Clinical utility of CT angiography in DIEP breast reconstruction

SIEA versus DIEP Arterial Complications

“…24 A meta-analysis of lowquality studies demonstrated that computed tomographic angiography may reduce flap loss and partial necrosis. 25 However, experts cite limitations and indicate that significant clinical judgment remains necessary for preoperative interpretation and intraoperative correlation of computed tomographic angiography.…”

“…25 However, experts cite limitations and indicate that significant clinical judgment remains necessary for preoperative interpretation and intraoperative correlation of computed tomographic angiography. 24 Computed tomographic angiography may be a useful adjunct for the SIEA flap, given the inherent variability of the SIEA anatomy, caliber, and angiosome. Preoperative computed tomographic angiography can characterize SIEA caliber and course, 26 SIEV drainage and branching, 22 and prediction of adequate anatomy for flap success.…”

The Deep Inferior Epigastric Perforator Learning Curve in the Current Era

“…However, they reflect a period during which the DIEP was being pioneered and do not necessarily reflect outcomes from the current era of surgeons who, having subsequently benefited from the lessons learned from this period, seek to improve on them. Additionally, the adoption of CT-A has proved to be an influential factor in the planning of abdominal perforator flaps with the ability to limit donor-site morbidity 20 and improve operative times 11,20,21 . Our results support the former finding with a significantly decreased rate of abdominal bulging seen after adoption of CT-A (P = 0.034) but could not accurately assess the latter because of the retrospective nature of the study.…”

Outcomes of Breast Reconstruction in Breast Cancer Patients With a History of Mantle Radiation for Hodgkin Lymphoma

“…Even in a hostile appearing abdomen with previous scars, preoperative imaging of the abdomen with computed tomographic angiography can assess the status of the main pedicle and perforator vessels. 26,27 If the abdomen is not suitable, other areas of the body such as the thigh (TUG) or buttocks (superior gluteal artery perforator and inferior gluteal artery perforator) can also be considered. Free f lap transfer has the advantage of bringing nonirradiated tissue to the chest wall, but has the disadvantage of donor-site morbidity and necessity of microvascular anastomosis.…”