Ledibabari M Ngaage1, Raed Hamed2, Georgette Oni3, Bruno Di Pace4, Dina T Ghorra2, Brendan C Koo BMedSci5, Charles M Malata6. 1. The Clinical School of Medicine, University of Cambridge, Cambridge, UK. 2. Plastic & Reconstructive Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Plastic and Reconstructive Surgery Unit, Alexandria Medical School, Alexandria Main University Hospital, Alexandria, Egypt. 3. Plastic & Reconstructive Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 4. Plastic & Reconstructive Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Plastic Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialities, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy. 5. Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK. 6. Plastic & Reconstructive Surgery Department, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Cambridge Breast Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Anglia Ruskin University School of Medicine, Chelmsford & Cambridge, UK. Electronic address: charles.malata@addenbrookes.nhs.uk.
Abstract
BACKGROUND: Abdominal scars can affect the patency of deep inferior epigastric artery (DIEA) perforators and are a concern when planning free flap breast reconstruction (FFBR). Computed tomography angiography (CTA) is routinely used for preoperative DIEA flap imaging. We investigated CTA utility in predicting the most clinically useful DIEA perforators in scarred abdomens. METHODS: A single surgeon's CTA FFBR patients were studied. All were imaged by one radiologist. CTA reports, abdominal scars, and flap intraoperative details were analyzed. The operative findings were then correlated with the CTA "predictions." RESULTS: A hundred and six patients with preoperative CTAs underwent 132 FFBRs, 44% (58) from scarred and 56% (74) from virgin abdomens. All flap transfers were successful. Concordance between perforators identified by CTA preoperatively and those selected by the surgeon intraoperatively was 95% (scarred 93%; non-scarred 96%, P = 0.470). There was a significant difference in the proportion of single-perforator flaps between the two groups (scarred 46%; non-scarred 28%, P = 0.041). "Scarred" flaps were heavier (789 vs 676 g, P = 0.0244) than those harvested from virgin abdomens. CONCLUSIONS: CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. "Scarred" flaps are more likely to be heavier and based on one perforator suggesting that scarring may have an effect on intraflap vascular anatomy. Further investigations are needed to delineate the mechanism by which this occurs. Crown
BACKGROUND: Abdominal scars can affect the patency of deep inferior epigastric artery (DIEA) perforators and are a concern when planning free flap breast reconstruction (FFBR). Computed tomography angiography (CTA) is routinely used for preoperative DIEA flap imaging. We investigated CTA utility in predicting the most clinically useful DIEA perforators in scarred abdomens. METHODS: A single surgeon's CTA FFBR patients were studied. All were imaged by one radiologist. CTA reports, abdominal scars, and flap intraoperative details were analyzed. The operative findings were then correlated with the CTA "predictions." RESULTS: A hundred and six patients with preoperative CTAs underwent 132 FFBRs, 44% (58) from scarred and 56% (74) from virgin abdomens. All flap transfers were successful. Concordance between perforators identified by CTA preoperatively and those selected by the surgeon intraoperatively was 95% (scarred 93%; non-scarred 96%, P = 0.470). There was a significant difference in the proportion of single-perforator flaps between the two groups (scarred 46%; non-scarred 28%, P = 0.041). "Scarred" flaps were heavier (789 vs 676 g, P = 0.0244) than those harvested from virgin abdomens. CONCLUSIONS: CTA accurately predicted perforator choice in flaps from scarred and virgin abdomens. "Scarred" flaps are more likely to be heavier and based on one perforator suggesting that scarring may have an effect on intraflap vascular anatomy. Further investigations are needed to delineate the mechanism by which this occurs. Crown
Keywords:
Abdominal scars or scarred abdomen; CT angiography or computed tomography angiography (CTA); DIEP flaps; Free flap breast reconstruction; Operative time or surgery duration
Authors: Michael Knitschke; Anna Katrin Baumgart; Christina Bäcker; Christian Adelung; Fritz Roller; Daniel Schmermund; Sebastian Böttger; Philipp Streckbein; Hans-Peter Howaldt; Sameh Attia Journal: Front Oncol Date: 2022-01-19 Impact factor: 6.244