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DIEP Flap Preoperative CTA: Assessing the Necessity when Preexisting Staging CT's Exist
Meghan Brown, MD, Cyrus Mirhaidari, Jordan Johnson and Derek Cody, MD
Summa Health
2022-01-10
Presenter: Meghan Brown
Affidavit:
I agree that this work is the original work of Meghan Brown and has not been published or presented elsewhere.
Director Name: Ananth Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Introduction
The deep inferior epigastric artery perforator (DIEP) flap procedure is the gold standard
in autologous breast reconstruction (1). Studies have shown the utility of utilizing preoperative computerized tomography angiography (CTA) to decrease harvest time and overall operative time (2-4). By evaluating a previously conducted staging CT for advanced breast cancer for the same anatomical landmarks that are visualized on the CTA imaging, it may be possible to achieve the same benefit. The aim of this study is to assess if utilizing preexisting staging CTs offer similar imaging data regarding perforator vessels, eliminating the need for the preoperative CTA.
Methods
A retrospective review was conducted for all adult patients undergoing DIEP flap reconstruction between October 2016 and February 2021 who had both preoperative CTA and staging CT. CT scans were reviewed for perforator location, measured from the pubic symphysis and number of perforators.
Results
We identified 10 patients with a total of 220 perforators identified. An intraclass correlation coefficient (ICC) was determined to be >0.996 (p<0.01) for 14 of the matched perforators found on each patient, indicating excellent agreement in the location of the perforators on the CT versus CTA. When looking at the average number of perforators identified using CT (15.3) and CTA (18.8) we identified no statistically significant difference p=0.247 utilizing a Wilcoxon signed-rank test.
Conclusions
Staging CT scans are as reliable as CTA scans in identifying perforators preoperatively for DIEP flap reconstruction. Not performing additional CTA could decrease IV contrast and radiation exposure to these patients.
