Computed tomography angiography (CTA) assisted preoperative planning and volume calculation of deep inferior epigastric artery perforator (DIEP) flap for breast reconstruction

Abstract

Background

The use of the deep inferior epigastric artery perforator (DIEP) flap has gained popularity as a technique for autologous breast reconstruction. This surgery entails finely dissecting the perforators of the deep inferior epigastric artery passing through the rectus abdominis muscle, while deciding which of the perforators will best supply the flap. Computed tomography angiography (CTA) has emerged as the imaging modality of choice for preoperative evaluation. This study evaluates the accuracy of CTA in identifying perforator anatomy and flap volume calculation, as well as its impact on the patient's outcome.

Methods

A prospective study was conducted. Thirty-two consecutive patients that underwent CT angiography prior to unilateral DIEP flap reconstruction surgery were included in the study. The control group was composed of 32 patients, who were operated on by the same surgical team, using the same surgical technique, prior to the initiation of the CTA study. The imaging provided by CTA was correlated with actual intra-operative findings. Operative time, the duration of hospital stay, and postoperative complications were assessed. The volume of the flap as calculated by CT was compared to the flap's actual weight after harvest.

Results

CTA identified 285 perforators; of these, 278 were found intra-operatively. There was no statistically significant difference between the data provided by the CT and intra-operative findings. The use of CTA was associated with decreased operating time (unilateral, 424 versus 546 min, p < 0.0001) and significantly decreased hospitalization (unilateral, 7.6 versus 11.6 days, p = 0.0002). There was good correlation between the volume of the flap as calculated by CT and the flap's measured weight after harvest (1117 cm³ versus 1181 g, r = 0.774).

Conclusions

CTA is an accurate tool in planning and calculating flap volume of DIEP flap and is associated with improved outcomes.

Level of Evidence: Level III, diagnostic study.

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