title: Three-dimensional computed tomographic angiography to predict weight and volume of deep inferior epigastric artery perforator flap for breast reconstruction.
abstract: BACKGROUND
  Three-dimensional computed tomographic angiography (3D CTA) can be used preoperatively to evaluate the course and caliber of perforating blood vessels for abdominal free-flap breast reconstruction. For postmastectomy breast reconstruction, many women inquire whether the abdominal tissue volume will match that of the breast to be removed. Therefore, our goal was to estimate preoperative volume and weight of the proposed flap and compare them with the actual volume and weight to determine if diagnostic imaging can accurately identify the amount of tissue that could potentially to be harvested.
  
  
  METHODS
  Preoperative 3D CTA was performed in 15 patients, who underwent breast reconstruction using the deep inferior epigastric artery perforator flap. Before each angiogram, stereotactic fiducials were placed on the planned flap outline. The radiologist reviewed each preoperative angiogram to estimate the volume, and thus, weight of the flap. These estimated weights were compared with the actual intraoperative weights.
  
  
  RESULTS
  The average estimated weight was 99.7% of the actual weight. The interquartile range (25th to 75th percentile), which represents the "middle half" of the patients, was 91-109%, indicating that half of the patients had an estimated weight within 9% of the actual weight; however, there was a large range (70-133%).
  
  
  CONCLUSIONS
  3D CTA with stereotactic fiducials allows surgeons to adequately estimate abdominal flap volume before surgery, potentially giving guidance in the amount of tissue that can be harvested from a patient's lower abdomen.
authors.affiliation: Department of Plastic Surgery, Johns Hopkins University, Baltimore, MD, USA. gedge@jhmi.edu
authors.forename: Gedge D
authors.initials: GD
authors.lastname: Rosson
authors.forename: Sachin M
authors.initials: SM
authors.lastname: Shridharani
authors.forename: Michael
authors.initials: M
authors.lastname: Magarakis
authors.forename: Michele A
authors.initials: MA
authors.lastname: Manahan
authors.forename: Sahael M
authors.initials: SM
authors.lastname: Stapleton
authors.forename: Marta M
authors.initials: MM
authors.lastname: Gilson
authors.forename: Jaime I
authors.initials: JI
authors.lastname: Flores
authors.forename: Basak
authors.initials: B
authors.lastname: Basdag
authors.forename: Elliot K
authors.initials: EK
authors.lastname: Fishman
mesh_terms: D034861:Abdominal Wall; D019074:Epigastric Arteries / Q000000981:diagnostic imaging*; D005260:Female; D057918:Fiducial Markers; D058752:Free Tissue Flaps / Q000098:blood supply*; D006801:Humans; D021621:Imaging, Three-Dimensional; D016462:Mammaplasty; D008408:Mastectomy; D008875:Middle Aged; D014057:Tomography, X-Ray Computed