J Reconstr Microsurg 2010; 26(1): 021-028
DOI: 10.1055/s-0029-1223854
© Thieme Medical Publishers

Preoperative Computed Tomographic Angiogram for Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction

Jaume Masia1 , Damir Kosutic1 , Juan A. Clavero2 , Jose Larranaga1 , Lorena Vives1 , Gemma Pons1
  • 1Department of Plastic Surgery, Hospital de la Santa Creu i Sant PaU, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
  • 2Radiology Department, Clinica Creu Blanca, Reina Elisenda Moncada, Barcelona, Spain
Further Information

Publication History

Publication Date:
09 September 2009 (online)

ABSTRACT

Precision in preoperative evaluation of the abdominal wall vascular anatomy is of utmost importance in successful planning and execution of perforator flap surgery for breast reconstruction after mastectomy. We performed a study in 357 patients scheduled for deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction to review our 5-year experience with the technique we developed based on our previous research confirming accuracy of a computed tomographic (CT) angiogram (multidetector row computed tomography [MDCT]) in preoperative planning of abdominal perforator flap surgery. Images obtained from the radiological study were used to create an accurate map of dominant abdominal perforators of the deep inferior epigastric artery, showing their location, size, and anatomic considerations of relevance for the preoperative flap design. Anatomic dissection of all perforators was performed in the first 36 cases to compare the data with preoperative MDCT findings. In the following 321 patients, the dominant perforator was chosen solely on the basis of MDCT and dissected directly. Exact correlation between surgical and radiological results was found in the first 36 cases. A significant reduction in average operating time and postoperative complications was noted in the following 321 patients. CT angiogram provides important preoperative information on inferior abdominal wall vascular anatomy, facilitating DIEAP flap harvest, saving operative time, and reducing complications and costs. It proved to be an invaluable tool in the preoperative algorithm for DIEAP flap breast reconstruction.

REFERENCES

  • 1 Koshima I, Moriguchi T, Soeda S, Tanaka H, Umeda N. Free thin paraumbilical perforator-based flaps.  Ann Plast Surg. 1992;  29 12-17
  • 2 Kroll S S, Rosenfield L. Perforator-based flaps for low posterior midline defects.  Plast Reconstr Surg. 1988;  81 561-566
  • 3 Allen R J, Treece P. Deep inferior epigastric perforator flap for breast reconstruction.  Ann Plast Surg. 1994;  32 32-38
  • 4 El-Markby H H, Milner R H. The vascular anatomy of the lower anterior abdominal wall: a microdissection study on the deep inferior epigastric vessels and the perforator branches.  Plast Reconstr Surg. 2002;  109 539-543
  • 5 Taylor G I, Doyle M, McCarten G. The Doppler probe for planning flaps: anatomical study and clinical applications.  Br J Plast Surg. 1990;  43 1-16
  • 6 Giunta R E, Geisweld A, Feller M. The value of preoperative Doppler sonography for planning free perforator flaps.  Plast Reconstr Surg. 2000;  105 2381-2386
  • 7 Blondeel P N, Beyens G, Verghaege R et al.. Doppler flowmetry in the planning of perforator flaps.  Br J Plast Surg. 1998;  51 202-209
  • 8 Hallock G G. Doppler sonography and color duplex imaging for planning a perforator flap.  Clin Plast Surg. 2003;  30 347-357
  • 9 Ahn C Y, Narayanan K, Shaw W W. In vivo anatomic study of cutaneous perforators in free flaps using magnetic resonance imaging.  J Reconstr Microsurg. 1994;  10 157-163
  • 10 Masia J, Clavero J A. Multidetector-row CT in the planning of abdominal perforator flaps. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC Perforator Flaps Anatomy, Technique & Clinical Applications. St. Louis, MO; QMP, Inc. 2006: 103-7
  • 11 Clavero J A, Masia J, Larrañaga J et al.. MDCT in the preoperative planning of abdominal perforator surgery for postmastectomy breast reconstruction.  AJR Am J Roentgenol. 2008;  191 670-676
  • 12 Masia J, Larrañaga J, Clavero J A, Vives L, Pons G, Pons J M. The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap: our experience in 162 cases.  Ann Plast Surg. 2008;  60 29-36
  • 13 Rosenquist S, Sandelin K, Wickman M. Patients’ psychological and cosmetic experience after immediate breast reconstruction.  Eur J Surg Oncol. 1996;  22 262-266
  • 14 Benediktsson K, Perbeck L. Capsular contracture around saline-filled and textured subcutaneously placed implants in irradiated and non-irradiated breast cancer patients: five years of monitoring of a prospective trial.  J Plast Reconstr Aesthet Surg. 2006;  59 27-34
  • 15 Spear S L, Onyewu C. Staged breast reconstruction with saline-filled implants in the irradiated breast: recent trend and therapeutic implications.  Plast Reconstr Surg. 2000;  105 930-942
  • 16 Handel N, Jensen J A, Blacq Q, Waisman J R, Silverstein M J. The fate of breast implants: a critical analysis of complications and outcomes.  Plast Reconstr Surg. 1995;  96 1521-1533
  • 17 Blondeel P N, Vanderstraeten G C, Monstrey S J et al.. The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction.  Br J Plast Surg. 1997;  50 322-330
  • 18 Hallock G G, Rice D C. Comparison of TRAM and DIEP physiology in a rat model.  Plast Reconstr Surg. 2004;  114 1179-1184
  • 19 Kroll S S. Fat necrosis in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps.  Plast Reconstr Surg. 2000;  106 576-583
  • 20 Masia J, Clavero J A, Larranaga J R, Alomar X, Pons G, Serret P. Multidetector-row computed tomography in the planning of abdominal perforator flaps.  J Plast Recostr Aesthet Surg. 2006;  59 594-599
  • 21 Uppal R S, Casaer B, Van Landuyt K, Blondeel P. The efficacy of preoperative mapping of perforators in reducing operative times and complications in perforator flap breast reconstruction.  J Plast Reconstr Aesthet Surg. 2009;  62(7) 859-864
  • 22 Kikuchi N, Murakami G, Kashiwa H, Homma K, Sato T J, Ogino T. Morphometrical study of the arterial perforators of the deep inferior epigastric perforator flap.  Surg Radiol Anat. 2001;  23 375-381

Jaume MasiaM.D. Ph.D. 

Professor and Chairman, Department of Plastic Surgery, Hospital de la Santa Creu i Sant PaU Universitat Autonoma de Barcelona

Sant Antoni M. Claret 167, 08025 Barcelona Catalunya, Spain

Email: jmasia@santpau.cat

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