Ryckie G Wade1, James Watford2, Justin C R Wormald3, Russell J Bramhall4, Andrea Figus5. 1. Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, Yorkshire, UK; Faculty of Medicine and Health Sciences, University of Leeds, Leeds, Yorkshire, UK. Electronic address: ryckiewade@gmail.com. 2. Faculty of Medicine and Health Sciences, University of Leeds, Leeds, Yorkshire, UK. 3. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK. 4. Department of Plastic and Reconstructive Surgery, Leeds Teaching Hospitals Trust, Leeds, Yorkshire, UK. 5. Department of Surgery, Plastic Surgery and Microsurgery Section, University Hospital, Cagliari, Italy; Department of Surgical Sciences, Faculty of Medicine, University of Cagliari, Italy.
Abstract
BACKGROUND: Prior to DIEP flap breast reconstruction, mapping the perforators of the lower abdominal wall using ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) reduces the risk of flap failure. This review aimed to investigate the additional potential benefit of a reduction in operating time. METHODS: We systematically searched the literature for studies concerning adult women undergoing DIEP flap breast reconstruction, which directly compared the operating times and adverse outcomes for those with and without preoperative perforator mapping by ultrasound, CTA or MRA. Outcomes were extracted, data meta-analysed and the quality of the evidence appraised. RESULTS: Fourteen articles were included. Preoperative perforator mapping by CTA or MRA significantly reduced operating time (mean reduction of 54 minutes [95% CI 3, 105], p = 0.04), when directly compared to DIEP flap breast reconstruction with no perforator mapping. Further, perforator mapping by CTA was superior to ultrasound, as CTA saved more time in theatre (mean reduction of 58 minutes [95% CI 25, 91], p < 0.001) and was associated with a lower risk of partial flap failure (RR 0.15 [95% CI 0.04, 0.6], p = 0.007). All studies were at risk of methodological bias and the quality of the evidence was very low. CONCLUSIONS: The quality of research regarding perforator mapping prior to DIEP flap breast reconstruction is poor and although preoperative angiography appears to save operative time, reduce morbidity and confer cost savings, higher quality research is needed. REGISTRATION: PROSPERO ID CRD42017065012.
BACKGROUND: Prior to DIEP flap breast reconstruction, mapping the perforators of the lower abdominal wall using ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) reduces the risk of flap failure. This review aimed to investigate the additional potential benefit of a reduction in operating time. METHODS: We systematically searched the literature for studies concerning adult women undergoing DIEP flap breast reconstruction, which directly compared the operating times and adverse outcomes for those with and without preoperative perforator mapping by ultrasound, CTA or MRA. Outcomes were extracted, data meta-analysed and the quality of the evidence appraised. RESULTS: Fourteen articles were included. Preoperative perforator mapping by CTA or MRA significantly reduced operating time (mean reduction of 54 minutes [95% CI 3, 105], p = 0.04), when directly compared to DIEP flap breast reconstruction with no perforator mapping. Further, perforator mapping by CTA was superior to ultrasound, as CTA saved more time in theatre (mean reduction of 58 minutes [95% CI 25, 91], p < 0.001) and was associated with a lower risk of partial flap failure (RR 0.15 [95% CI 0.04, 0.6], p = 0.007). All studies were at risk of methodological bias and the quality of the evidence was very low. CONCLUSIONS: The quality of research regarding perforator mapping prior to DIEP flap breast reconstruction is poor and although preoperative angiography appears to save operative time, reduce morbidity and confer cost savings, higher quality research is needed. REGISTRATION: PROSPERO ID CRD42017065012.
Authors: Susana Heredero; María Isabel Falguera-Uceda; Alba Sanjuan-Sanjuan; Stacey Nedrud; Juan Solivera Journal: Plast Reconstr Surg Glob Open Date: 2021-06-11
Authors: Carlos Mavioso; Ricardo J Araújo; Hélder P Oliveira; João C Anacleto; Maria Antónia Vasconcelos; David Pinto; Pedro F Gouveia; Celeste Alves; Fátima Cardoso; Jaime S Cardoso; Maria João Cardoso Journal: Breast Date: 2020-01-12 Impact factor: 4.380