title: Optimising the preoperative planning of deep inferior epigastric perforator flaps for breast reconstruction.
abstract: OBJECTIVE
  Preoperative planning of deep inferior epigastric perforator (DIEP) flaps has become increasingly important in radiology services as multidetector CT angiography (CTA) has been proven to be the technique of choice. We aim to optimise the process, checking the value of the "Navarra criteria," assessing radiological and surgical concordance.
  
  
  METHODS
  Preoperative CTA was obtained in 105 DIEP flaps involving 101 women (mean age 49.1 years). A main perforator pedicle and an alternative were chosen, applying a modification of the "Navarra criteria," assessing the correlation between the main perforator chosen by the radiologist and the one that was ultimately used to perform the flap using the Kappa index.
  
  
  RESULTS
  In 100 of the 105 DIEP flaps (95.2%), the perforator pedicles chosen were ultimately used to raise the flap. Four of the perforator pedicles that were not used were dismissed due to avoidable errors in the radiological approach. Concordance was very high, with a Kappa index of 0.93 (95% CI: 0.87-0.99). CT room time was less than 12 minutes, and reading time was 10 minutes.
  
  
  CONCLUSIONS
  The application of the "Navarra criteria" in preoperative planning of DIEP flaps improves radiological and surgical concordance as well as the reading process.
  
  
  CONCLUSIONS
  DIEP flap is one of the best techniques for breast reconstruction. Preoperative planning is essential in DIEP flaps. CTA is the best option for the preoperative planning of DIEP flaps. "Navarra criteria" allow radiologists to choose the best perforator to form flaps. Modified "Navarra criteria" improves radiological and surgical concordance.
authors.affiliation: Department of Radiology, Hospital Universitario de Torrejon, C/Mateo Inurria s/n. C.P.28550, Torrejon de Ardoz, Madrid, Spain, casaresmiguel@gmail.com.
authors.forename: Miguel
authors.initials: M
authors.lastname: Casares Santiago
authors.forename: Emilio
authors.initials: E
authors.lastname: García-Tutor
authors.forename: Gil
authors.initials: G
authors.lastname: Rodríguez Caravaca
authors.forename: Julián
authors.initials: J
authors.lastname: Del Cerro González
authors.forename: Léa Marie
authors.initials: LM
authors.lastname: Klein
authors.forename: Alberto
authors.initials: A
authors.lastname: Alonso-Burgos
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D061525:Perforator Flap / Q000098:blood supply*; D011300:Preoperative Care / Q000379:methods*; D017568:Rectus Abdominis / Q000637:transplantation*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*