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Use of MRA In Pre-Operative Planning of Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction
Christopher G Zochowski MD
Hooman Soltanian MD FACS
Case Western Reserve
2010-03-22
Presenter: Christopher G Zochowski MD
Affidavit:
Director Name:
Author Category: Resident/Fellow
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Background:
Many studies validate the use of CT angiogram for DIEP flap reconstruction. CT angiograms expose the patient to ionizing radiation and nephrotoxic contrast media. At our institution we have used MRA for delineation of the perforator anatomy with great success.
Methods:
A retrospective review was performed of all cases from 1/2007 to 2/2009 of DIEP based breast reconstructions.15 patients (17 breasts) had completed MRA analysis preoperatively. 18 patients (21 breasts) did not have an MRA. The cases were assessed for patient demographics, outcomes, and complications. The intraoperative locations of the perforators were compared to the MRA findings.
Results:
Free flap reconstruction was completed in 13 patients (16 breasts). The procedure was aborted in one case after discovery of occult recurrent cancer along the internal mammary vessels. There were no complete flap losses. In all cases, the preoperative MRA mapping matched the intraoperative findings. All perforators used for the reconstruction had been previously visualized with the MRA study. In several cases, the intramuscular course of the perforators was delineated by MRA and facilitated the intraoperative decision making and dissection.
Conclusions:
The use of MRA in this series for preoperative evaluation proved beneficial. With the use of new imaging sequences, the surgeon can delineate the anatomy, caliber, intramuscular course, and branching patterns with high degree of accuracy and reduce operative times. The use of MRA can be considered less morbid compared to standard angiogram, and less harmful compared to CTA in regards to ionizing radiation and nephrotoxic contrast.
