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Can Previous Diagnostic Examinations Prevent Preoperative Angiographic Assessment of the Internal Mammary Perforators for (Micro)Surgical Use?

Schellekens, Pascal P.A. MD*; Aukema, Tjeerd S. MD, PhD; Hage, J. Joris MD, PhD; Prevoo, Warner MD§; Kon, Moshe MD, PhD*

doi: 10.1097/SAP.0b013e318268a896

Background and Aim Preoperative assessment of the internal mammary artery perforating (IMAP) branches enhances IMAP-based reconstructive procedures. Conventionally, color-flow Doppler, selective catheter arteriography, or CT angiography is used for such assessment. We studied how often these examinations may be rendered superfluous by assessment of previously performed diagnostic examinations.

Methods A radiologist and a plastic surgeon jointly assessed whether information on the dominant IMAP could sufficiently be obtained from the thoracic CT scans of 12 head and neck cancer patients and 12 breast cancer patients, and from the mammary MRI of 12 breast cancer patients. Secondly, we retrospectively assessed in how many of the 10 patients who underwent an IMAP-flap head and neck reconstruction, and in how many of the 10 women who consecutively underwent a deep inferior epigastric perforator (DIEP) flap mammary reconstruction such previous diagnostic examinations were available and informative regarding the level of the dominant perforator.

Results All 24 CT scans and 11 of the 12 MRI scans sufficiently allowed assessment of the level of the dominant IMAP. Previous information had already been available in all 10 DIEP flap patients and 6 of the 10 IMAP-flap patients. The distribution of IMAP dominance over the intercostal levels on the scans differed from that found by cadaveric or intraoperative assessment.

Conclusions Previously performed diagnostic CT scans and MRI scans that included the parasternal region usually allow sufficient preoperative assessment of the internal mammary perforators for reconstructive procedures. We advocate re-assessment of such previous examinations before ordering additional angiography. Additionally, we suggest to include the parasternal region in diagnostic scans.

From the *Department of Plastic and Reconstructive Surgery and Handsurgery at the University Medical Center Utrecht; and †Departments of Nuclear Medicine, ‡Plastic and Reconstructive Surgery, and §Radiology at the Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.

Received April 23, 2012, and accepted for publication, after revision, July 8, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: J. Joris Hage, MD, PhD, Department of Plastic and Reconstructive Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX Amsterdam, The Netherlands. E-mail:

© 2014 by Lippincott Williams & Wilkins