3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps.
OBJECTIVE
Since the first report of TRAM flap reconstruction, there have been numerous studies to reduce complications of elective breast reconstruction. Current methods of preoperative perforator localization can be time-consuming, inaccurate, and imprecise. Thus, we sought to evaluate ultra-high resolution 3D CT angiography for the preoperative mapping of DIEAP flap perforating vessels.


METHODS
We reviewed all perforator-based breast reconstructions performed over a 5-month period. Candidates for DIEAP flap reconstruction were sent for a focused CT scan of the abdominal wall, using the 64 slice multi-detector CT scanner.


RESULTS
This article presents our first 23 flaps in 17 patients with preoperative ultra-high resolution 3D CT angiography. The reconstruction plan changed in three patients (18%). There was one take-back for venous congestion, but no partial or total flap loss.


CONCLUSIONS
Preoperative perforator flap planning for breast reconstruction utilizing 3D CT angiogram is safe, easy to read, and can change the operative plan.
Rosson
Gedge D
GD
Division of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. gedge@jhmi.edu
Williams
Christopher G
CG
Fishman
Elliot K
EK
Singh
Navin K
NK
D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D000792:Angiography / Q000379:methods*; D001940:Breast / Q000098:blood supply; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D019074:Epigastric Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D017568:Rectus Abdominis / Q000098:blood supply* / Q000601:surgery; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome