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Application of Three-Dimensional Printed Vascular Modeling as a Perioperative Guide to Perforator Mapping and Pedicle Dissection during Abdominal Flap Harvest for Breast Reconstruction
- Source :
- Journal of Reconstructive Microsurgery. 36:325-338
- Publication Year :
- 2020
- Publisher :
- Georg Thieme Verlag KG, 2020.
-
Abstract
- Background Advancements in three-dimensional (3D) printing have enabled production of patient-specific guides to aid perforator mapping and pedicle dissection during abdominal flap harvest. We present our early experience using this tool to navigate deep inferior epigastric artery (DIEA) topography and evaluate its impact on operative efficiency and clinical outcomes. Patients and Methods Between January 2013 and December 2018, a total of 50 women underwent computed tomographic angiography (CTA)-guided perforator mapping prior to abdominal flap breast reconstruction, with (n = 9) and without (n = 41) 3D-printed vascular modeling (3DVM). Models were assessed for their accuracy in identifying perforator location and source-vessel anatomy, as determined by operative findings from 18 hemi-abdomens. The margin of error (MOE) for perforator localization using 3DVM was calculated and compared with CTA-derived measurements for the same patients. Flap harvest times, outcomes, and complications for patients who were preoperatively mapped using 3DVM versus CTA alone were analyzed. Results Overall, complete concordance was observed between 3DVM and operative findings with regards to perforator number, source-vessel origin, and DIEA branching pattern. By comparison, CTA interpretation of these parameters inaccurately identified branching pattern and perforator source-vessel origin in 28 and 33% of hemi-abdomens, respectively (p = 0.045 and p = 0.02). Compared with operative measurements, the average MOE for perforator localization using 3DVM was significantly lower than that obtained from CTA alone (0.81 vs. 8.71 mm, p Conclusion The results of this study support the accuracy of 3DVM for identifying DIEA topography and perforator location. Application of this technology may translate to enhanced operative efficiency and fewer perfusion-related complications for patients undergoing abdominal free flap breast reconstruction.
- Subjects :
- Adult
Patient-Specific Modeling
medicine.medical_specialty
Computed Tomography Angiography
Mammaplasty
Free flap breast reconstruction
030230 surgery
03 medical and health sciences
0302 clinical medicine
Humans
Medicine
Aged
Computed tomography angiography
medicine.diagnostic_test
business.industry
Dissection
Deep Inferior Epigastric Artery
Perioperative
Middle Aged
Epigastric Arteries
Computed tomographic angiography
030220 oncology & carcinogenesis
Three dimensional printing
Printing, Three-Dimensional
Female
Surgery
Radiology
business
Breast reconstruction
Perforator Flap
Subjects
Details
- ISSN :
- 10988947 and 0743684X
- Volume :
- 36
- Database :
- OpenAIRE
- Journal :
- Journal of Reconstructive Microsurgery
- Accession number :
- edsair.doi.dedup.....a8feef93e3c7038b1c11335165ae721b