DIEP Flap Planning 

3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps

Gedge D. Rosson, M.D. , Christopher G. Williams, M.D. , Elliot K. Fishman, M.D. , Navin K. Singh, M.D., M.Sc., M.B.A

Division of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD

Abstract

Purpose: 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.

"Preoperative perforator flap planning for breast reconstruction utilizing 3D CT angiogram is safe, easy to read, and can change the operative plan."

3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps
Rosson GD, Williams CG, Fishman EK, Singh NK
Microsurgery 2007; 27(8);641-646

"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."

3D CT angiography of abdominal wall vascular perforators to plan DIEAP flaps
Rosson GD, Williams CG, Fishman EK, Singh NK
Microsurgery 2007; 27(8);641-646

"We also found a clear decrease in the number of post operative complications mainly partial necrosis of the flap. Partial necrosis of the flap diminished from 12% in the previous study of 100 patients to 2% in the 90 patients in the second phase of the study."

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Clavero JA et al.
AJR 2008; 191:670-676

"The ability to detect the dominant perforating artery preoperatively saves considerable time for the surgeon. In our series the time needed to elevate the flap was halved."

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Clavero JA et al.AJR 2008; 191:670-676

"Before the use of MDCT in the preoperative planning of DIEP surgery, the elevation of the flap lasted an average of 4 hours, because this step included dissecting the inferior epigastric vessels, selecting the dominant perforating artery, and dissectng the dominant perforator artery."

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Clavero JA et al.
AJR 2008; 191:670-676

"The average operating time saved per patient was 1 hour 40 minutes and there was a significant reduction in postsurgical complications"

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Clavero JA et al.
AJR 2008; 191:670-676

"MDCT provides valuable information before surgery about the arterial anatomy of the inferior abdominal wall. It enables accurate identification of the most suitable dominant perforator vessel and makes surgical perforator flap procedures for breast reconstruction faster and safer."

MDCT in the Preoperative Planning of Abdominal Perforator Surgery for Postmastectomy Breast Reconstruction
Clavero JA et al.
AJR 2008; 191:670-676