Breast Reconstruction with Deep Inferior Epigastric Artery Perforator Flap: 3.0-T Gadolinium-enhanced MR Imaging for Preoperative Localization of Abdominal Wall Perforators

Chernyak, Victoria; Rozenblit, Alla M.; Greenspun, David T.; Levine, Joshua L.; Milikow, David; Chia, Frank A.; Erhard, Heather A.

doi:10.1148/radiol.2501080307

Cited by 53 publications

(45 citation statements)

References 9 publications

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“…The virtually infinite number of potential donor sites, with a highly variable vascular anatomy, requires preoperative visualization and mapping of perforators [13]. Preoperative perforator mapping optimizes flap design, reduces operating time and has become standard in certain areas of reconstructive surgery, such as breast reconstruction [5,[14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

et al. 2015

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Aims: The high technical demands associated with perforator flaps demand a precise preoperative identification and evaluation of perforator vessels. Color Doppler Ultrasonography (CDU) and Dynamic Infrared Thermography (DIRT) are currently used for preoperative perforator mapping. Each individual technique has advantages and disadvantages. The purpose of this paper is to analyze the value of combining the two methods in order to optimize the process of preoperative perforator mapping. Material and methods: CDU and DIRT were used for preoperative perforator mapping in 10 pigs. The results were compared to intraoperative findings. Total number of perforators, localization, and identification of the dominant perforator was analyzed for each method. The examination time was recorded for each procedure. Results: Both methods had a high sensitivity in determining the number and localization of perforators when compared to those identified during surgery. DIRT produced a higher number of false positive results. CDU accurately identified the emergence of the perforators in the fascia in all cases. Both methods correctly identified the dominant perforator. The sensitivity, positive predictive value, and accuracy of CDU were 93.56%, 97%, and 91.30% respectively and for DIRT 95.05%, 80.67%, and 77.41% respectively. The average examination was 39.76 minutes for CDU and 10.24 minutes for DIRT. The average time taken into account for the analysis of a single perforator in order to confirm DIRT findings was 1.83 minutes. Conclusions: Preoperative perforator mapping has become a compulsory step in nearly all reconstructive procedures. In our study, both CDU and DIRT correctly identified the dominant perforator in all cases. By combining the two examinations overall mapping time can be reduced significantly. A reduced examination time translates into increased patient compliance and a lower procedure cost. The combined mapping technique facilitates the selection of the ideal perforator in all cases. Correctly identifying the dominant perforator preoperatively reduces operative time, lowers complication rates and ensures an overall better result.

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Section: Discussionmentioning

confidence: 99%

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

et al. 2015

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“…MRA is beginning to be explored as an alternative to computed tomography angiography (CTA) in mapping perforator arteries where MRA has the advantages of no ionizing radiation and fewer contrast reactions. MR has been studied for the preoperative mapping of rectus muscle perforators at 3 T with promising results (6,7). There is no study that looks at MRA use in evaluating rectus and gluteal muscle perforators for this type of flap procedure.…”

Section: Discussionmentioning

confidence: 99%

Perforator flap magnetic resonance angiography for reconstructive breast surgery: A review of 25 deep inferior epigastric and gluteal perforator artery flap patients

Newman¹,

Vasile²,

Levine³

et al. 2010

Magnetic Resonance Imaging

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Purpose: To evaluate the accuracy of magnetic resonance angiography (MRA) for preoperative mapping of rectus and gluteal muscle perforating arteries prior to autologous flap breast reconstruction. Materials and Methods:Preoperative MRA on 25 consecutive patients undergoing perforator artery-based autologous breast reconstruction was performed at 1.5 T using 3D liver accelerate volume acquisition (LAVA) of abdominal or gluteal regions acquired during injection of 20 mL of gadobenate dimeglumine with bolus timing optimized using MR fluoroscopy or SmartPrep. Perforator artery size and coordinates relative to umbilicus or top of gluteal crease on 3D MRA were compared to findings at surgery. Reconstructed breast volume estimates from MRA were also compared to weights at harvesting.Results: In all, 132 perforator arteries were found at surgery to be located within 1 cm of the coordinates measured on MRA and were surgically verified to be suitable for flap perfusion. Surgery verified the arterial course and caliber through the rectus and gluteal muscles visualized on MRA in 48 of 49 arteries. Volume rendering of 3D MRA predicted a breast reconstruction volume with a mean difference of 47 g compared to measurements at harvesting.Conclusion: MRA accurately maps rectus and gluteal muscle perforator arteries for preoperative planning of autologous flaps for breast reconstruction.

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“…46 DIRT has been used in the preoperative planning, intraoperative and postoperative monitoring of flap perfusion. Thermal images are captured with an infrared camera before, during and after exposure to a cold challenge provided by a fan blowing air for 2 min over the abdomen.…”

Section: Other Methods:-mentioning

confidence: 99%

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

Bahhati.¹,

Gravvanis²,

Karakitsos³

et al. 2017

IJAR

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Breast Reconstruction with Deep Inferior Epigastric Artery Perforator Flap: 3.0-T Gadolinium-enhanced MR Imaging for Preoperative Localization of Abdominal Wall Perforators

Abstract: Gadolinium-enhanced 3.0-T MR imaging can be used to accurately localize IEA perforators and to select the optimal perforator to be harvested for DIEP flap reconstructive breast surgery.

Cited by 53 publications

References 9 publications

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

Using dynamic infrared thermography to optimize color Doppler ultrasound mapping of cutaneous perforators

Perforator flap magnetic resonance angiography for reconstructive breast surgery: A review of 25 deep inferior epigastric and gluteal perforator artery flap patients

Integrating Imaging Techniques in Deep Inferior Epigastric Perforator Breast Reconstruction.

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