title: Preoperative CT angiography reduces surgery time in perforator flap reconstruction.
abstract: The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in perforator flap reconstructions to visualise each perforator more accurately. The main objectives were to reduce surgery time and the number of complications. A chart review was conducted 1 year after CTA introduction to investigate if these objectives were met.
  
  
  METHODS
  Patients with a deep inferior epigastric perforator (DIEP) flap who underwent preoperative analysis through CTA were retrospectively evaluated. The population <or=1 year before CTA introduction were the control group. The two groups were compared with respect to surgery time and complications (including flap failure).
  
  
  RESULTS
  One hundred and thirty-eight DIEP breast reconstructions were done; 70 underwent preoperative CTA analysis, and 68 had preoperative Doppler investigation. Surgery time in the CTA group was significantly lower (P<0.001) than in the control group, 264 min (SD+/-62) versus 354 min (SD+/-83), respectively. There was a tendency for fewer complications in the CTA group compared with the control group. All flaps were successful in the CTA group. In the control group, one flap failed and partial necrosis occurred in three flaps. The differences were not statistically significant.
  
  
  CONCLUSIONS
  Preoperative CTA in the assessment of vascular anatomy during perforator flap reconstruction was safe and reliable. It helped reduce surgery time, and may prevent the number of postoperative complications.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Uppsala University Hospital, Uppsala, Sweden.
authors.forename: Jeroen M
authors.initials: JM
authors.lastname: Smit
authors.forename: Angeliki
authors.initials: A
authors.lastname: Dimopoulou
authors.forename: Anders G
authors.initials: AG
authors.lastname: Liss
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: Morten
authors.initials: M
authors.lastname: Kildal
authors.forename: Iain S
authors.initials: IS
authors.lastname: Whitaker
authors.forename: Anders
authors.initials: A
authors.lastname: Magnusson
authors.forename: Rafael
authors.initials: R
authors.lastname: Acosta
mesh_terms: D000792:Angiography / Q000379:methods; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D017060:Patient Satisfaction; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013997:Time Factors; D014057:Tomography, X-Ray Computed