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Improving Free Flap Breast Reconstruction Using 3D Printed Templates To Map Perforator Artery Anatomy
Justin Beiriger, Michael Magnetta MD, Lucas Dvoracek MD, Michael Gimbel MD
University of Pittsburgh School of Medicine
2019-02-14
Presenter: Justin Beiriger
Affidavit:
Justin Beiriger, BS, MS1, participated in the submitted study through his collection and analysis of the data, review of the literature, and composition of the abstract.
Director Name: Vu Nguyen
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Successful abdominally-based free flap breast reconstruction requires careful dissection of the deep inferior epigastric vessels and perforators. Patient anatomy varies considerably, especially perforator location and trajectory.
Patients undergoing DIEP or muscle-sparing TRAM free flap reconstruction were identified and underwent abdominopelvic CTA. An experienced radiologist performed CT segmentation of the deep inferior epigastric arteries and perforating branches, which were digitally projected onto the skin plane of the soft tissue. Models of this skin plane were 3D printed and on-laid onto patients' abdomens intraoperatively. Vascular anatomy was traced onto skin with attention to perforator location.
Nineteen consecutive patients undergoing free flap reconstruction had CTAs analyzed for the creation of 3D-printed templates. The models enhanced preoperative discussion of anatomy and surgical approach with trainees. Perforator anatomy matched the template markings well.
3D-printed perforator templates correlated well with vascular anatomy in abdominally-based breast reconstruction. Additionally, this innovation improved trainee education, allowing for directed preoperative discussion of surgical anatomy and approach. The ability to preoperatively map perforators can improve flap design for procedures that are sensitive to precise vascular anatomy. Although abdominally-based flap design is not sensitive to precise perforator location, this study serves as a proof-of-concept that 3D templates can map perforators prior to incision and aid in flap design. Flaps that are more sensitive to skin incision design (e.g. lateral thigh, propeller flaps) may benefit from this design strategy. In the future, we will apply this technique to procedures where the anatomy is more variable and flap design is dependent upon perforator anatomy.
