One hundred cases of abdominal-based free flaps in breast reconstruction. The impact of preoperative computed tomographic angiography

Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS
A GhattauraS E James

Abstract

An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is essential in deep inferior epigastric perforator (DIEP) flap reconstruction. We present our experience of using computed tomographic angiography (CTA) of the abdomen as part of our standard preoperative assessment of abdominal-based breast reconstruction. One hundred consecutive cases were examined retrospectively, divided equally into non-CTA and CTA periods. Following use of CTA, fewer superficial inferior epigastric artery (SIEA) flaps were performed (18% vs. 0%), although the number of DIEP and muscle-sparing transverse rectus abdominis myocutaneous (MS TRAM) flaps remained similar. There was an increased use of single perforators in the CTA group than in the non-CTA group (48% vs. 18%) as well as increased numbers of medial-row perforators (65% vs. 32%). Unilateral reconstructions were performed 1h faster in the CTA group (489min vs. 566min). Finally, hernia rates decreased from 6% in the non-CTA group to 0% in the CTA group. A clear knowledge of the dominant perforator(s) to the abdominal skin prior to surgery can greatly increase the success of this procedure and reduce surgical time. In addition, by choosing the largest well-placed perf...Continue Reading

References

Jan 1, 1979·Scandinavian Journal of Plastic and Reconstructive Surgery·H Holmström
May 8, 2002·Plastic and Reconstructive Surgery·Marc VandevoortGerd Fabre
Jul 27, 2002·Plastic and Reconstructive Surgery·Maurice Y NahabedianPaul N Manson
Apr 15, 2004·Plastic and Reconstructive Surgery·Paul S GillRobert J Allen
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Jul 16, 2008·Plastic and Reconstructive Surgery·Warren M RozenG Ian Taylor
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Citations

Jan 8, 2013·Annals of Surgical Innovation and Research·Geoffrey C GurtnerMichael R Zenn
Nov 16, 2013·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Rachel L TillettSherif M Wilson
Sep 16, 2011·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Narayan KarunanithyAdam Mitchell
Dec 15, 2015·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·David E KurlanderHooman T Soltanian
Jun 15, 2014·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·Theodore G NanidisNavid Jallali
Sep 20, 2011·Journal of Plastic, Reconstructive & Aesthetic Surgery : JPRAS·A D Murphy, H J C R Belcher
Dec 15, 2015·Radiologic Clinics of North America·Ryan B O'MalleyPeter S Liu
Mar 18, 2011·The Breast Journal·Grant W Carlson, Wadley R Glenn
Jun 22, 2018·Plastic and Reconstructive Surgery·Rachel L O'ConnellJennifer E Rusby
Sep 5, 2018·Journal of Plastic Surgery and Hand Surgery·Daniel P ButlerNavid Jallali
Oct 31, 2019·Annals of Plastic Surgery·Zulfükar Ulas BaliLevent Yoleri
Jan 29, 2016·Plastic and Reconstructive Surgery·Brett T PhillipsMichael R Zenn
Nov 8, 2012·Annals of the Royal College of Surgeons of England·J CubittM Tyler
Oct 13, 2020·Seminars in Plastic Surgery·Shimpei OnoRei Ogawa

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