title: Magnetic resonance angiography in preoperative planning of deep inferior epigastric artery perforator flaps.
abstract: Accurate preoperative localisation of deep inferior epigastric artery perforator (DIEaP) provides optimal surgical planning for DIEaP flaps. Cross-sectional imaging by contrast-enhanced magnetic resonance angiography (CE-MRA) has advantages over previously described techniques for perforator imaging including reduced radiation exposure and better muscle to vessel contrast. A retrospective series of 10 unilateral free breast reconstructions following preoperative CE-MRA of the anterior abdominal wall is presented. Mean age of the patients at the time of surgery was 50.3 years (range 44-63 years). An average of 2.8 perforators per study (range 1-5) was identified. Mean perforator luminal diameter was 2.6mm (1.4-4.0mm) with a mean intramuscular course length of 22.3mm (6.4-51.9 mm). Perforator course length was classified as 17% long intramuscular course (>4 cm), 80% short intramuscular course (<4 cm) and 3% paramedian. In all 10 patients, DIEaP flaps were successfully elevated. In all cases the flaps were elevated on vessels identified in preoperative review of the CE-MRA. There was a significant difference in the rates of conversion from DIEaP to transverse rectus abdominis myocutaneous (TRAM) flaps in the group who underwent CE-MRA in comparison to historical controls from the previous year (P=0.025). CE-MRA is an effective tool for DIEaP flap planning.
authors.affiliation: Department of Plastic Surgery, Nottingham City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK. jneildwy@doctors.org.uk
authors.forename: J G
authors.initials: JG
authors.lastname: Neil-Dwyer
authors.forename: C N
authors.initials: CN
authors.lastname: Ludman
authors.forename: M
authors.initials: M
authors.lastname: Schaverien
authors.forename: S J
authors.initials: SJ
authors.lastname: McCulley
authors.forename: A G B
authors.initials: AG
authors.lastname: Perks
mesh_terms: D000328:Adult; D019074:Epigastric Arteries / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D020858:Tissue and Organ Harvesting / Q000379:methods; D016896:Treatment Outcome