Radiology: Volume 249: Number 1—October 2008
Timothy J. Phillips, MBBS, GradDipSurgAnat Damien L. Stella, MBBS, FRANZCR Warren M. Rozen, MBBS, BMedSci, PGDipSurgAnat Mark Ashton, MBBS, MD.FRACS G. Ian Taylor, MBBS, MD, FRCS, FRACS, AO
Institutional review board approval was obtained for this study, and all patients gave written informed consent. Autologous surgical breast reconstruction with use of ab¬dominal wall donor flaps based on the deep inferior epigas¬tric artery (DIEA) and one or more of its anterior muscu-locutanepus perforating branches (DIEA perforator flap) is being used with increasing frequency instead of breast reconstruction with use of traditional transverse rectus abdominus musculocutaneous and modified muscle-spar¬ing flaps. Preoperative mapping of the DIEA perforators with abdominal wall computed tomographic (CT) angiog¬raphy may improve patient care by providing the surgeon with additional information that will lead to optimization of the surgical technique, shorter procedure time, and reduction in the frequency of surgical complications. The branching pat¬terns of the DIEA, the segmental anatomy of the anterior adipocutaneous perforating branches of the DIEA, and the importance of these features in pre- and intraoperative surgical planning necessitate a different approach to ab¬dominal wall CT angiography than that used with other abdominal CT angiographic techniques. In abdominal wall CT angiography, the common femoral artery is used as the bolus trigger, CT scanning is performed in the caudocra-nial direction, the automatic exposure control feature is disabled, a scaled grid overlay tool is used to present information to the surgeons, and radiation dose is mini¬mized (average dose, 6 mSv). The anatomic accuracy of abdominal wall CT angiography has been investigated in cadaveric and surgical studies, with sensitivity of 96%-100% and specificity of 95%-100%. This detailed descrip¬tion will allow other radiologists and surgeons interested in free DIEP flap surgery to incorporate this useful tool into their practice.