The effect of CT angiography and venous couplers on surgery duration in microvascular breast reconstruction: a single operator’s experience

Ngaage, Ledibabari M.; Oni, Georgette; Pace, Bruno Di; Hamed, Raed; Fopp, Laura J.; Koo, Brendan; Malata, Charles M.

doi:10.21037/gs.2018.07.11

Cited by 11 publications

(7 citation statements)

References 33 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…11,12 For example, prior studies that have demonstrated a decrease in operative time have examined patient groups before and after the routine implantation of CTA prior to DIEP flap surgery, and are thus subject to potential bias from a surgical learning curve as the surgical team gains more experience. 13,14 Routine CTA was not implemented in our study cohort and was only utilized by the surgeon when there was a specific concern about the location or patency of the DIEP vessels given a patient's history. Even among patients with prior abdominal scars, preoperative CTA was utilized in only 16.8% of patients in the current study.…”

Section: Discussionmentioning

confidence: 99%

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

View full text Add to dashboard Cite

Background This study examines the effect of prior abdominal surgery on flap, donor-site, and overall complications in women undergoing deep inferior epigastric artery perforator (DIEP) flap breast reconstruction and assesses whether preoperative computed tomography angiography (CTA) affects outcomes. Methods All DIEP flaps performed at our institution between 2004 and 2015 were identified retrospectively. Patients were stratified based on a history of prior abdominal surgery and whether or not they underwent a preoperative CTA. A subgroup analysis was performed to compare operative times and incidence of complications using adjusted odds ratios (ORs). Results Over a 12-year period, 425 patients (640 flaps) had prior abdominal surgery, and 393 patients (547 flaps) had no prior abdominal surgery. Of the patients with previous abdominal surgery, 67 (15.7%) underwent preoperative CTA and 333 (78.4%) did not. Patients with prior abdominal surgery were more likely to have donor-site wound complications (OR: 1.82, 95% confidence interval [CI]: 1.15–2.87, p = 0.01), fat necrosis ≥2cm of the transferred flap (OR: 1.39, 95% CI: 1.0–1.94, p = 0.05), and were more likely to have bilateral DIEP flap reconstruction (OR: 1.61, 95% CI: 1.22–2.12, p < 0.001). Preoperative CTA did not reduce the risk of complications and did not affect operative times. Conclusion DIEP flap reconstruction can be safely performed in women with prior abdominal surgery. However, these patients should be counseled that they are at an increased risk for donor-site wound breakdown and fat necrosis of the reconstructed breast. Preoperative CTA does not reduce complication rate, overall operative time, or time needed to dissect perforators in women with abdominal scars.

show abstract

Section: Discussionmentioning

confidence: 99%

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Daly

Doval

Lin

et al. 2020

J Reconstr Microsurg

View full text Add to dashboard Cite

show abstract

“…Furthermore, flap failure was not associated with venous thrombosis underlining the superiority of venous coupler systems compared to handsewn anastomoses (23,30,36). As a preliminary finding, the combination of venous coupler anastomosis and preoperative CTA is a valuable tool to enhance the safety of autologous breast reconstruction using abdominal free flaps (37).…”

Section: Discussionmentioning

confidence: 86%

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

et al. 2020

View full text Add to dashboard Cite

Background: Breast cancer is the most common malignancy in women. The interdisciplinary treatment is based on the histological tumor type, the TNM classification, and the patient's wishes. Following tumor resection and (neo-) adjuvant therapy strategies, breast reconstruction represents the final step in the individual interdisciplinary treatment plan. Although manifold flaps have been described, abdominal free flaps, such as the deep inferior epigastric artery perforator (DIEP) or the muscle-sparing transverse rectus abdominis myocutaneous (ms-TRAM) flap, are the current gold standard for autologous breast reconstruction. This retrospective study focuses on the safety of autologous breast reconstruction upon mastectomy using abdominal free flaps. Methods: From April 2012 until December 2018, 193 women received 217 abdominal free flaps for autologous breast reconstruction at the University Hospital of Erlangen. For perforator mapping, we performed computed tomography angiography (CTA). Venous anastomosis was standardized using a ring pin coupler system, and flap perfusion was assessed with fluorescence angiography. A retrospective analysis was performed based on medical records, the surgery report, and follow-up of outpatient course. Results: In most cases, autologous breast reconstruction was performed as a secondary reconstructive procedure after mastectomy and radiotherapy. In total, 132 ms1-TRAM, 23 ms2-TRAM, and 62 DIEP flaps were performed with 21 major complications (10%) during hospital stay including five free flap losses (2.3%). In all cases of free flap loss, we found an arterial thrombosis as the main cause. In 24 patients a bilateral breast reconstruction was performed without free flap loss. The majority of free flaps (96.7%) did not need additional supercharging or turbocharging to improve venous outflow. Median venous coupler size was 2.5 mm (range, 1.5-3.5 mm). Steiner et al. Interdisciplinary Breast Reconstruction Conclusion: Using CTA, intraoperative fluorescence angiography, titanized hernia meshes for rectus sheath reconstruction, and venous coupler systems, autologous breast reconstruction with DIEP or ms-TRAM free flaps is a safe and standardized procedure in high-volume microsurgery centers.

show abstract

“…Pre-operative CT angiography has helped predict the chance of success with a DIEP flap reconstruction by identifying candidate perforators and conversely indicating those patients who are technically unsuitable for this procedure. The biggest advantage of CT angiography in breast reconstruction has been to speed up the surgery ( 88 ) as it provides an intraoperative roadmap for perforator selection, location and dissection.…”

Section: Autologous Tissue Versus Implant-based Reconstructionmentioning

confidence: 99%

Oncoplastic and reconstructive breast surgery

2023

View full text Add to dashboard Cite

This article provides an overview of the principles and techniques of oncoplastic and reconstructive breast surgery for patients with early-stage breast cancer. Oncoplastic breast surgery (OPBS) with partial breast reconstruction is a natural evolution in the application of breast conserving surgery and permits wide surgical resection of tumours that might otherwise mandate mastectomy and whole breast reconstruction. These reconstructive techniques must be optimally selected and integrated with ablative breast surgery together with non-surgical treatments such as radiotherapy and chemotherapy that may be variably sequenced with each other. A multidisciplinary approach with shared decision-making is essential to ensure optimal clinical and patient-reported outcomes that address oncological, aesthetic, functional and psychosocial domains. Future practice of OPBS must incorporate routine audit and comprehensive evaluation of outcomes.

show abstract

The effect of CT angiography and venous couplers on surgery duration in microvascular breast reconstruction: a single operator’s experience

Cited by 11 publications

References 33 publications

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Role of CTA in Women with Abdominal Scars Undergoing DIEP Breast Reconstruction: Review of 1,187 Flaps

Interdisciplinary Treatment of Breast Cancer After Mastectomy With Autologous Breast Reconstruction Using Abdominal Free Flaps in a University Teaching Hospital—A Standardized and Safe Procedure

Oncoplastic and reconstructive breast surgery

Contact Info

Product

Resources

About