J M F Hughes1, J R O Smith2, L Jones3, S Wilson2. 1. Department of Plastic and Reconstructive Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK. Electronic address: julianahughes@doctors.org.uk. 2. Department of Plastic and Reconstructive Surgery, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK. 3. Department of Radiology, Frenchay Hospital, North Bristol NHS Trust, Bristol, BS16 1LE, UK.
Abstract
BACKGROUND: Abdominal CT angiography (CTA) has become an integral part of the pre-operative evaluation of patients undergoing free Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. It aids accurate delineation of perforator anatomy, assists pre-operative decision making and reduces operative time. However, such detailed imaging invariably yields a variety of incidental findings, with quoted figures of 13-36% in this setting. The purpose of this study was to identify the rate of "incidentalomas" when using DIEP CT angiography and, review how such findings influence our management. METHOD: A retrospective review was performed, looking at pre-operative scan reports of 154 consecutive patients undergoing free DIEP flap breast reconstructions between July 2008 and June 2012. RESULTS: Of 154 CTA's reviewed, 116 (75.3%) demonstrated incidental findings. In 71 patients (46.1%), these "incidentalomas" were inconsequential. However, in 37 patients (24.0%) the CTA prompted further investigations, and notably in a further 8 patients (5.2%) metastatic disease or other significant pathology was discovered which changed the operative plan. CONCLUSION: The overall rate of "incidentalomas" presented in this study is substantially higher than other similar published series, and most importantly, significantly altered the surgical management plan in 5.2% of cases. As such we would advocate that a pre-operative "staging" CTA, imaging the chest, abdomen and pelvis is useful for more than just delineation of vascular anatomy in patients undergoing DIEP flap reconstruction.
BACKGROUND: Abdominal CT angiography (CTA) has become an integral part of the pre-operative evaluation of patients undergoing free Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction. It aids accurate delineation of perforator anatomy, assists pre-operative decision making and reduces operative time. However, such detailed imaging invariably yields a variety of incidental findings, with quoted figures of 13-36% in this setting. The purpose of this study was to identify the rate of "incidentalomas" when using DIEP CT angiography and, review how such findings influence our management. METHOD: A retrospective review was performed, looking at pre-operative scan reports of 154 consecutive patients undergoing free DIEP flap breast reconstructions between July 2008 and June 2012. RESULTS: Of 154 CTA's reviewed, 116 (75.3%) demonstrated incidental findings. In 71 patients (46.1%), these "incidentalomas" were inconsequential. However, in 37 patients (24.0%) the CTA prompted further investigations, and notably in a further 8 patients (5.2%) metastatic disease or other significant pathology was discovered which changed the operative plan. CONCLUSION: The overall rate of "incidentalomas" presented in this study is substantially higher than other similar published series, and most importantly, significantly altered the surgical management plan in 5.2% of cases. As such we would advocate that a pre-operative "staging" CTA, imaging the chest, abdomen and pelvis is useful for more than just delineation of vascular anatomy in patients undergoing DIEP flap reconstruction.
Authors: Vivian B Boer; Jan J van Wingerden; Carolien F Wever; Joost J Kardux; Michiel R Beets; Hester J van der Zaag-Loonen; Willem J Theuvenet Journal: Gland Surg Date: 2017-12
Authors: Ryan D Wagner; Andres F Doval; Nikhilesh V Mehra; Hung B Le; Paul A Niziol; Warren A Ellsworth; Aldona J Spiegel Journal: Plast Reconstr Surg Glob Open Date: 2020-10-23