choice and dissection, and thus decrease complication rates.…”

Section: Discussionmentioning

confidence: 99%

Effects of pre-existing abdominal scar on postoperative complications after autologous breast reconstruction using abdominal flaps: A systematic review and meta-analysis

Chung

Sohn

Jung

et al. 2021

Journal of Plastic, Reconstructive & Aesthetic Surgery

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Preoperative vascular mapping with multislice CT of deep inferior epigastric artery perforators in planning breast reconstruction after mastectomy

Abstract: Studying DIEP with CTA is useful in the surgical planning of breast reconstruction, even though it requires careful optimisation owing to the critical timing of opacification typical of that vascular district.

Cited by 11 publications

References 19 publications

Free‐style technique versus computed tomographic angiography‐guided perforator selection in deep inferior epigastric perforator flap harvest: A prospective clinical study

Free‐style technique versus computed tomographic angiography‐guided perforator selection in deep inferior epigastric perforator flap harvest: A prospective clinical study

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

Effects of pre-existing abdominal scar on postoperative complications after autologous breast reconstruction using abdominal flaps: A systematic review and meta-analysis

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