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[Preoperative CT angiography for planning free perforator flaps in breast reconstruction].
- Source :
-
Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V.. [Handchir Mikrochir Plast Chir] 2011 Apr; Vol. 43 (2), pp. 88-94. Date of Electronic Publication: 2011 Apr 20. - Publication Year :
- 2011
-
Abstract
- Preoperative Doppler ultrasonography for planning free perforator flaps is widely established to identify preoperatively perforators. The method allows one to localise the penetrating point of the perforator through the abdominal fascia. By this means it is not possible to see the intramuscular course or the position of the perforator in relation to the inferior epigastric artery. Lately the technique of computed tomographic angiography provides an opportunity for visualising the course of perforator vessels in these tissues. This paper summarises our experience with the preoperative CT angiography in our breast centre. Since spring 2009 we have reconstructed the breasts of 44 female patients by using free flaps from the lower abdominal wall. 6 of these were bilateral. In a total number of 50 breast reconstructions we used 23 deep inferior epigastric perforator (DIEP) flaps and 27 muscle-sparing transverse rectus abdominis muscle (TRAM) flaps. In addition to the preoperative ultrasonography, a CT angiography of the lower abdomen was conducted in 29 patients. On average they showed at least 2 perforators on the left as well as right abdominal sides, which could be used as flap vessels based on their signal intensity. Based on their estimated microsurgical dissection complexity, the perforator vessels could be classified into 3 groups: 1) direct perforators of category A with short intramuscular course (39%), 2) perforators with long intramuscular course of category B (50%) and 3) "turn around" perforators of category C, which pass medially around the rectus abdominis (11%). The technique of CT angiography permits a reliable preoperative visualisation of perforators in their entire course and facilitates the selection of the supplying perforator as well as the intraoperative procedure for the surgeon. The suggested classification of perforators into 3 groups simplifies the preoperative assessment of the microsurgical dissection effort. Compared to the commonly used Doppler ultrasonography there are disadvantages like the additional cost factor and the radiation exposure. However, in our experience the more detailed planning increases the safety of flap raising and reduces surgery time, so that we consider CT angiography a positive tool to facilitate free perforator flaps.<br /> (© Georg Thieme Verlag KG Stuttgart · New York.)
- Subjects :
- Adult
Aged
Female
Humans
Microvessels diagnostic imaging
Microvessels surgery
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Ultrasonography, Doppler
Young Adult
Angiography
Mammaplasty methods
Microsurgery methods
Surgical Flaps blood supply
Tissue and Organ Harvesting methods
Tomography, Spiral Computed
Subjects
Details
- Language :
- German
- ISSN :
- 1439-3980
- Volume :
- 43
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Handchirurgie, Mikrochirurgie, plastische Chirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Handchirurgie : Organ der Deutschsprachigen Arbeitsgemeinschaft fur Mikrochirurgie der Peripheren Nerven und Gefasse : Organ der V..
- Publication Type :
- Academic Journal
- Accession number :
- 21509699
- Full Text :
- https://doi.org/10.1055/s-0031-1275282