The value of multidetector-row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps

Abstract

The deep inferior epigastric artery perforator (DIEP) flap has recently become the first option for breast reconstruction. However, the anatomy of the deep inferior epigastric artery varies greatly from one individual to another and even from one hemiabdomen to the other. An optimal pre-operative evaluation method that adequately maps the underlying vasculature has been lacking. The advent of multidetector-row CT (MDCT) angiography has proven highly accurate at detailing the vasculature, but no reports have documented its value during pre-operative planning. From December 2006 to May 2008, 22 consecutive patients who underwent MDCT angiography before breast reconstruction using DIEP flaps were selected as the test group, and 22 former patients who did not undergo MDCT before the same procedure were selected as the control group. The two groups were evaluated for the ratio of pre-operative redesign, intra-operative method changes, time spent on flap harvest and the ratio of flap-associated complications. The pre-operative redesign ratio was 22.7% in the test group and 0% in the control group. The intra-operative method change ratio was 0% in the test group and 13.6% in the control group. The mean time spent on flap harvest was 2.8 +/- 0.2 h in the test group and 4.4 +/- 0.2 h in the control group (p<0.05). The flap complication rate was 1/22 in the test group and 3/22 in the control group (p _ 0.04). In conclusion, use of MDCT angiography during pre-operative planning promotes a significant reduction in operating time and complication rate.

CT‐angiography prior to diep flap breast reconstruction: A systematic review and meta‐analysis

“…After screening the full text of 20 articles, eight were selected for critical appraisal (Fig. ) . No additional relevant studies were found by screening related articles and citations.…”

The Impact of Preoperative CT Angiography on Breast Reconstruction With Abdominal Perforator Flaps

“…The authors also reported that they did not make any intraoperative changes to the preoperative planning of these 22 patients. 11 Furthermore, Piorkowski et al evaluated SIEA adequacy of 113 patients based on pCTA and compared the results to operative dissection and determined that 50% of patients who were found to have at least one adequate SIEA on pCTA had a single breast reconstructed with an SIEA flap. 12 The differences in accuracy of pCTA between studies available in the literature can be attributed to variations in patient population, surgeons' preference, and interpretation of operative or CT findings.…”

Contrast-Enhanced Magnetic Resonance Angiography for Preoperative Imaging of Deep Inferior Epigastric Artery Perforator Flaps

“…[13][14][15][17][18][19][20]26,38 The DIEP flap is associated with a steep learning curve, 39 a relatively tedious flap dissection, and a higher rate of flap complications than TRAM flap harvest. Presurgical imaging may, therefore, allow flap complications to be reduced while maintaining the benefit of reduced donor site morbidity.…”